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02110029 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BU1L2lJ_C591=S,R0SARIO AV TOM ' S PLUMBING PERMITNCO2110029 owWAYATO RICHARD M AND MERLE J 12246 SAPATOGA SUNNYVAL ?PLICATI1NIS RAJF2002 Akk orZONE. (408) 867-6010 SANITARY NO. // CONTROL NO. ARCHITECT/ENGINEER. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u�ipp LICENSED CONTRACTOR'S DECLARATION ado Ihereby affirm that l am licensed under provisions of Chapter 9(commencing WATER SERVICE Job Description w His 1iun 7000)+4 Divi sin n3 of Jac ncss and Pmlcssiona Co�.and myhcemsclis in eronce Claandeff ta� 98 FINALED �Z Classes �Y/J Lic.N - Z p Date _s_ Cnnva'ro r i2�2 'CT CL I N 01 oa understand m'41acts anapbe y\ pnb mea°s JAN '1 6 2003 =,oisr n•ssi nal ( aP OWNER BUILDER DECLARATION z1 hereby alfrm that I am exempt from the Contractor's License Law for me WILDING ¢"104 0 i K 00 following reason.se,mon 7831 5,Business and Professions Code:Any city or county ><Q which requites a permit m construct,alter,improve,demolish,or repair any structure tu'✓r prtorm its omstee.also.,aimsthe applicant for seen pe.iuo file a ii,ordswwmenl �3a that hens licensed pursuant the provisions(if the Contacmrs License Law(Chapter 9 1y.�11H2f)ArM Valuation c�0 (communing with Section 70lk)of Division 3 ufthe Business and Professions Code)or W3$ fiat he is exempt therefmm tied dw basis for the alleged exemption.Any violation of Seclion 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of N-N Occupancy Type not more than eve hundred dollars(S501). 202 - UNDERFLOOR LUMBING I,as owner of the property.or my employees with wages as their sole compensation, will do the work.and Ne structure is not intended or offered for safe(Sec.70&1,Business — ggpp and Professions Code:The Contractor's License taw dues not apply to an owner of 3 O 2 — TUB 6, Wtlons property who builds or improves Jmmon,and who does sash work himself or through his ownemployees.provided donsach iropmvementsare nm intended oroRered formic.If. 502 — FINAL PLUMBING ENERGY however,the building or improvement is sold within one yearofcompletion,the owner- SO6 — GAS TEST builder will have me burden of proving that he did not Wild or improve for purpose of sale.). 507 - FINAL PLUMBING I,as owner of the property,am exclusively convening with licensed contractors m construct fie project(Sec.7044,Business and Professions Codey The Contractors Li- st law does not apply to an owner of propeny who Wilds or improves daemon,and who contmc¢for such projects with a convachomid licensed pursuant m Ne Contractor's License Law. ❑ I am exempt under See B&PC for this reason Owner Dale WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Workers ComKn savers,ss provided for by Section 3701 of the tabor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the laborCale.I theperformance o7 the work for which this pe man is Issued. My Workerr's C_ ppen�ation Insurance carrier and Policy number are: Cyfacr'�"" aLs /nqa�••. Folic�.��[,_N1.c�ott)-`I(/•�' yG CERTIFICA OF EXEMPTION FR WORKERS RKERS' COMPENSATION INSURANCE Me,sectum nerd not W completed If the Permit s for one hundred dollars($10) in ca".) I certify that in the performance of the work fnr which this permit is issued.I shall not employ any Person in any manner se,as to become subject to the WorkersCompensation Laws of California.Date Applicant NOTICE TO APPLICANT:II,after making this Certificate of Exemption,you.should become subject is the Worker's Compensation prior......of the Laher Code,you most QO forthwiih comply w.,h.archprovcsme,or,h,gmail shall Wdeemedmoked- z CONSTRUCTION LENDING AGENCY [r r I hereby affirm not there is a construction lending agency for the performance of t7 the work for which this permit is issued(Sec.3097,Civ C,) IS.t Q Lenders Name_ — U C LendAddress's Add Q V 1 certify Nat I have read this application and xmm thio the above mfortna(inn is /y---- IL P correct.I agree to comply with all city and county ordinances and state laws relating m 0U building construction.and hereby surname,representatives of mc,city Pon the shoe-mentioned pfoPeny fnr inspection purposes. (We).,me to save,indemnify and keep bumless the City of Cupertino.,area( rV) liabilities,judgmom,coo and expenses which may in any way acme against said City V U Z lin consequence of the granting of this permit. a+ APPLICANT UNDERSTANDS AND WILL COMPLY WITHAL ONPOINT Issued by: Date SOURCE REGULATIONS. / 9a..eo.L. M ��4 if�l•�'`- Re-roofs Si won Appicanvcommc(or f I Dana HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the appliraol or future hmWin,oce.pam,sore nr handle hanaNuus material as defined by IM Cu,,morm Municipal Code.Chapter 9,12,and the Health and Safely Cade,Section 25532(a) All roofs shall be inspected prior to an roofing material bei.. Installed. Hues tg,Nn P P � Y g g WWII thea applicant or home building ant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove pct s scup earn mr.o m,air cor arrinards as refined by he Bay Arca Air Quality Management all new materials for inspection. Di.unn'7 DYr, ophilr l have mad me hasaNnus mawnalsrcquiremenu under Chopmr695of theCelifte- ma Health&Smel,Calc,Scenes 25605.25533 and 25534.1 underswod ma(ilthe building does til curtently nave a tenant,that it is my responsibility to nomy the occupant of me rmmowvawhieh nod Wmet pnorp=ancrofecenmeam I larracy. Signature of Applicant Date --1��—(/��a I rt`'� All roof coverings to be Class "B" or better O ncr ora norvcJ�nt Date