02040094 CITY OFCUPERTINO • -• .,..•>.n-
BUILDING DIVISION PERMIT ;CONTRACTOWINF.ORMATION .
BUILDING ADDRESS: PERMIT NO
02040094
ORWER'S NAME:
APPLICATION SUB DATE
'IOMESTEAD LANES 04/18/2002 •
po .HONE SANITARY NO. CONTROL N0.
µo o ARCHITECT/ENGINEER: BUILDING PERMIT WFO
BLDG ELECT PLUMB MECH
i) zC LICENSED CONTRACTOR'S DECLARATION lob Description
Z a Y I hereby Affirm that l am licensed under pryryvisions of CMpur 9 lmmmen,,.s p '
=C wish Sea ton of Division3oF,hABusiness,gd_91:ssion1Code.endanyIianse NEW SIGN.
_ I)In IYII(OTC 'CBC iV
.06 License CIA moi- Lie N
Comrenw
y,O ARCHITECT'S DEC O g�
I understand.111.shall be used As public records •'q q
�Co Ucensed Professional SEP O LOOL
F OWNER-BUILDER DECLARATION
1 hertby ARnn on I am caempt from she Contractors :Any c law for the I?C
which
hfollwire reason.(exhort 7031:5,Business end Professions Code:Any city u county $2000
lh irhrequires]Tennis n ainaa the gticimprove.h pormitt or¢pairany swmurt
u6u13$"pout_utxuancga)sorcqu it i,a anam(u such ,&,Lfik,eL*.(u,mem -. .. ._ _ __
Ni,hucbctnut piriuonuo Uw prun ons of the Cvnwc,ofs L,ttnu 4w ILTAq r 9 ----
(co mmc,ppwal,Section TOM)of Division 3 of IM Business And Prof aumns Code) ! 1,x� Ltl1'Vb V•;'-t�b�lt ry_�,.;'f.'f¢'3' Valuation
or thor he is exempt rhe,efmm and the basis for to Allaed'oem,m6 An s
p P- Y violation
-of Section 70315 by Any opplicant for a permit subjects the Applicant,o A civil penalry-
Lr,ioimortiAahRvehundred aoll.'n(ss00). 101n<PN�ATION •" ' Occupancy Type
Cl 1. ownu o(the property,w my employee_nh wages u,heinole compenotion, 103
-will Bu the work..and the iiructurt n not,mended or offeand tw Ale-(Sec:T00.1,-
Busineu eM Professions Code:The Convenor's License Lew does rix apply to an 104 - REBAR Required Inspedtidns 1D`-``Le•+�-T`
owner of property Who builds or improve comma.end who does,xh work himself r
_or threuth hieownemployecs..Provided.that suclyimpmbe�qts-Am m,imendcd.Or _ _.._1.0.5_._=__ANCHOR_B.OLTS
a Rued IA,uta If,however.the hcildin u im -. ..__.....__
t pmvemenr is sold within one yen of '
'bo,nplxion.m ...,builder will have the burden of pmvinpthn he did as bon °IT,.:i:^;e or 304 — ROUGH ELECTRICAli"
improve for purpose of"Ic),
........ _ _ ...___.__ _ . ._505...... __FINAL ELECTRICAL
_,. --- ----
construct - - -
f3l,arowner otNeprogcny.eine:sinessycomrxunpwith CW-:)The
514 FINAL PUBLIC
License
,he Projdoes
no(Sec.appl 9044,Business And Profen om Codn)The va to thereon,
j License Law tats nm apply loan owner of.,cm who builds sa improve,hereon,
And.who.rs Liceu.fL.,uch.pajecu.with.a.canrrauor(s)-Ikenrd.pur,u,nt.to�Nn_ _._..._..__...__...__._._ ..._.�_.:_:c_. ..
z "R9C G SI -' .'JU'LI
onuenors L¢ense � C 1 B'&PC to Chia won
P! 7
" -' Owoir,.cn'].0.>fDri,,:,.:a.o- ,..c:n.:.. .,...�sC-.+.. .
- -- �Dne .- n ho-a--•
WORKER'S COMPENSATION DECLARATION
_ <n',Ihe,eby aRw oMxpm,hy`W PeV47,�ofU,etollowingdeeWeUoru:-
A ❑ I hivk end will'maf'I m'a'Cenifkare AT Con-01 1o'x1f-iAs.m for Wer ker',
Y j2 CompmAA, n;A pmv,d d for by-Section 3900 of-ihe labor-Code,-!ushe
perrormmice'cif me svork,roz which thio pemdl is issued.i „[
❑1 have a will'melnuln Wohn s CAmpCnutbn Im.r/nx a iiQ,iiied Eysknion
STOO o/rhe LAbar`Cadq,for rhe perfpripe9ce of Ne Work for which Nn perwt d
sit My o eft mpe semen Insunnce tem rl rid PoI ryjjnu,S,ber,ie K
i t .
:rz 1 t IFl ON OF E%FD1PAbITFROM.WOR " f. r:� L
r'" e:.lr, z :li.�' _:! xt�:�j• L 7 .:`P.
.c.+;•-,_fThu xn,on neeA ha y��5ATI0N INSURAf{CE_.`, k, •.;••' � ,.
COMP
.C,l.t. - , ..._,�........
' com lkmo,fhe
dollar 'it?.r s^ "'i.i r:i.'n'..•.G 1,•.• .•
ISI00)u le ) P perrtut is for one huntlmd
ry„ I amfy rlpi In,Me pert once ohhe ohh('( h vh this perm r to wad.'I B .'0 ^i,. �, ,..,,x14 „ CI �Lin.,..all not empl y pry-person I any mohne�u m, bkco' �kbJecl to @aiWarkeii � -
,
CdplP t,n t La s dfCal(amts Dau, ' '
A I a t ` d4mf this Genl('ca,t of mp,on you shv Id - ,;AV
vJ N haat on pm s om of rhe LeboI Cade you mail
0 A:omet'ub i ro It Wuchk s Com o this pe t shall b dim d revoked
CETOpPPLICANpI a(mr m- —
a
Q Q lonhw,h comply w,tX such pm n,o
' CONSO)VCTION LENDWG AGENCY s
F '-,' c:r f hertby eRmi Ihn Neu Is 4cpnswn o I ibtny apcncy fu die pe,ftin,iinde. Z.-Ki N t`.'i
W q� ofd,ework Yar h12XNspe,ml e,uued(Sec'7Q9T C( C) - '
r1-.Z. LebdeM1 Addrkn. . v
y+ I c<mfy Karl h a re d th s opplipuon eM sive theRhe ebb a information is
kifkn 1 alrtrmcnnrylY with all gty.er,d coo IY ortlmanpe and mse law remng
^ 'j. mbuddmp co swnion and hertby emhbnze rcprtsenudves of Uu3 coy venter upon
�< W the above neared Property for Impccrion puryoxs.,r -, S
t^ Y;I (We)ajree to eve indeltwfy end keep harmlw Ne C,ry of CWpen,bo'ejuns,
r Vl,• Iiab,Ones,Judpmepu,cow ere tapenxe wT,ch may v any waY ucrve aRunstssej4
Issued by: Date4—A
cNr 'a a S��P vlkep P[vt3r d�AS.' Cvi'^e ( 7/
s 9 RE r
Iwel b App¢aoryCanuanm 2 -� I t s 'i r Oia t ' TRyeProof R
1 HAZARDOUS MATERIALS DISCLOSURE ' ' ., 4 '`
(Will the applirhnr a NNu bu,ldleg acupant a.or handle huallous meunW - e O Roof.,"
s
pp dtamd by the Cupanlne Mu�nkiipd Code Chapter 9.12.and the Health and Sa(ery -- "
Codk Sveuon)55331s47 e'f 4rANo�r i` t '' fl ° p c 'S ;,.t 9 lis ''I sh it r s I,q•.Jtt s9 r ..' jti4. _.. I'l i'
°Ye _.All,roofs shall,be mspected.pnor-to,any roofing.material being installed.. .
OutWd mil Air i'an,ohaws ddin�p pamuseegwpm mmdnuA hire If a roof is installed witbbut first obtaining an ins ecnon;"I a ree'to'rbmove
r"I'Wal the.pl can haws utl ili by Ne Bey Artai QA, 'lepkmI g
Dismcr t .£,.•.,, ,a r .. ...._.n:..' c.. .c•r .. .• g
- all new materials for.ins eQtion.-A licant uriderstands.and,will comply with
i•t ❑Ye ' ' - - P Pp
,1l' _ 1' sl:{' .1 all non-point source regulations ;;T , : CJiiY-' •, ,:< ----_._
1 have read'the huardoui mearitls rtqutrtmenu�uoder Chepier 6.9Tat U,k
Celifomu Health&$efery Code:Sadgns'753Wr H)3)and 15534:I'undeuuntl,hat
O Uu butte he mu roe currently have uenant shat I!is responstb h!ymnoltfy,he --_..
' of the rtgbirk h mei,be met poor m,s umca of,Cmlflpati of 'O . ..
a
uvan K`,`
Signature of Applicant..._.....
.. . ' AW. . G ..- ... .. ---
[ - or pwhorize opens S �,(,y' t t - rGt�, Dau ,• All roof coverings t0 be Class"B"OI better "
. y,lu _.------
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