02100115CI'T'Y OF CUPERTINO
$ :-.
BUILDING DIVISION PERMIT
CO,NTRACTOR�INFORMATION:--
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BWL1: 1 -BEL AIRE CT
PERMI"rte®2100115
0WN1-B1SM WALLACE M AND LINDA A
T
APPLICATTPOSY81D5r'%7 2002
//
ONE:
SANITARY NO. CONTROL NO,
ARCHOT:CT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECIf
0 0 0 0
j LICENSED NTRS DFC
I alarmtI lam licensed
i d under provisions (if Chapter (commencing
Jb Description
CHIMNEY
with SttLiin 7000) of Dihtin3nf the Business and PnTfcesinns Cnticand imy license i
REBUIL'i
in tell and cl
a Cha
hiccnw Civic Lich
I Da%{Z7�Cnmmcln
i A Ellb CTS DEp�ATION
1 unJcrvanJ my plans shall he used as pupNi ranrJs
( L¢tnuJ Pndcssianal
j OWNER-BUILDER DECLARATION
1 bract, affirm Thar 1 am cscmpL from thc Conuacmr's Liccnu Law fnr thc
NI V p.),
NSI/
i following Troon. (Section 711315. Business and Professions Code: Any city or county
L AU6�
which requires a permit to omni alter. impanel, demolish, or repair any struemre
priono its issuance, also requires the applicant for such permiuu file a signed statement
that he is licenscJ pursuant the provisions of the Contractors License Law (Chapter 9
$g 6Bt.9�3@AI@0 A4 Dation
� �'
(commencing with Section Vast) of Division 3 of the Business and Professions Caddie) tit
N)i
. Nat he is eumpi therefrom and the basis for one alleged eaempLion. Any violation of
Section 7871.5 by any applicant for a permit subjects the applicant to a civil penally of
not more than revs, hundred delta. ($508).
'uAPNNkiWMPJ AiiUN Occupancy Type
312 - CHIMNEY REBA & STRAPS
❑ Las the pmprny,o my employees with wages astheir cmmponsinen,
a wore(
will do IM work, and the is nor, offlod fi (Sec. Business
he Cmil
and The ,kensded Law do
License Law Jas not apply to an
apply to an owner of
equtre nspectlons
propertyldsoCodr nencorcon.
who buildswho or himselfor his
car whobuildsored
adoes m not edthrough
own
own provided thatsuchimpmvem
that such intended for salt.
wtharcnot ea, oftlmtureen,
yer.m tui
, Nc building improvement is sold within one year of completion, the owner-
ur
builder have the harden of proving Thal he did not buil) Lir improve for pugmu of
ms, of
sale)will
salt.).
I. as owner of the property, am exclusively emmoseting with licensed contractors an
construct the project (Sec, 7D44, Business and Professions Call 'Dia Contractor's Lh
close law Jas not apply to an owner of property who Wilds or improves theuon, and
who concocts fm such projecu with a conuacror(s) licrnud pursuant to dm Contractors
L' ss, law.
I am tacmp, under Sec. B & P C for thi ..a ge
OwC Dam B D
WORKER'SCOMPENSATION ECLA
I hereby alarm under penalty of perjury one of lie fnihav ng larations:
I have and will maintain a Cenilicam of Conant m calf-insme for Worker's Compnm
sato., . provided for by Section 3700 of the IaWr Code, for the performance of Lha
work for which Nis permit is issued.
I have and will maintain Worker's Compensation Insurance, as required by Section
3](NI of Ne Labor Code, fnr the performance of Ire work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number arc:
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COM PENSATION INSURANCE
Oris section neon not he Completed if the permit is fortune hundred dollars (S I IX))
nr 10"
1 certify that in the Performance of the work fo yyrh ch this permit is issued. I shall not
mpiny anY,cantor apy new try yh �fg�hj Ltu thc Wmkcrs'Cnmpcnsatinn
lowly( alifo D, iiT //��CC
App1C 47-5
NOfIC 1P LCA : IL a Ica maks g s C ro0 c of Eacmptinn, you shoal]
Wrote sob else the Worker's Compensation previsions of the Labor Code, you must
forthwith comply with such Provisions or this permit shall M deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby mlirm Nat there is a eonsuuednn lending agency lilt the performance of
the work for which this pormiI is issued (Sec. 3697. Civ. C.7
Lender's Name
Leader's Address
1 canoe Nal 1 have read This and stem that Lhe above relating is
�s
yapplication
bonding 1 agree with all city and county nNiwnas and stmt laws r
laws
elcomply
representatives nfthls chi Itu enter upon con
abvingentioned ion,only hereby au upon t e
above (We). cJ to orlysail for emnify an purposes.
p
against
(Ws,) ogres w cast, indemnify and keep harmless the Circ of Cupcnst
liabilities, judgments, costa and expenses whirr may in any way accrue against vin City
a
in consequence of the granting of this prams L.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POI
Issued by:
SOURCE EGUI, 10
Date
Re-roofs
Si Nature of Applicant—t seam - a¢
IIA2ZDOUS MATERL DISCLOSURE
Type of Roof
Will the .,Pill..' or (more building occupant time or handle ha outims rameni l
a defined by that Cumni nn Municipal Code, Chapter 9.12, and the Ilcalth and Safety
Cao. Section 25532(.)]
.0 Yes
All roofs shall be inspected prior to any roofing
fing material being installed.
Will the applicant or future building Occupant tune equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
mit baeaNaus air contaminants am defined by the Bay Arca Air Quality Management
District?
all new materials for inspection.
❑ Yes lo
1 have neol the ha/mOms materials requiremer sunderChapterfi95ofthcCaliliu-
niaii-IO&SulrIYCvd1,Sahnns25N15,25533and25534.1undcr., dNmil thc htomng
Jas nor currently have a Tenant. Nat it is my respune hil sty to not,I thc acup.m of thc
rcyu' 'm e, w ieh amst W me noel is lc m. nifcam f cy.
Signature of Applicant
�`
Date
All roof coverings to be Class "B" or better
n r an0mi,ed.gent „e