01100130 CITY"OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS'. PERMIT NO.
10293 S TANTAU AVE. PRECISION PIPELINE 01100130
OWNER'S NAME: APPLICATION SUR DATE
ddkl ANDREW NAITO 5294 RAFTON DR 10/24/2001
PHONE: (408) 723-1411 SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INF
mF BLDG ELECT )QUUr MF,CH
I L=7
LICENSED CONTRACTOR'S DECLARATION
S�' I mb affirm that I am licensed under ons of Chet 9lcommew,a lob DesertIfOn
i-C y provisions Chapter g
wihS ton]U(Ip)ofDiviOw3ofNeBusroessandPmfessionsCodeandmyliccnu SEWER MAIN REPLACEMENT.
,xE ;si 1111 home ande"V36 y
If
...W< e s Class Lic.UECLARATION
S 0 O U .tan /O- 2 -Z 00 C mmcmr_ LrNSm�i
ARCHITECT'S DECLARA ON /
u do t d y hall W used as public recordsof
O
Kso
.Q p c sc ssto al
-°•n OWNER-BUILDER DECLARATION
-y I hereby affirm that I ant exempt from the Conmetim's Lice rim Law for the 9�
G following mumm.(Section 7031.5.Business and Profusions Code:Any cey or coumy / $4000
000
which requires a pcmtit m conswa,alter improve,demolish,or repair any swnum
,t E pdonoin,ve...ce,also inquires Neapplicam for such permi m fkasigned mammant ---- ,�r-- - - --- -- -- - - --- - ------ --- -------
a.3- Nat h4ie,licmuJpursubnndth6 provisom or the Contractor's License Law(Chapter 9 I,3 M�f]YG4..Calp Acp t - - Valuation - -
�•(It MJ1 YYT�VV'•VV r'l,7tTa,.- r 1 Valuation
or that be ii cwiu,th SemisfrooBBnd the bsisn.atthe BuFnes�andioi.A.,vi Code) Y.�; y.- 1. 'k. 1.5 If.
or that he is azempt any applicant
and the bass for the a1&ged demant to Any violation
of Section 783 LS by any apPlicamfor apcmnit subjects the applicant mecivil Penalty
:of not mom than rive hundred dollars($5w) 10 6APPs1 �Lt*tR & WATER i, "" ' Occupancy Type
❑I,as owner of the property,w my employees with wages as their sole compensation, N
will do the work,and the stmrtum is not intended or offered for sale(See.70,14, 3 O 1 - ROUGH PLRFApIHfEN&spectibns
•Business'and'I'micisions Code:The Commcmrs License Law does not apply to an t
Owner r of property Who Wilda or improves rhercon,and who does such work himself 302 - TUB & OR SHOWER_ , _
or through his own employees,provided that such improvements are not one yew or
completion,
for sale.If,however,the building or improvement a sold within and year of - - - - -
aathpleran,Neawnenhu;merwinhave NaWmenafnrovingthat nedid natbaddar 502 - FINAL;- ENERGY
ian,Omlbr,w,,reofsala.). 506 - GAS TEST i
--- --- - . . - -. 507 ---- FINAL FINAL PLUMBING--` _
El 1 as owner ohne pn,peny,am e.cwsively contracting with licensed contractors to .
construct the project(Sec.7044,Business and Professions CWt:)The Contractor's rl ,
jLicense law does not apply m a l owner of pm,.,who builds or improves the., -
'r and who contracts for.such projecit.w'ith a com emods)licensed pursuant.to the
Contractor's License Low.
i4 I❑I am exempt under See.`I - B&P C for this reason
own - Data .. '
WORKER'S COMPENSATION DECLARATION
I hereby M.under p a by of I.erjury one of the fallowing dmlara nds-
f�have and will maintain n CertifcuIn of Con.ient to self-mum,for Worker'.a
Compensation,as provided for by Section 37W of the Labor' Cri far the
_ performance of the work for which his permit is issued.
❑1 have an ill rawati rim.kerk Compensation Insurance,as nobirtd by Section
3700 of t labor Code,for,the performance of the work for which Nts it is
.: issued- yW rkeT'-rC - rvinuntlnsut mdP It numMcpra+ ', .-
. F<
CCRTIPICATION OF,E%HMP1'ION FROM M'ORKI:RS"- . > i . p t,_ t. a 1.3v a.4 1,
COMPSATION INSURANCE
- EN '" "' j `
OF _,.._
•-'4 '(r isuctiminccd .not be completed if the permit is for one hundred dollars isIV fr-'Ia�'a' . .'.:up a.. :VI ,
151887 less)
.1 iwhich
1'en fyt . ;nth pbf of the Itfol whiM1th p.o the ,sued, s I ,•�
shell not emplo ry pe o m ony u as w becom subject m the Worked
C' pcnsatio all om;o, ata
ws ...
pPlicani -
OTICET Phe ANTWeakest
after Compensation
this Certificate m ofExemption,
,youshould '
comes 'duothei latch rCompensationprovisionsl the Labor Code,you Inuit
0 forthwith mply with such provixinns or Nis pcmtit shell M damcd invoked. •
�.✓" s
` l;CONSTRUCTIONLENDING'AGENCY i
oiler's hcrady Nude farm that therxis a constriction lending agency for the performance
h this aermi CJ,
W-Q of the work for which this i is issue)lsec.)097:Civ. a
CW de Ad
Undmss"
.7Z .. . . . .i• .. ;q'
I unify that l have mad this application and state that the dove Information is
correct.I agree to comply with all city and county,ordinances and state laws relating j
0.,U to building construction.and herebyu le
who ofthis city to enter upon
y ed the above-mrntioned property far Inspection purposes.
(W gmot.love,'rod
and keep harmless'the City U CLpenin'o'biainst
habildi ,judgments,costs and espenses which may ,in any way acerae against said
V;
/I:
canaequc of rhe gmming of the.' Imlf.,"
CANT ER$TkNDS AND COMPLY WITHALL NON/ OI E RE "' ''ti' , d , Issued by: Daterc_o ashe "whouctor ""•" ""' ,Dat Re-roofs
HAZARDOUS MATERIALS DISCLOSURE - -
' wiu`m apyli2 t alt eb ildin6uccuP sna arh el havicousnot 'al ...Type of Roofas effluent by the Cupertino Municipal Code Chapter 9.12.and the Health and Safety
t 2
Code $ uon 255320 i. 1F ( ♦ r 1 f r'4r r r 4Y )�,1 'v:'Z:• he4 `x,
❑Yea .•'t ';s .._,All roofs shall Ne inspected,prior to any roofing.material.being.installed. . _
-.NII the applicant orfnum Wilding occupant use equipment or devices which If a roof is insialled without first obtaining an inspection;I agree to remove
hand...air emorminams m defined by the Boy Arta Air Quality Management
�raam2 all new materials for inspection. Applicant understands and will comply with
°Y ONO. "all non-poifi[source regulations:•( I,
'I ha
clod the ha dous mains Is requ mmcnls under Chapter 6.95 of the
Celf' hh&Salary f yC db$ tion 25505 255]1 end 255]4:I undersmnd Nm _
if N Id g dyes note tly h e t I that t'.my rcspons b l ty to no fy the
a pant f Ne equircm-u Much- t W Tel pnono Issuen<e of Car, cam of
` P `Y a Signature of Applicant Date
'- - inot l Z� All roof coverings to be Class "B" or better
n<r harixe Deem;5•'. ate
OFFICE . .._._. _- . .