02120088 CI'T'Y OF CUPER'1'INO
xuu.nlNc DIVISION PERMIT CONTRACTOR INFORMATION -',
BUILDING ADDRESS: CUPERTINO PLUMBING PERMIT No.
22311 JANICE AV 02120088
OWNER'S NAME: 10297 S DE ANZA BLV APPLICATION SUB DATE
ah� ED ZIQUIS 12/23/2002
ZONE: (408) 253-0618 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
m = LICENSED OCTOR'S DECLARATION
mw- I hereby afirdstmcemax!under provisions of Chapter r v(commencing Job Description
ywill Section lid Iffe niviaiunfol the Ouainncaa Pn,Icsxinns code.and mYlittnu is
�„ mmnf re nderrect1 � REPIPE WATER SERVICE.
Llz Liverac .. L,e.x �•L�/�lU
yp Dau Z 7�. n2H CnnD RATION J V
v'
ARCHITECTS DE At, t(�9 CJAL5vE0
C z< I under am n pl 5 iha I�be used Not, a
�LLdOyU �
i- Lice J Ica v
OWNER BUIL Eche CoATION
w a F I cry al)irm that I am exempt From the Cu uactor's License law for the .IAN 1 0 2003
apo foplowingtemon.(Sea)on7fnl.5,Businevand Profeeainns C,,&:Any cilyormunry
e a 2 ff which requires a prm,il w construct,alcor.improve,demolish,or repair any structure
Prior m its issuance,also requires the applicant for such permit m file a sipped naremem
FSGthat he islicemadpursuant todo,provisions ofthe Comractur'sLicense Law(Chapter 9 Sq. Ft. Floor Area '"S4.P. 3M �IQLtion
ed C (commencing with Section 7000)of Division 3 Of the llusincsa and Pndcavions Code)ar
that he u exempt therefrom and the basis for the alleged exemption.Any violation of
Section 703 L5 by any applicant for a Permit subjects the applicant to a civil penalty of
not mom than five hundred dollars(s50B). Occupancy Type
❑ 1,u owner of Ne pmpeny,or my employees with wages az their sole compensation,
will do the work,and the suucwre is not intended oroffemd for sale(Sec.]TWA.Business
and Professions Code:The Conductors License Law does net apply to an owner of 301 - ROUGH & cV, Ons
property who builds at improves thereon,and whudoessuch work himulf or through his
own employees,provided that such improvements am not intended or offered for safe,If, 502 — FINAL PLUMBING ENERGY
however,she building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve far purpose of 507 — FINAL PLUMBING
sale.).
0 L as owner of the property,am exclusively contracting with licensed contractors to
ImOnct the project(Sec.7fWA,Business and Professions Code:)The Contractor's Li-
cense law does not apply to an owner of property who Wilds or improves Neuron,and
who contracts for such projects with a etmlraeler(.a)licensed pursuant the Contractor's
License Law.
El I am exempt under See ,B&P C for this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 herebyaffirm under
Penalty of perjury one of the following declarations:
I have and will maintain a Cenificam of Consent toself insumfor Worker's Comped-
unn,as provided for by Section 37011 of the Laird Code,for the performance of the
717000of
rk for which this permit is issued.
I have and will maintain Worker's Cumprnsatino Insurance,az required by Section
the Label Code,for the perOommics,of Ne work for which this permit is issued.
y Wo key Compensation lnaumna tamer and Policy number am:
m Poliry�fy�� 7/30i uwl
CERTIFI ATF,OFE%EMPTION FROMWORKERS' Iv—o
COMPENSATION INSURANCE '7(P
or Ices](Ibis section need nut he completed if tW pm rd is for one hundred dollars(S lot))
I unify that in the performance of the work for which this permit is Imued,1 shall out
employ any prrun in any manner ser az to become subject n the Workers'Compensation
Lows of California.Date
Applicant
NOTICE TO APPLICANT:11:after making this Cenificam of Exemption,you should
become subject m the Worker's Compensation provisions of the labor Code,you most
Q 0 forthwith comply with such provisions or this permit shall be deemed revoked.
z 7) CONSTRUCTION LENDING AGENCY
[-� l hereby affirm that there is aconswcllon lending agency limhe perlixmance of
C' the work for which this permit is issued(Sec.NOT,Civ.C.)
ft1 Lender's Name
a' finder's Address
U Z
U 0 1 mnee that 1 have read this city
and County
and smm that the above iw nrmatinn is
CS. F., burdingconstruction,
oreewco,plyand hith all rebyaulyand countyotatives of and sat to enter
upon the
C) U above mentioned ooand hereby reitum rerprows.representatives of Nix city to enter upon Ne
obolific.mentioned pmprny fillond aspr mils purlmua
H y (We)agree m save,indemnify and cp harmless Ne City of Cuprnino against
h in I.i ses.judgm ttyy gray and expends icb may in any wayaccrue against said City
C.3 z in conseyucncetfie granting ufo s it vN
APPLIC DERSAND ILL COMPLY WITH
S NON-POINT Issued by: Date oY
E ATI 5.
-62
Sigr fApplicamiConuutnr Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hataidous material
c as defined by the Cupcninn Mun cipal Code.Chapter 9.12.and 0.Health add Safety
Colic.Section 25532(a) 'r J
L:]yes d�Ivn All roofs shall be inspected prior to any roofing material being installed.
Will the applicant Or future building occupies use equipment or devices whim If a roof is installed without first obtaining an inspection, l agree to remove
emit ha,aNdu+air contaminants sea defined by the Bay Area Air Quality Management all new materials for inspection.
District! 1
❑Ycs ,gU No
l h readth wank/ms mamii 'myu-cmcntsunde,Chapurli.95of NCCalifon
nail a1N&Sefcly c,Sol u 25 ,255 and25534.1underdauthalifthc building
urns dol cu call Mate a m an4 N it is respares hility no notify Occupant of thc
quiremI aw most clp it nate of milie trot panty
Signature of Applicant Date
o rnr mo agent Date All roof coverings to be Class "B"or better