02100059 CITY OF CUPER'1'INO t •� "' k`'
BUILDING.DIVISION PERMIT CONTRACTOR INFORMATION.'
BDIL1)1873 '7D.3ESLA RODA DR LEONARD A VALENTI INC PERMITN(02100059
GwIHRDN,IAIERS DAVID L AND ROSE C T U481 AUZERAIS AVE APPLICAT191fUIfB ffy2002
ONE: 408 848-9688 SANITARY NO.// �� // CONIROLNO.
ARCHITECTIENGINBER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
0 0 0 0
Cj LICENSED CONTRACTOR'S DECLARATION
p 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing ob Description
< w with CoLmO70000) EDivisiun3nfwcBuincssanJPrnfcssiomCralcenJmyliccnseis REPAIR CHI
�> in lull(erec antLflf y3i Lo# — 2-
ZO$j Lierato Class fY!/��ICLI
F=� Datf/ o Cnnracrnr / P�y./
77 ARCIIITECI'S DECLA I /
tun unJ Aygdans shallM mum public records n'SONY, /Q
y/
co is Licensed Professional
EssigOWNER-BUILDER DECLARATION
1 hereby affirm that IM exempt from the Contractor's License Law for the $1800
sa00 following reason.(Section 703 1.5,Business and Professions Calc:Any city or county
a�$ which requires a Permit oe ennstruel,alter,improve,ikmoliah,or repair any suuctum
FZ`= pnorto its issuance.also requires the applicant for such permit(1)file a 111,11041 statement
i< that he is licensed pursuantotheprovisionsoftheContractor'sLicenseIsw(Chamer9 3Sq9B.40Qb6A1@JD Valuation
ta (commencing with Section 7(XXB of Division 3 of the Business and Professions Cree)or
y W$ Out he Of exempt them0om no the I ssis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of PN'N Occupancy Type
not mare than five hundred dolmm(s5O)' 312 - CHIMNEY REBA & STRAPS p Y YP
0 I,as owner of the property,or my employees with wages as their sole compensation.
will do the work,and the structure is not intended or offered for sale(See7044,Business 5T4 -
and Professions Code:The Contractor's License Law does not apply to an owner of equlre nspechons
property who builds or improves thereon,and who does such work himselfor through his
own employees,provided that uch improvements are not intended or offered for sale.If,
however,the 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 for purpose of
sale.).
1,as Owner of the probarrY am exclusively convecting with licensed contractors to
mnsttucl the project(Sec.7044,Business and professions Code:)no Contractor's U.
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such pmjecu with a cnmranoru)licensed purview to the Coloomo is
License Law.
❑I am exempt under Sec. B A P C for this union .
Owner Dow
WORKER'S COMPENSATION DECLARATION .
I hereby amtm under penalty of Perjury one of the following declaration:
1 have and will maintain a Cenificate of Consent set I.insure for Worker's Comma-
sation,as provided for by Section 371)of the Labor Code,for the Performance of the
he for which this Permit is issued
I have and will maintain Workers Compensation Insurance,as equiwd by Section
'al,
(g)of the"he,Code.for the perfnmunec of the work for which this permit is issued.
\\ My Worker's Compensation Insurance carrier and Policy numberom:
Cartier.s.��} F.4i�Policy RO
CERTIPICA F. F F.MPI'ION FROM WO K S'
COMPENSATION INSURANCE
(This section need net exmmpleed if the roman is formic hundred dnllaa(5101)
,it loss.)
1 unify that in the performance of the work for which this Permit is issued,I Bull not
employ any Person in any manner so as to become subject e the Workers Compensation
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the I<Mu Csak,you must
OO
g M fonoalh comply with such provisions or this Permit shall be JCOmed revoked.
CONSTRUCTION LENDING AGENCY
(-. r.r Ihemhy affirm Nat there is a comlwwion lending agency for the Performance of
C4 the work for which this Permit is issued(Sec.AN7,Civ.C.)
Q1<nder'a Name
7 z Le Z's Address
U C I unify Nat 1 have read this application and sum that the above infemulien is
[s. P cotmct.1 agree to comply with all city and county ordinances and state laws rotating to
O U building comwction,and hereby authorim minesentativelOf this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
F y ;iabi lilies,judgments,cosy and expenses which may i n any way auric agiumt said City
C.) z n con scyuoncev(tho - gat this permit.
r APPLICANT U RS NDS A ILI.COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE R LAT ,S^�6
��Rl/T fT,2 RC-roofs
Sign f Apphcr UC waor —�Dm�
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building oecupam store or handle hazardous mamdal
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code, rlWe zs532(ay! All roofs shall be inspected prior to an roofing material being installed.
❑Yea Ne P P Y g g
Will the applicum nr fumrc uilJing acupam tow cyuipmcm nr Jcviccs which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District!
❑Yes \No
Ihavc rcatlth vdous mamrialsre anems under ChaPmrfi 95 nl'lheCalilnr-
niallcuWt65Wel Tal,Scninns 25505 lanA 25534.Iuuch Jmlil the buil ding
does nm cunt y tr a tvnnnl Wa' a my reslxrnsihihay,It notify th upont of the
requirement Idem c rtoisvecocef.Conifica au �e Signature of Applicant Dale
` owner au@miyc a i All roof coverings to be Class "B"Or better