03010002 (2) CITY OF CUPERTINOa
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING A DUE ESS: WATER QUALITY PLUMBING PERMITNO.
10191 VICKSBURG DR 03 0002
OWNERS NAME: 1860 ALMADEN RD APPLICATION SUB DATE
CABRAL GLENN L AND ANN T 01/02/2003
HONE: (408) 267-9330 SANITARY NO. CONTROL NO.
ARCHITECUENGINEIE1 BUILDING PERMIT INFO
RLDG ELECT PLUMB MECH
�200 LICENSED CONTRACTOR'S DECLARATION O O O O
b P I hereby affirm that 1 am lies ted under prnvidens of chapter 9(commencing Job Description
,26 withaccllon7(gg))mf DiOsion3.f Ne Busine5saa uProfessione Cdde.anefi,licenmis
<�" inr°Bin aPdcf m �• I COPPER REPIPE
o=ho Liee Gl °t' FINALE®
ARCHITECTS DE A
�a I understand my plans shall be used as public ords
LLI� LicenseJProfcssionat JAN, 0 6 2003
OWNER-BUILDER DECLARATION
<P I hereby affirm that 1 am exempt from the Contractors Liecnm Law for the
following reason.(Section 7031.5.Business and Pramminns Code:Any city or county BUILDING which requires a permit fir construct,alter,improve,demolish,our repair any structure Ir
F$ prinnn its imandee.also mobil.thcapplicant fortieth permit m fleaaigned statement
CC Npursuant Beat he is licensedpursuanoMepmvisionsofineComemod'sLicense awlChapter9 Sq. Ft. Floor Area $4VMQtion
��$ (commencing wish Section 7008)of Division 3 of the B uainess and Professions Code)or
y Nat he is exempt therelram and the India for me alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit sobjCcm the applicant us a civil penalty ofGCCU Occupancy not mare then five handled dollars($500). p y s7p
❑I.u owner of the property,or my employees with wages as their able compensation,
will do the work,and the structure is not intended or offered for We(Sm.7064.Business 2 82 UNDERF
and Professions Code:The centimeters License Law does not apply to an owner of 301 — ROUGH LCJIvI �eCli ons
property who builds m improves thereon,and who does such work himself.,through his
own employees,pro"Mol tha"lich improvements are not intended or offered formle.If. 502 — FINAL PLUMBING ENERGY
however.Ne building or improvement is mid within one year of completion,Ne owner-
builder will have the burden of proving duet he did not Wild or improve for informs of 507 - FINAL PLUMBING
Sale.).
❑1,as owner of the property,am exclusively comracting with licensed contmcmrs to
cbnshuct the project(Sec.](144,Business and Professions CmIr:) Contractor's Li.
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such Protean with a contmmm(a)licensed pursuant to Ne Contractors
License Lew.
❑1 am cacmrt under Sec. .B&P C for this mama
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby a1Gne under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent set Ginsure for Worker's Compete
satin,as provided for by Section 3781 of the ichor Cndc,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Inmmuce,ss required by Section
3780 of the Labor Code,for Ne performance of Ne work for which this permit is issued.
My Worker's Continentall amenecatricrand Polwynunn raw: �6
C is,:: I Policy // 0
CERTIFICATEOFE EMPION[MOMWORKER '
COMPENSATION INSURANCE
(This awdon need nm be complctrd ifthe Permit is for one hundred dollars($100)
I'm,)
1 ccnify Nat to the performance of the work for which this permit is issued.I shall ant
employ any person in any manner an res to become subject o rhe Workao'C.mpensadant
Laws of California.Date
Applicant
NOTICE TO APPLICANT:II.after making this Certificate of Exem prion,you sh.0 Id
become subject to the Workers Compensation provision of the lahnr Code,you must
O O fonhwim comply with such provisions orthis permit shall M domed rcs.1md.
CONSTRUCTION LENDING AGENCY
h r the why affirm Nut there is a Constrictior lending agency for the fell announce of
lYi the work for which this perm it is issued(See,3097,Civ,C.)
QLender's Name
0. z Lenders Address
U Q 1 ccnify that 1 have read this application and state that Ne above information is
Ira P correct.l agree to comply with all city and county ordinances and state laws rclatingm
C)U building Construction,and hereby unman m represcnwtivcs of this ci iy to enter upon the
r W above mentioned property for inspection purposes.
G (We)agree m save.indemnify and keep hadomm the City of Cupertino against Owl
to liabiliidis and expenses which may in anyway rumme against said City
1.OR APPI.ICANTcb c STtN ofthtNDrWILL COMPLY WITH ALL NON-POINT Issued by: Dat6
SOURCE 0
Re-roofs
gat ter ppE 'nnoacmr oat
IAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thea licam or future building rccupam sone or handle hnraNnusmmerial
m defined by the Cupertino Municipal Code.Chapter 9.Iz,and the Health and Safety
code.Section0Yc,zss3ztar, All roofs shall be inspected prior to any roofing material being installed.
Will the applieant nr futh, budding mecupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
Cori,hazamnus air amtnminants i clincd by the Bay Arca Air Quality Management all new materials for inspection.
Dis ricd7
❑Yes
I hove ad the Nous materials mquircmemsunderChapterfi.95ofus,Celifor-
malicadfM saoty ,Socdnns25A)5,25533 and 25534.1 undcrstvulthwifthu lwllthng
does not cunemlyh u ten, VtIrR it is my w',manihility m nmily the occupied nl Ne
quimmema 'i must e f riorit,ismanceof.Cenifca¢T, Qcup cy. Signature of Applicant Date
3 All roof coverings to be Class "B" or better
Owmr'iVmnh zv4 pl olil