02090095 (2) CITY
'BUILDING DIIV�rISIONNO
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10195 VICEROY CT -ADVANCED PLUMBING TECHNIQ ESO209OO95
OWNER'S lsME: APPLICATIO SUB DATE
ITEM �iOBERT 701-22B KINGS ROW 09/16/2002
PHONE: 408) 559-3733 SANITARY NO. CONTROL NO.
(
G s z ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT LU h1ECH
a i r=1 J _I L.1
S H= LICENSED CONTRACTOR'S DECLARATION Job Descri tlGn
of-o Inerebrarermthatlanthamea➢neerpro.i.ion.orcn➢pter9(commencing COPPER REPIPE/MAIN SERVICE
F'3tw withsmion]000)of Drvisi nJ ofthe Business antl Pm sipns(jgOe.arl mYlicenu
bin full for ➢n -/I 7<s�pI SII 9=95MARaE-93
reO 6
Dam. Camrocmr
ad
RCHRECr'S DECLARATION ]] p
9 I undcrmand my plans shall W used as public mcanls OCT 0 3 2002
r
to i p0 Licensed Profcsional
R
OWNER-BUILDERDEthe Con ION
I hereby.(Sinn on I a1.exempt from the Contractor's License Law for the BUILDING $19700
t z< following m➢wa(Sinton 7031.5.Business and Professionsli Code:Any city of county
Z O which requires a permiuo um,I die, plia improve.for such
demolish,are a sig ed structustatement wl-m P t l uarceal req tbeappres OfthesIXhpcmutm Elea,,Law(Chatiphi9 ,.
n.3- Ihth al<engd pun m(t tit provislona of the contractors Lttnu taw lChagcr9
(e - n g ith 5 i ]BOD)of Divts on 3 of,hc Business and Profu.nn.Cade) {`I;* ,3;2 5931E-4-100004517ea;L ""+'1 '�a a) „ Valuation
m thin fie la driemPt thircfrom aM rite Wwx for rite ellegN nempuod.Any viol.tion -' -
-of Section O031.5 by anY➢pplicaWt fm a penniuubjeeu the appli<anno a civil pcnadry
,nf nm more than five hundred Bogan tssrul. 202 API'UN91ff12EF'LOOR PLBINE"°" Occupancy Type
❑I,as owner of the property,or my employees with wages as their sole compensation, 301 ROUGH PLUMBING
wilPacks and erklessionsCSWctare Cnot"intended dneRLawered for snot Secapply to an 502 - FINAL PLLR'&Z dd�InE �i3GsY)'`"•!.+ '.r
'Business and'Profeand h Carlo:The isammeter's License law dor not apply to an
owner of property who Wilds or improves thereon,and who does such work himself 507 - FINAL PLUMBING
or through his own employees.provided that such Improvements are not intended or
-,dffereJ for idle.If.however,the buildit,'cir improvement is sold thin ane year of
ampdedon,the own in W ilder will have the burden of proving that he did not Wild or '
improve for porpoise of sale.).
phos owner of the p(SeertY.am exclusively Promingwnhlreenseo,Cmmonm ?C:i L!'•S';:P.J: t7. %.
construct the does
(Sec.7040,Business pro a ry who
Codea The Ces torn r s
-o' Licenu ru does of apply uc man owmr of pmgrdra who Wilds or improves Merton.
.andwhocummense Law ch.Pmje<n,with.➢camrvdartal.Iicenud.Pur.tunem.the .—._.—__.._._._....__._...__________ ____1._.___._—._-_____..___.
Contractor's License law. _. _-- �------- ---_
_ ❑lam xemptundersx;f °�" •','B&P C for this recon JO11 ii':i, 'l�s1F311
caner 'Date
"'WORKER'S COMPENSATION DECLARATION
the byaffirm under"IY of perjury one ofthefollowing dectimations:--
= I ❑ 1 hSJc and will maintain 5 Certificate of 6pscit to self-imma for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
-_ perforrI of the work for which thus pe not is issued.�,,
❑Ih a ill nimbUtio Wrker.Co pc t I' ra q red by,S._I
37M of the tabor Cele for Ne perfomun f thework f which this perm I,s
is\csLNf'W ro,r//�C n`ywrs I nn -c..nnce r c J P I y Fe
mer CEltl'1 %EMPI'ION R 1\ ORKER`A l)�`V t r...t�,_ +k��aO L•)ta:lt IIJ I �• ..e..` il.i( ..i'
)ll' COMPENSATION INSURANCE •"'^ _
-gTNI7 acto;u`uecd irut be-complciN ifthe permit is for one hundred dollars "-i.l.'C: \' -` I 0,-. Dw '� i')➢t'
ISIWI or less.)
I ndy thonntht"'fornumoi< e, kf became
brit Permititis seed 1.
kiudl not employ;any person m no tinter w zs td become sub)en to tie Woden'
C pco f Lows dt Cal forn:a Date
.:Applicant. ..y..
^NOTICE TO APPLICANT.'If.after making this Certificate of Exemption.You should `
coti a subject to the Workbr s Compemation provision[of the labor Civic.you must
O Wcforthwith cmndy with.such ism,isiom or this Permit shall be deemed revoked.
f/ t' I'TCONSfRUCT1ON LFNpIMG AGENCY
1 hercAy off tin that <t: m tmtt t4 lend ng agency for Perform to
;.. of the k f hich tits Permit is isiu d(sec 3691;Civ C 1
y:c "L dr N ...
ILILcndcr Ada zs,' 1�1 lr .SI}: •tJ
V0 „I certify that 1 have read this application and stoic that the above information is
(y:F £iirrcm-I agree in comply with all city and counrypNin.nces and,,are lawsrelating
to Wilding<onztruciion,and hereby authorize represemanio&of the;city to enrerupon
r� tit above t sed p party for inspectionpuHt ...
L (w )Sin,icm indemnify and kph le<the Cty ifC penin into"
(n liabilities,3dg m t d gpcu homay nany y g➢_t. id
U.Z Cty apo nc fth g 1' fIW pc t
APPLICAS aCR$T1sD$/yJDKILLCOhIHLYWITH ALl6 t5-P Date
Issued b
SOURr Onmf 1 }"
g air App tsU-C,o t ct _ ate - Re-roofs
`
HAZ
1 ARDOUS MATERIALS DISCLOSURE
wilts- ppl< tor ft Wlangpnrtreerh mehaamdans t I Type of.Roof-
handle _ - __ ,r -. _..._ _ :__--„� >.........._.__
a def M bvibe Cupertino Municipal Code.Chapter 9.12.end the Health and Safety
CMC Sa 5$3 O - s 7).•."Y °. �. .bi'f fa -31'' : yt
❑Y {' I'''' "n " ^ t -"t - _All roofs shall be inspected.prior to.any.roofing.material being installed.__-• .__,.•
F
11 WBm ppr t f.treWildi.g«cupantu.wequipmentordevicehich If a roof is installed without first obtaining an inspect3onf'I'agre'e'to remove
�
cum,- it ill nc t t. sdefinedhY the ByArc A Quality Management
District?, all new materials for inspection. Applicant understands and-will comply-with-
0 Yes
omply.with-_❑Ye. CI No ? . -all Pion-poidf source regulations,` t ..tw_.
.r I butte read the h➢iaof..minimal,requirement.under Chapter 6.95 Of the
�:Jifomii Health ik Safny Cade Sectio.25505.25533 and 355]4.I understand that
if the Wilding does not currently have atenant,tM1tt is my Po.bilif to n t fy the - - - - - - --
Ira f ih t mems hich te t be ten t I e of
D `y .fes I Signature of Applicant Date
r!' r
IX n1 cot
0 C Pan
Due, All roof coverings to be Class B'of better