02060162 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BWLDWGADDRESS: .'.i - ,s ,. PERMITNO.'',
10652/54 GARDENA CT DIJOSEPHS PLUMBING 02060162
OWNER'SNAME: APPLICATION SUB DATE
LARRY CASTELLI 205 WYANDOTTE DR 06/25/2002
iPHONE: SANITARY NO. CONTROL NO.
q l (408) 365-2058
W O D ARCHITECT/ENGINEER: BUILDING PERMIT INFO
E BLDG ELECT PLUMB MECH
P:'!`�'.'LICENSED CONTRACTOR'S DECLARATION.
eros-0 1,1 barely afrm,that I am licensed under provisions of Chapter 9(commencing Job Description
F=t withs I..n7000)ofDivisionJ ofm<Business a'd Professions Calc,end my license COPPER RE—PIPE
a `� ismfmlf eIR t x 'a�
rc a
Luca.Claws n ` _ Liv.. T
u 3 Date 'mmor or
A HITECT' DEC
t O r I under'mnd my plans shall ha used ox puhlic recoNa
an a6 O O Licensed Professional
Oat I am exempt Even,DECLARATION
tt "4-y f hereby.(Seto on 1 1. exemptanthe Contractor's License Law for the
t
-which
g .(Sec.t ]o l5 Businessand Profession Cade Any sty or county $8200
S O wh ch req perils.to const talter,improve.each
demolish, i re
ystructure, Y
$
PH.,ho nsu.once,al gwru the apple tf s ch pe no fleaagr l tatement, --- -_
3--that fS ts.l cpn¢pd puts p Ito Fh"pR iD s of the Contractors Lic la (Chapur9 oya,.�hpt� IpOC P.a. ♦ , Valuation
"(cm encmg !h 5cu..."Dilof Uiv.' J fth Bsl ess Jprofy sCodel '(,e�N'l 3f20,V,61U •1•.;'V,V,>„C�',1,.-`f h'14,y\ v
m that he ie exempt thercfmm Dad the hasie fur the allcged'exainialo Any nolaion
+of Secom 103 L5 by any applicant far a permit subjects the appheam m e civil penelry
faotmoRme.r1ahandleddouars(s5Bn), 106APNh & WATER Occupancy Type
❑1,as owner of the propcay,or my employees with wages as their sole compensation,
will
- dii wark:und the'swaure'Is nor intended or offered for sale(Sec.-701-t:- - - - - - - - ------ - -- - ----
'
'Bu'iaess'and Professions Cadc:The Contractor's License Law does not apply to an 301 - ROUGH PLgMilg4dnspections''^"- -'`IF
owner of properly Who builds or improves thereon,and who does such work himself
o through his , employees p .provided that clsimprovements are not intended or 302 TUB & OR SHOWER
offered ford' 1[h - rthe buildig "'p meats. Idwth a`yearof " "' ""---- .._. .__. _ ._.,._ ..._-._ ._ .. ....__-
completion,the owner-builder will have the burden of proving that held not build or 502 - FINAL PLUMBING ENERGY' . '' 'ic
improvefor Pmpo'e Dfaale). 506 - GAS TEST
--i's _traw- --_..._..__ ..._ .___ __ __ - -.._ ------
--
-_ _!
01. 507 admmctingwi@IicenseJconmcmrsio 507 - FINAli PLUMBING -- --^- �����^����� �-�---�-----
cotsvuct the pmjcct(Sol.]1141,Business and Pmfessiaas Code:)The Cientmcmr's I ,io•: ,u ::s o
i Liana law does nm apply to an oxncr of pmpeny who builds nr improves thereon, -
,: .:.,,, and;who.contmets for SuchRmjaciawint.a.n,mmetorb)licensed pursuant to Ne-._..._._ �_. _- _ _.___-._.._.__. ............_.-_ -
' ipl mpt' IeSe F's - sB&PC fonhis rtvxon ;i'' i!p•;r�),!s)Il`_
O D t
'!'WORKER'S COMPENSATION DEClLkRATION.
i' 3"'ie lhereby,effran under prnalry,of perjury one of the following declarations: /� C
❑ I hdai and waif maintain's'C<nificme sal Cdnunt to aelf-insure for Worker's FI NAL
�-cona
Penson n as provided for by Seca 3700 of the Labor Cade, for the
-, rs p A rmance bf the w rk f r h ch thjs pc r t. sada. ,,. p p
❑1 h nd will mmm Pe
W k 'ssComnsm n Insurance,ai required by Section J l)� \7 (.
7700 of the Labor Code,for the performance of the we
for which this permit is
i ansa d My Worke/a Comp[[e�� ,tan Insurance tamer anti Poncy[n%umber a ` 'yry�'py
- `5��1•P ,7�GN�':Pollry Nn ���Z(-4/�`L(1.1 •�r37�r :...•}`_ ted z�'ttf�-:t^,6��iLi11YGY..,,....1"::.�;':;--._._..__......_
3.1. GERTIFlGAT10N OF EXEMPI'IOIJ}t�jM WORKENSt s. t,. \.�i�, r Asa CS t•.•l d:t.-5.�,e x,.
„ I COMPENSATION INSURANCE•^'* ^' ' e - __ _ � _
100ucimir needim be co nplcieJJlhe penntis lar nue ht nJrcd Jollurs 's q7.r .' Ct I `p.: s. 'C _
(8100)or le".)ss.)
I -i' thin h dorm c.. Interior
Y pe a of the work for er ch this .it s issued,I
'shill not employ any person in any manner so as to became'.byes,to the Workers
Compehulion laws of Culifomb,Dare, - I
__APPllcani. '
NOTIbecaeETO,APo the Worker's
after Comnmkiti this Certificate of of Labor iood.'o.mulJ . . ,.,
became uby n the W'ker s C ions i provisions' ll th Labor Code you must
Q O I'nnh ih c ' ply Itl h Provisions o th.pe t shall be deemed revoked
.. .. ._...,. .. _. ... . . .. ... ... _._ ,2..,...
fill - affirm
CONSisi oNIFNDING AGENCY ' f! "sf '
hereby affirm th t theresued(Sam lending s. .) for the performance
of Lethe k for hath thisPermit issued(Sec 3(19],Cis.a 1
Lend Addrec _
� z
V 1 c ilfy that I have tend ti application and stare that the above information is
�T+d[s torten
.,.a to tq comply withsit lily and loamy oN mutes and sate laws telling
�pV thebuilding hioca ..Iso la alone bynmh 1 p ellives fah city
t ewer upon
r)e W
the b t cd p e.ny f- . .pen pu per
E.19U1 j(Wedg- -ts a In and
fyunJk phsr in they iy f c (n isaganet
-Vy Cliabilities,, I judgments,costs r d xpoft loch road n any ay ¢else against said
V!Z APRnA q eofthe printing ANDfth perm.
sioupICA.NTUNDEIS ?/SASD WILL COMPLY,WITH ALL NON POINT
- -'. SbuP-E7iE .Lime /q:I pr^-'�I Issued by: Dale
_L
nawreof Applrearitc." e'or„ 7-+ t `Dare 'r
f HAZARDOUS'MATERI MATERIALS DISCLOSURE -roofs
^'' N 11 the ppl c t ar f t ie buildmy c up rRt nr handle h rar l is tot Type of.Roof. _
'is def dhy the Cupenn Mu "plCd Chapter 9,12.a he Health and Safety ` '`
Code S❑ectin 257181 . s } ,q r. t k•}t +v )� I rt ps. 1 :u
1 1.; fir l � tit Idle t.
n r v ! All roofs shall biimspected,prlor.to,any roofing,material being.installed
' W um ppl m r t buii� gaccup t q 1pmemo deices which �If a roof is installed without first obtaining an'inspeciton'-I agree to remove
card,h vN c t is as a lined by the Bay A 2::a Quality Management
�D ' e'0Y Nn all new materials for inspection. Applicant understands and will comply with
alllation's.
non point source regu
1 M1 eaJ'ha,hazad8u, ei,e remelts sande 6uprer'6.95 of the
Lif
fomta Healti Safety Code,Sections 25505 25533 and 25534.1 undersand that
he building does not curren0yhave a tenant,that it is my responsibility to notify theup nt oq . prtossaceenicate of Pan y; Signature of ApplicantDaten oAll roof coverings to be Class B or b'Itter
.,. OFFICE._ .._.....__ . _. . . ._. ... .. .. . . .. ..,.._. _..-.. . .