02030208 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORTNFORMATION:
BUILDING ADDRESS: PERMIT NO.
1107 KENTWOOD AV CUPERTINO PLUMBING 02030208
OWNER'S NAME: APPLICATION SUB DATE
BARBARA MORGAN 10297 S DE ANZA BLV 03/27/2002
'HONE: SANITARY NO. CONTROL NO.
(408) 253-0618
WO O O ARCHITEC iENGINEER: BUILDING PERMIT INFO
g so- - BLDG ELECT PLUMB MECH
<z� L> fJ I= L'L7
ao<6
zLICENSED CONTRACTOR'S DECLARATION
yZ lherebyaRrmthat lamlicensed under provisions ofChapter 9(commencing Job Description
�_Cu with Section 7000)of Division 3 ofrhe Busineavtnd Professions Code.and my license WATER HEATER mag
;,H ix in ran mrc�gna effeL Z� e�U S ®��Prbdr
re0 u License Clasyt. 3 Lica ya
i 3 y,yoOL
ARCHITECTS DELL'S F.CL TI N
O I understood my plans shall be used as public reroNx �� O (k
r D
i z p O Licensed Professional
°' OWNER-exempt into
die RATION
c ]�
usi�w 1 hereby affirm that 1 em exempt from Nc Convenor's Lierrue Low for Nc LOA
F?< fallowing roman.Permit
to
7031.5. t,Business and Professions Cale:Any tiny on county �r'p7v4=pb`b
yE p which requires a permit ro connrvct,alcor,improve,demolish,or repair any swarm
ny3m ..prlN lolls liWaa[C.81aa RQ the ppllLant for auto p[r11Y11 (I Bxlgnetl alalelll<nl _ _. _.. _ _ __
(coWnt sanig with
pumuanrta the pro! lion!JU Conwcrnes andN Lesions Code) C, 4 3 Valuation
1� ft U17 :t7 tt �r _..
.1that a Is exini,Sectunniii'mafD iasis a to Business jeradipgq.An vi Code) { �� l 1•. j -- ,y 'i.,,.l tilt- •
or Natio Is exempt Ihcrt(mm and the aper Tor the alleged nernpnt to Any l Amnon-of Section 7031.5 by any applicant for a permit subjects the applicant m e civil penally- `
I ofnot:mam than rite hundred dollars(Sf00). 50,APNN '2ftL PLUMBI G ENERG10ecupancy Type
01,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 far sale(Sea 7044, - - -
Businan'mid'Professions Code:The Comraclor's License Law does not apply to an 507 - FINAL P$ $lfapeetioils 1 ,.
owner of property Who builds or improves thereon.and who area such work himself
or Nmu h his own employees.provided,lm such improvements arc or intended or r
offe or Meat.howcvcr,the building or ifnprovcmem iv sold within one yeei of -- - " ---'-'- --""'"-"--"""--"'-----'"—_..__-_---..__- ..-..,..-----.,._
'improve for the ownep sal.).will have the huNen of proving Nvt he did not build or
improve for P.W.of soled.
L as owner po the property,7 am exclusively convecting with licensed commemm to
�F Lonswn Ne project(See.]OM1,Business and property
b Cale:)The Cmmm�ort sL v „
License co docs not apply no an owner ih property who builds s improves Ihefeon, '
r
_.and who contracts for.such.projens;wiiWu convecrods).licensed.pumuem.ro.Ne. _...'..._ _._.. .. _ _ ........ ....... ... ..:..
Col am ex's pt under
Law..
_ ❑1 amps under Stt. "'I ,B&PCfor this reason
Owner Data
WORKER'S COMPENSATION DECLARATION ,
I hereby affirm under penalty of perjury one ofi the following declarations:
�E ❑ 1 have and will mnintuirt.Ccnificma of C.treat to eel0insum for Worker's
- Compensation, as provided for by Section 3700 of the Labor Code, for the
perfomibnee of the work for which Nis permit is issued.
❑1 have arta will moimnin Worker's Compcns.um insurance,as'required by Section
37W of the Labor Cade.for the pifformance- of the work for which this pens t
issued.My Workers C mpenseuon 1luno < e end Policy numbe arc;;
�r� r^tFrJ.yoranL .7/�/UA/�TOG��7G
cone , ',fti s 1 T•,tt
!'CHRTIPICATION OF HXHMPTNS FROM WORKERSI ,I,,... + + (1 v..... . •,_ k'. .L.4'N L_ 9,
,,:- COMPENSATION INSURANCE.. _.,_,-,_.,._.____`._ __ _-- .
_. .
' (fhra section need nm be tom lend 1f the 1`,t ,i-
(f 100)or less.) p pemw rs for one hundred dollars
I
1
certify that in due rosin.in cry.c Ia the war for which rbi perm t s W1
shell not employ any f CaNf m any manner so m m become utiles at NE Workers'
Zli6incetian Lows of Cali I :1 Dare. r
_Apel erns OA - .._ileo. . .._
1 NOTICETOAPo the Wi'1.19 after making IlirCmonsof ch L&Wr odYou should •,v '.e1
0 liihwiubjeciy it such pr Compensatios Permit shall rheearner Coaked. trust
fonhwiN'comply with such provisions err this parotin shall be domed rtvakea.
r,-t.� is :"•.'.: "'r"•CONSTRUCDON LENDING AGENCY "'""' --� :if :: •(r
a.� ""I hereby 7Rm1 Net there is a ionniunion lending agency for Ne pedormena ..-. �( - „ r . ..
D"z
IFhder's Andress'�-�-"� _...__._._.. _..-. _ _...-__ .
. V-� - 1 certify rAoi 1 neve read this aPplicelion'end nem than rhe above informaiion is '
: kecF �ortdct.I agree ro comply,wiN all city and wumy ordinanLa and sum lever mining
"U mbuilding conswerion;and hereby amhodu rtprtsenutives of Nis city mcnter upon
,„:[� Ne above-memioned pmperry for inspenian Puryoses.,,, -
�Ry.� iks IWe)agree m save'iMe ify end keep harmless rhe Cily of Cdpenino ejainn
U V] liabilities,judgmmr,c a s which may in any way ecemc egeinn said
I (,L:'Z CirY in co cqu ce 1 min This pemdt. "" ' " ' '
..... ND A WILL CO WtrH'ALL'NON: NT's
.i Issued by: i Dat 77
8 pp a Cantron •..'.'. . '..-.... rte' Re-roofs
H i ALS DISCLOSURE " "
T'P
N Ne a Cupert`r(court g occupant Sole or handle Heal is con Safety a of Roof.. .. _..: „. ..., .._._..,, .. r. -. --.�sc: ..�-- ^-r
: as do red ibyim the Cupertino Municipal Cod Chapter 9.12.., the Health end Sa(ry -' -- "
Cola Seenonit,75f72 )leen + u7 I' -` ISL' .1T
0Ye (, ...
All roofs shall be inspecte-d pnoc to any,roofing material being installed.
Will the applicant or future building oc p nt use equipment or devices which If a roof is installed-without first obtaining an inspection,7'agiee'.to}emove
em9 herardo nYconipminamsmdefincd by NeB yArcu'Ati Quant
y Menegemem
OSmcn all new materials for ins ectlon A licant understands and will comply with
ore: _ N y P PP.. P X, .
u,n t .95 o : 8 non-pdtnfsource regulanons a.,
1 have read Safe,
e,xCode iicaw s rtgmremenn'uitder Chapter 6.95 of the
Colic Wilin do,Sato Code' ecia cluoifOfat itis and 3ff3ibil,. crsund Nat
'ifi6ehuildf doe oiL ntl a enant,that tlrmy rciponslhJn,no notify the-
me6p ' issue e f e Ce fest of
Ocau en[c r (serer sr. ..,,
< „ nem t pr r.a 7 G Signature of Applicant Date
name
d a " pm All roof coverings to be Class "Bit or better "
OFFI