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02100135 (2) CI'I'Y OF CUPER'11NO ' 's' x Ix BUILDING DIVISION PERMIT - CONTRACTOR INFORMATION:.•; --Is �✓xk �r ButDI 4- . FFORD DR ABLE SEPTIC PERMIrN02100135 ,,KA0EyfiDREXLER 520 REED ST . APPLICATpps�TTY-2002 ZONE: (408) 377-9990 SANITARY NO. CONTROL NO. ARCHnTCrrENGINEHR: BUILDING PERMIT INFO BLDG ELECT PLUMB MECII O , LICENSED COMRACTOR'S DECLARATION re 1 hereby affirm that 1 am licensed under provisions ns of Chapter 9(commencing Job Description <i wim Seetion]1XXgof Division lar me livloessand PmfesionsCde.andmylicenselx CLEAN OUT in lull force and effect. FI N A L F T1 =�M��_ License Class LIc.N Dale Contractor ARCI IITIiCPS DECLARATION s' O g sSy rc a 1 undomm til my plans shall be used as public records NOV O O 2002 L OyU SLL0 LicknvJ Ynrlcasinnal [y'Yai OWNEmCXCMPERmtheCaATIONdat BUILDING $100 I bonny ailuro that 1 I ausint from the Conous Co License Law for my i— o0 following reason.(section 703 IS.Business and Professions Code:Any city or county %2 ff which mutat a Permit m am amen.alter.improve,demolish,or repair any structure11 m prior its Issuance,also requires the applicant for such Mrmil to f le a signed nmermin ,i< that M In is licensed pursuanto the provisions of the Contractor's License,Law(Chapter 9 33l2Et61 bb@Ate© Valuation ,,II-—o (enmmenci ag with Section 7000)of Division 3of the Business and Professions Code)or y 2 that he is cxcmpl thcmfrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjccmthe applicant toacivil Penalty of PNN Occupancy Type not more dean five hundred dollars(SAIB). 202 - UNDERFLOOR P UMBING ❑I,ac nwnenR,he PmpenY•or my employees with wages ac,heir sole mmpensadon. will dome work,kind the structure is not intended or offered for sale(Sec.%Imo,Business and Professions Code:TIN Contractors License law dors not apply to an owner of 3 02 - TUB & q (.LIOns property who builds or improves thereon,and who does such work himself or through his own employees.provided that such improvements am not intended oroRemd ler sale.If. 502 — FINAL PLUMBING ENERGY however.me building or improvement is sold within one year of completion,Oc owner- 506 — GAS TEST builder will have the burden of pmving that he did not build or improve for purpose of .role. 507 - FINAL PLUMBING caner of the prnpeoy.am exclusively contracting with licensed em oraaurs In nsmcl c pmje ]Baa.B d Professions Cbcii The Contractors Li- nu tat f n aPP1Y t n ow crtY who builds or improves the......d c oto I. '�iI ch pmjer vim r(s)licensed pursuanuo B¢Conifactori nee ❑ pr caw I 'r Sec. .B&PCr this / WORT. OPENSATIO RAILo 02 I hereby of ion under Penalty of perjury one ofallowing declarations: I have and will maintain a Ceiificate of Corasenuo self- Work", as Provided Tor by Section 3%1X1 of,he tabor Code, it the penormance of But work for which this Permit is issued. ❑1 have and will maintain Worker's Compensation Insurance.as Inquired by Section 3701 of the labor Code,for the performance of IM work for which this permit is issued. My Worker's Compensmion Insumnee canner and Policy number am: Carrier: Policy No.: CERTTIFICA'I E OF EXEMITION PROM WORKERS' COMPENSATION INSURANCE (Thi need mol W completed iftM permit is hnnno hundred dollars(S lml) r less) ` 1 coolly Ihal the f the �:it t i' thirycr� issued.I shall nal employ any Pe nn ins vas r opt I N' is CompcMaion laws of Cali lin Dute— Applies I NOTIC APPLIC .II,arta making Ccnifical n ,y"u should nccnm u'mO In the Worker's Compensation provisions of Chex yuu as, OO forthwith comply with such provisions or this permit shall he decree voted. z CONSTRUCTION LENDING AGENCY (-y 1 I hereby affirm that mere is a construction lending agency lot the Performance of y' 7 the work for which this Permit is Ismed(Sce.3IyO.Co.C.) W C) Lcndcr' Nam a. a z 1 odes Address V I middy Nat I have read,M1ix application and sole that me above information is W — correct.I agree to comply with all city and county nNinanees and stmt laws relating to CU nuildi stroction.and hereby sum"rim representatives of thus city to enter umthe have can, it,, for ineites'on purp,ses. WO t too dcmmfy keep ha a lets the City of Cupertino against „Foy N liabditi chid v cons cap rm l yinanywayaccmoagainslmid City aate. U z ^Proove act truth 1 thho OMPLY WITH ALL NON-PO NT Issued by:s4taA Date V SO RCE 'GUL S. !�/ ,9r.-roofs Signamrc of APphc,mVComm,r I)do HAZARDOUS MATERIALS D OSURE Type of Roof Will the applicant or future holding receptionist handle haraNnus material as defined by @k CuPcnloo Municipal Codc.Chapter 9.12 and the Hcal,h and Safety crach k.See "n zss32(a)% All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will thea licant or I mrc buildin occupant usec tri cm ordkviccs which If a roof is installed without first obtaining an inspection, I agree to remove PP gby the q it emit nar.allous air contaminants as dclincd by me Ony Arca Air Quality Management all new materials for inspection. Yes aemu c va n ma I. uitecn,s mbr Chaplcrfi93 ofthc Califon 'afkel S dty ',acc,. -15. d 3d.l understand mal Blue building to mllC n, ho nu a dM it it it, the .Pa.of req -meats tee be etP ran, am mcaeat Parry. nitalureofApplicant Date All roof coverings to be Class "B" or better nor nr aw vcJ age m