02020066 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: APPLICATION SUB DATE
GRAVES MARGARET P AND ROGER 12246 SARATOGA SUNNYVA RD02 20 2002
PRONE: SANITARY NO. CONTROL NO.
(408) 867-6010
w O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
U BLDG ELECT PLUMB MECH
`Lt< LI
zSZ LICENSEaliseACTOR S DunsCaSNIhembyaRrmthmlmcendunder prlooffhper9(commencing Job Description
zi -.
with Seaion](MI))of Dwist0n3 ofthe Business and Professions Code.and my license
r E isinfullfomaaadefm REPLACE WATER HEATER.
u License Class �-' ln L;c.a
t O a Date �s� ComracmrOk
+t a i vii " -- ARCHITECT'S Df CLARA
I undemmad my plans shall be used as public records
�Y
us o o I.trcn.ee rromaamnm
OWNER-BUILDER m the Contractor's
n 1 hereby affirm that 1 am exempt from the Contractor s License Law for the
C?Q following mason.(Section](1315. t,alter.and Professions Code:Any city or county
Is C which requiresn permit to squires me
t,aloes improve,demolish,or a asig n d structure
i3m_Prior is pursuaalso nt rpapplicant f h uofileangnee stnmmem-
thhthe I ud p p n. fah t Buttress
and Pe Law ons Code)
$ Ft,FIOObACea-
(m g w N s imi ]000) f Dn ision 3 f e B 'sea and Professions Code? "t f f s l 6 , PI 0'..', Valuation
of that he i exempt tang Imli and tae bass for the object,
if U,exemptpu Any v olauon l' �'L i3 1 O 3 2 Oa1'9 s.SO'O�'�Atq 5}
of Section LS ay any applicant for a permit mbjec¢the vpplicam to a civil penalty
.ofnot mom than live hundred dollars SSW). APN Number Occu ane e
❑I,as owner of the propcny.°r my employees with wage.sastheir sole compensation 502 - FINAL PLUMBI :ENERGY P YAP
- will do the work,'and he'stmnum is not intended or offered for sale(Sec:7),cI: - - -- -b U b--
(Bminos.,ano'Professions Code:The Contractors License law does no apply to an e,�i I pectionsl', ` ':�'c
owme
r of p.,o,Who builds or improves tbercm,and who doe..such work himulf 5 0 7 - FINAL P 1 N
or through his awn employees.provided that such improvements arc not intended of
'oReied""for sald'If;however,die builain-u7im---" year """'""-- '--" '--""-"---'-- ""'--' ----- -......... - -----
g provehenils sold hedid ane' -""of- --"'""' "_ _ ._. _._. ...a t ,_„
completion,PurTomenctic.).will have the huNen of proving that he do not build or `� �'stl `+' •' •`• •-
improve for purpose of salt.).
13 L-m go(Ne Pmpeny,oto Business and
Professions
with acensad co Commences
mmenc m
'construct theproject(Sec ] axe
tkka Business a J f s ions Cad )Th Contractor's 9,1]f :•''1
License L d of .sue t n f property ho build improves thereon
and.who contra is for h p oleos with.a c tome ar(s)he
onsed.priournmrs,the __.c7 r
Con"clor's License La
❑1 am exempt under Sac. '`1' -•B(&P C for this reason )i
Owner...' •, •
_ pi« APR 0 1 2002
WORKER'S COMPENSATION DECLARATION
Thereby eff nn under p7alt of perjuryone of the following declarations: p
❑ I have.1 wi:1'in`mm1in'e Cenificam'of Consent to self-insure for Worker's BUILDING
f ,Compensation, as provided for hy-Section 37W of he Labor Code, for the
- perrmmonce of the work for which chis permit is issued.
- ❑1 have Ad will maintain Worker's Compeortion Insurance,as required by Section
3700 of the Labor Code,mi the performance of the work fir which this Permit is
kstuodf My Worker,Compensation Insum e caTtd Pel y u bar
IPclwy N /' N %70,1`WL 611 %70,1`
�,. L (CERTIFICATION EXEMPTION FROM WORKERS I f t F4 ky ^��'.1;Lt 1'(" Y
C MPENSATION INS NIJJ+� Cly"
L-� t/---�
`s fTh -at a of c m�erad f taeforces
(Slfq)or I's
7 p perms v hundred dollars s rrr __ ;?
t
.• I - - ... . ... .. - ,- t
sof Ih" rkf M1ch N's Pe t .ad I
Icomelyl thot'in er peri -
'shill of employ dojo personr manner s0 as m become xublect ro the Wurkers
CompensaGan Laws of Califomie:Dare
Apjilicemdl
i'NOTICE TO APPLICANT If h k
z 0Z become subject t k C ions tion-psin uno'(acsw of thfELatipuCoM,y you'nimt
forthwith comply with such
'- ----'" -' -""----'
provisions or this permit shall k dearradrovoked. '
•' s CONSTRUCTION LENDING AGENCY '"' v
a. ' o 1h by which that construction lending agency for the perma
forntt
W .. the winNpi sk for which i perm t slued(Sec 3097 Civ;C) -
LdersN
n "< - nn:_ _t__._: I ------W.a.. . _ ....._.-_._ ...... ___ _ .. .... .... ... :_.._ .._ __ .
enders Address
I ol
certify that 1 have read Nis application and state that the shove information is -
lsa..E. ,cuneci,I agree ta,comply,with all city and county ordinances and state laws misting
io Wilding construction:and hereby authorize represematives of this city to enter upon
}' W theabovcmentioned property for.inspection purposes.
Fs 0. (W)agrair to s cl fy and k p harrinicisthe City' fC perf1078gamst
Z) City in judgment,t o and peaces which may n any way g ort said
U.Z City sTUNDof TANDi gof this permit - ' _
APPLICANT UNDEkSTAhOSAND WILLCOMPLYWITHALL Y-'P INT''
S UR REGUL TIQNS ,;- - _ J'r Piz Issued by: I. Date
- ignat o,Ap wantlCommnor+"•'^t' .. ..`•, .,....• .JC.•..�Date
HAZARDOUS MATERIALS DISCLOSURE (-' Re roofs
°.
Will line applioort or ficum building usecosol saiiin,or handle ohandson.nerstionsi Type of Roof
is dined by the Cupertino Municipal Code Chapter 9.13 d the He Ith and Safety t - --" - --
Code S ton 25512(a - • ' -
❑Y r ° t
` r All roofs shall be inspected pnor[o aljy,roofing matenal being installed.
Will the o f t rt Wilding p ryAromt use li t re<vta,wn`or �-If a roof is insfalled'without first obtaining an•inspectioti;dtagree�to remove
<mitn a s ma n t enn<dh N B a
Distna❑Y .�N 5 y a o al ty n'an'g`,m`°t, all new materials for inspection. Applicant understands and will_comp ly with _
all non-point'sou�ce-regulations.- ' - - -
1 a " •r..al' . .
1 ha 'rc d thhaiva us- renals q emesis and Ch pmr 695 of Ne '
Calif
m Hach&Safety Cod<'S<crions 25505.25533 and 25530 1 undemend that
i!,nmjWildirl,,dwax netl tl,ha a tern t th Yt is my responsibility to notify the
Moo t bf Ne gmrcment hich must be t n i°issuance of a Ccmfichte of
Occup. cy h..; "'I
P
Yt1 0 oL t S?gnature_. .APPIic ant Date
of
r own< aamori adngenat l Z L Dai< Al] roof coverings to be Class "B" or better
- - OFFICE _. -