03060014 CITYOFCUPERTINO �1�,� '• Y° '^^ r, -fir
BUILDING DIVISION PERMIT `°vN ��Ogt`N���4�1V1
. ..
Bu1MING ADDRESS: CUPERTINO PLUMBING PERMITNO,03060014
owNER's NAME: 10297 S DE ANZA BLV : , MRhf")�gATb2/2O03
IVELLO JOSEPH
NE: (408) 253-0618 SANITARY NO. CONTROL NO.
ARC HI'IBC74ENGINEER: BUILDING PERMIT INFO
BLDG ELECT LU MECH
O O O
306 LICENSED CONTRACTORS DECLARATION JobDescli tion
i3z I bomb aM t m Ilanwd under proviuom of Chapter 9(commenting O
n<
with Sall ) vs Nle Busineu and Profculom Code. mYlkemch
< a .nae ZL/9o� REPIPE L�
j nom CI Lie.11
C D Con DEnor
LL `N
As 211 use DECLARATION
$ � t
understand my pkm shell be used u public records
kc
Licensed Pmksslontl
Sy OWNER-BUILDER DECLARATION ))
.�i I 1 hereby affmn that I am exempt from the Convenors License Law for the 3/
i❑0 (allowing won.(Secdon 7031.5.Business and Pmksu.m Code:Any City or county /
S$ which requires a permit in comtract,Bluer,lmpreac,demol sh,or repair any someone
k7
priorm its W.mcu..k,i requires the appllanl forsuch permit to Olcuignadmiteram
that the I.licensed partner,in the provisions of dam Contractor's Uccrat,Law(Chapar 9 Sq.FL Floor Area $1glbion
3a (commencing with Section 7")of Division 3 or the Business and Professions Cade)or
Net he Is exempt therefrom and the bash for dm alleged exemption.Any violation of
Section 7031.5 by my applicant far.permit subjeeu the applicant to a civil penalty of 3 M I UffiFer 0 0 Occupancy
not more Nen flue hundred dollen(5300). p y `Ty
'
0 I,u owner of the pmyeny."my amployeu with wages u their wk compenudon,
will da the w,okmd thesuuclme h not mandW".Rexed mrak(Ses.70 N,Budems —
cod Pormuslov Code:The Comma mr's Lianas Law does not apply m en awner of 3 01 - ROUGH LS
propmywhobulldt.,i.Kr derwn,andwh.d....hw"khi..If.rtluoughhis
own employua.provided thatsucb lmpmwmems me notineMM arofrered for ask.It, 502 — FINAL PLUMBING ENERGY
however.the building of improvement iswld wJthi..m year of completion.the own a.
builder will have the burden of proving that he did not build or Improve for purpose of 507 - FINAL PLUMBING
sale)
0 1.as"corer of the properly,me exclusively contracting with licensed Creasman to
construct the project(See.7044.Business and Professiam Code:)The Contraemrs U.
case law does not apply m an owner of property who builds or impmws Hereon,and,
who contracts for such projects with a car uumr(U licensed pursuant w the Conmemra
License Law.
0 l an exempt under Sec. ,B&PC f"Nh won
war Dau
WORKERS COMPENSATION DECLARATION
a
1 hereby affirm under pen.11y of perjury one of the
following declandiom: t,
1 hew end will maintain•Certificate of Covent to ulbiasum fa W"kcra Cooper- Y
cation,as provided for by Section 3700 of the labor Cade.for the performance of Ne
work far which this permit is issued.
❑1 ban a d will maintain Warkers Compensation Imunncc,u required by Section
3700 of bar Code,for the performance of the work for which this permit is Issued
M rke,e Commp�enution ineunn¢artier and Policy number am:
Cartier.r.'v 9;C""� A" PolicyNo.: ���2��
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisucti.n wed notbecompletcd Bthe Permit Is form=hundred dollen($100)
nr lest)
I mrafy that in the performance of the work for which this permit Ie issued,I shall nor
employ any person in my mannerw as to become subject to tiro Worlmes Compensation
Laws of Califomi.Dau
APPImml
NOTICE TO APPLICANT:If.afar making this Certificate of Exemption.you should
become subject in the Workers Compensation provisions of the rah"Cock,you muse
,JO foMwith comply with Such provisions"this permit shill be doomed mvoked.
'Z CONSTRUCTION LENDING AGENCY
(—ice I hereby affirm NU Nem its construction lending agency for the perfureaam of
Gx> the work for which Nis permit is issued(Sec.3097,Or.C.)
dA Lenders Name
=z Larder.Addw
U O 1 certify Nu I Mw read this aPpIkAlka.nd sou that am above in(amotion h
Iy F market.1 ag(ee 10 Comply with all city and county ordinwm and sum lawn mating in
CU building commuction,and hereby authorize mpeftalmoe of Nie city la enter upon the
4kj ahovamendoned property for inspection pury"es.
LL (We)agree to sew,indemnify and keep hiamleu the City of Cupertino space
W liabilities,judgmcns,costs and expense which may in any way section against mid CRY
U in consequence of the granting of this Permit.
APPLI NT UNDERSTANDS AN WILL COMPLY WITH AL NON-POINT Issued by: Date
SOU EG L TIONS
2 Re-roofs
arc of Applicant/ on r Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de epplicanr or future building aecupwt uom"handle hamadous nu meal
u de0ned by the Cupertino Municipal Code.Chapter 9.12,and the Health end Safety
ads. 0,
Dyes
Y All roofs shall be inspected prior to any roofing material being installed.
0,
WIII the applicant or future building acupant tie cyuipmcm or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It luyardous air mourinanu u dcnncd by the Bay Amo Air Quality Management - all new materials for Inspection.
roc'?
0Yea Nu%
I haw mW the ham res materials requirements under Chapter 6.93 of the Caller.
nh He &Safely Codc,Sodom 2550,25533 vu125534.1 undcreanddutifthe building
d t cwrentlY Mw. that it my respomi'iliry.=wdfy the"cupwt of the
�g whi must dor ivuaac of.cknifiam of Oa-m�°,w,err. Signature of Applicant Date
KY" �}'—�� All roof coverings to be Class"B"or better
Owner or authorized ag rat Dam
CIT OF CU RTI
REI'II'E/S� NVH RS/ AIN SEH$VHC
�CUPECiiTINO CA ON FO
Building
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Owner's Name:
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Contr � p Phone: License
acto : #:
Zv,, T� &Z YgOS
Contact: - hone: Cupertino Business License#:
�-kcl C�! l�di�4 X08 ) Z�3 -O6 75
(a-2, Y105
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description: ..
A 1�� /1/}"/A S
Residentialommercial ❑
Cost of Project:
Qty. if
A le Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
PERMTIFEE /
Plumbing Permit Issuance PLUMBING
PIPE Re i e of Fixtures PLUMBING
r�� BPWSVCS
FIXTURE Pbl . Fixture PLUMBING
r Main Water Service PLUMBING
SEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING
e