01080057 (2) CI BUILDING DIVISIION O PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10191 VICKSBURG DR 01080057
OWNER'S NAME: APPLICATION SUB DATE
am LABRAL GLENN L AND ANN T 08/09/2001
PHONE: SANITARY NO. CONTROL NO.
M 00 Z 'ARCHITEC`ENGINEER: BUILDING PERMIT I
kL"w BLDG ELECT PLO MECH
a i W L=1 I'—I - I J
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Z v>= LICENSED CONTRACTOR'S DECLARATION Job Description
O Z Z_G 1 herc¢pellirm that 1 am licensed under provision of Chapter(commencing
nem f-w with Se tlWlof UivisionJnf the BusinuxanJ Professions Calc.ondmylicense WATER MAIN SERVICE.
u SS is' I force and ellen / I I r�
dc W a (cense Clan. r'-�b Lie.N e�i�'s 6_J 6
3 m Contiaor
ad G ARCHITECT'S DECLARATION
�'O
r g 1 understund my plan,shall be used as public careens
�
waa o O Licensed Prnfia,iunal
°' OWNER-BUILDER DECLARATION
to I hereby infirm(bar I am exempt from the Contractor',License Law for the
1-Z< following Franca(Section 7151.5.Business and Prufessions Code:Any city or county, $500
Y O which requires a permw
it to construct.alter,improve,demolish,or repair any strvcre
an 3,$ prim t ts'.. e I rc9 th applicant for Inch pcmdu fl -g d comment. - - _.._..._
that heslicensed p at to the provisions of the Conametar's License La (Chapter
9 �pyy, �Qy� FQOC/ey[�a Valuation
(co nangwth sect n]LYIB)at Division J or the Badnessarofevsonx Cale) 1 :30 l)t )Fd r ,
or that he is exempt thirefrom and the basis for the allegdd exemption.Any violation
of Section 7031:5 by any applicant for a pcnnit mbjects the applicant to a civil penalty
of not mom than fivehundred dollars($500) 202AP_N I FLOOR PL BING Occupancy Type
❑1,as...or of the property,m my employees with waga.as their sole compensation,
well do the work.and the Code: i,not Fm's Li m seofferedLaw for sale(ser.](a n 5 02 — FINAL PL�SI iTAb SPY
Business a il work.and the
Code:The Contractor's License Law does not appl(Sec. to an S `
owner of property Who builds or improves thereon,and who docs such work himself
or through his own employees.provided that such improvements For not intended or ..--._._.50-7.-- --.FINAL .PLUMBING_._._._..
bRc d f . 1 If,howe the building p t within' y f ; ,
improveon n b (der 11have N bNe fpm gthat hdiel tbuild or
improve f p pm Fon. of sale.).
r-
_❑I f the property.am exc1 . ly cminsecting withf sM contractors to
counter h l t(Sao
Toa Businessd Praia... Cada:)no Contractors
Lictorce Law does not apply to an owner pent Wi11 o improvesthereon.
wh 'its for such projects with a t uomsl licensed pursuant.t theCotset ..
LttnseU
❑1 me mptinJer Sec B&PCfee this maxon + '/ •I./„
Owner Date /
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations.
❑ 1 have and will =main a Certificate of Corecnt an self-in.sent for Worker's
Compensation, as,provided for by Section 37W of the Lahr Code, for the
_ performance of the work for which this Kim it is issued,
❑I haveand will maintain%coker'.,Compensation Insurance,as required by Section
37W of the L➢Wf Cale,for the performance of the work for which this Permit is
ism ad.My Work p uat nce carrier and Fol icy numhee art •, .•, _ .. . _ _. _ •. .. - .. - ._.
C e Pal<Y o - i
. ION OF FROM WORKERS r.
COMPENSATION INSURANCE
Is
" (This senimn need Inst be complete)if the permit is for oo bumlFed dollars
(SIM)or(ccs.)
-1 canny that in th parr( f the work for which thismi is issued.I l i i.� I I _
,hall not employ any pecan to any manner m as to beecorre object t the Workers
Compensation Laws of California.Date
,'NOTICE TO APPLICANT If ifffar making hisCarififittme of Escapism,yogi should
Q 0 became wbject to the Worker,Colppt.s limi pe.,isimactofine Labor Code you oust
forthwith comply with such provisions or thispermit shall he dared mvokcd
- CONSTRUCTION LENDING AGENCY -
C1 hereby uWat that there is a con.aluei an lending agency fur the performance
r
of
W Ute work for which this pcnnit is issued(See.3097.Civ.C.)
Q L,ndcr'a Name' ._ .:... .. . .
iiLe
rkhre.,Address )t,
f..2 �' I ttnify(hat I lrm'r:nJ Ihly ap;tlic:41va and slum that the nboea inlormaunn is
Ls+'.Ey runs:(.1 agree to annplytwlth all city aad county ordinances and stale laws¢lacing
C9 to Wilding construction,and hereby authorize representatives of this city to enter upon
`r Cs7 nhe.have-memioncd property fur inspersion poroses .,
Ea d (We)agree mmve.indemnify and keep harmless the City on Cupertino against
zn liabilities,judgmtano..,is and expense,which may in any way acme against,said
C Z City in rierseyuenm attic fmneng of this permit.
TAP Nr UNDERSTANDSANDw"jC�OMPfLN.�1THALLNON-POI.NT Issued b Date
URCE REGULATIONS. `1—1 �- Y:
Igmamre nr Arphcm AZAR ao ,Date Re-roofs
.-. ing occupaTERIALSnt
DISCLOSURE
.. asdependb theu nnoMunclailCae.Chaptstme2.andteHealthaa Safety ., _TypeofRoof- -. . .. ..- --- . . ._ .. .. . -- '- - -- . ..-.....
Will me applicant or Future W'Ila ..
' as Y R p Cale.Chapter 9.12.and the Health and Safe? �� •1.t;. . .,.k -�,I; i...
dc:Sermon 25532fa1°'0�o.oN ' '' '.....'Over,
-_.AII roofs shallbe.inspected.priorto.any.roofing.material.being.installed. _ .. ...
Will thea applicant or future building acu I use equipment or devices which
pp g cam aipmcn If a root is installed without first obtaining an inspection,'1'agree to remove
emit District?
mus air contaminants as defined by the BayAma Air Quality Management.atemr.
Diall new materials for inspection.. Applicant understands and will comply with
ours C1No all non-point source regulations..
I have read the huzallous materials requiremcros under Chapter 6.95 of the
C.Iifornia Hcahh its Safety Code.Stations 25505,25533 and 25534.1 understand that _. ..,
if the building dos not curint have a tenant that it is my resconsibilinvmnotirYthe
aeupant en tit requimne is which mu ua prior m issuance of a Cenifica¢of l
r Ottupancy. -
���) Signature of Applicant .-, . . - .,, .. Date
Divine. silt sea age Data All roof coverings to be Class"B•' or betier
.. .. .OFFICE. .. .. ... -_ . .