02070133 CITY OF CUPERTINO - � ` .
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
818ING404RDEMPSTER AV HOT WATER INC PERMIT'62070133
D d'10BERT L AND FRANCES K IR2531 GRACELAND AVE APPLICAT"Snl)2J T�2002
PHONE: V / G
t (650) 298-8494 SANITARY NO, CONTROL NO.
D e Z ARCHITECDENGINEER:
L C BUILDING PERMIT WFO
u O_ BLDG ELECT PLUMB MECH
;S?2 LICENSED CONTRACTOR'S DECLARATION
_o Ihereby alBrmth.lamlicensed im&,provisions ofa,ipmr9lrommando, REPLACE WATER 1i�YfpDon
H�-u with Section]000) fDivision3ofthe Businewnnd Professions Cade.vita mylicensc
m ee< is in full tote and ef(2F� 7/
O u DiccnufAss ` Jlo Lic.tl
Date / Commctor /
(n ARCHITECT'S DECLARAT O ''qq
g 1 understand my plans shall be used as public records 7 v/
i e n O Licensed Professional
uec. OWNER-BUILDER DECLARATION
=' 1 hereby affirm that 1 am exempt from the Convector a License Law for the
< following reason.(Section 7031.5.Business and Professions Code:Any city or coumy $500
f F m which requires o permit m mmduct,alter•improve.demolish,or repair any structure
3- _Priono its issuance,also requires theyppPlicvm for such permit to file a signed statement
mSt hc.i{dlcensed paiabeni w dif pmsisioru of the Co..,.,License law(Chapter 9 _ AkW _
(commencing with Section 7")of Division S of the Business and Professions Code) i ]i'N
h- 1"+ ',`� Valuation
or that he is eiernpithcmfmmand the basis for the alleged exemption.
P C pion.Any violation
"of Section e than iv any hundred
o ll for 1 permit subjects the applicant to a civil pennlry
of Out more than five nanarea ann,rs(ssoo). _ ccupancy Type
-0 1,as owner of theproperly.or my employees with wages as their sole compensation, 506 — GAS TEST
will do the work:-and the structure'is not intended--ar'offered'for sale(Sec.VBu,"-
Busieess ori]Professions Code:The Contractor's License taw does not apply to an it ifspecti ons
owner of pmpeny Who builds or impr.'es thereon,and veno does such work himself
or through his own employees,provided that such improvements am not intended or
g or improvement is sold within one year of_.
comple for saki❑,howevv,the building ...
imprawaoar turrOse owner-Wilder will have the burden of that he did Wild or . ,.`t„`�•..•” t:.I',): :U
improve for purpose oLsele.), Provin6 I
_ _ Cmowar Of the P(Sec.7 am excBusiness and ntwctssiong ns CMc:) he Connects. '.:I
comtmct the Project(Sec.]040,Business and Professions Co]e:)The Connector's I, i'`. ,
and who
law]as hat apply .an owner of A cimuy who W lids se improves thereon,
s.
-Co vector's vectse a.wch.prdjece with.a.comrwtor(s)Ikcnscd-purwanr to the
c. Iamee pt under SecI f .fR ' 134
&P C for this -------
C - -----
. . sates f m rSmd1
-_ Owner, J .. .. Dale... .�, �.... ... - ...
WORKER'S COMPENSATION DECLARATION JUL 2��2
1 hereby afnnn un]er Pctuhy of perjury one of the following declarations:
F C 1 have and will ro iidein a�Cenificdm or Cons37W o to self-insure for Worker'sothe
BUILDING
sy_
Compensation, as provided for by Sttlion 3]00 of the Labor Coda for the
_ perfomunce of the work for which this permit is issued. ,
n will inoininin worker's Compensaiion Insurance,as uquiied by,Saetion
37Pihe LaborCode:for the performance of the work for which this perom is
slued My W k Y Compe "don Imurenm cams and Pol n onlierare
Cent,r a J - Nlicy No.
CER IFlCATI N.OF EXEMPTION OM ORKERS - . ;> 2 \ C.1'w.tom,`,�,z, „s>i M •t, .i J�.
IN SVRANCE' :"
e
($100)oless.)tdollars,
n' flic TWO need not be co if the permit is for one hundred
r - - '
1certify that in erc perf d f th '"fl,for which sub .. __..__._.__._.. __. ......
pe n¢issued,
Coninew employ Y Perwn y manner w ns t become subject to the Workers'
Contpcnsaison laws of Cebfamta.Doc '-
NOTICE TO APPLICANT If aft ak g n C si team of Labor Code
should -" - "-`-'--
tr
Z fHome subjectcomply
the WorkdrC ions Of
i Fro a neo Is,deemed
CMe.you must -
O forthwith omply esti s h provisions or ths Permit shall be deem d revoked
I
-,'. "'CONSTRUCTION LENDING AGENCY r' t
the byaffim@atth is
constwS ledng C) for the p.- -v-e \I,:
R MIS '309] -:. ...
0. ..t o!th work f6-which t 'ts su-„ .. ,.. :. LL•.
Q - Ledd s Ne a '_.: ,
Iantiers Address v c
It
0 1 i•
1 ttlime to c 1 have with this application and e.m tnces a above information g
fist f Ft then:.agree to cpmplynwith all city and county ordinances and nate laws elating
:.0 to Wilding canswciion.a eAc.,in,by..thi rcPresdmmivea of This city menmr upon
the salve-mentioned f r
Y'=W ,Property o insptttioppurposes,t
[r.0." f,j.. ee.sa.,,indemnify and keep hamdess the City of Cupertino against
U Z• livbil des 1]gmenA co t d penus,wh ch may my way u e Against said
U Z. City co sequc ce of Ne grenwg of this pertnn
APPLICANT tTDERSTANbSAND WILL rpO\dPLY WITH ALLNON POINTE- Issued by: J/
SOURCE REGULATIONS t
Date
- - Stgna.m of AppLc HAZARDOUS . ...",.:�.'..� .,>- -'• r - am "i,HAZARDOUS MATERIALS DISCLOSURE „ n1'e Re-roofs
'!,Will e6p5p3l2i(qr'toefuue buildingevanFs.re or handle
u .me
as defined 1, -in- uad Type Of Roof-,
CodeSemo Nddi a ,,
--• ---" "\<' - _----. - _-
OYW
- r - All roofs shall.be inspected.pnor to any roofing.material being,installed....__. .
Weil the ppl cent fmurc Wtld ng scup ay Area
Ai tp a vtges wore If a roof is installed without first obtaining an inspection,,hagree to'relriove
emth zartlous ter cont tmnat der cd by the Bey ARdAl Quality Men'gemem g p
Dtsma
�e CYesf r I N - - g]I nOn- OIDI sOUiCe 7C D1aC10n5., understands and COnlply W1tI1
a new materials for inspection, Applicant unders
1 h ve Tend then zsardods mert'els q tremcros tmdc Chapt '.695.6(the p g
y f sue c ! Ca/mycat est_ _ 1.
C I fo a H hti&Safety Code Sections 35503 25533 M 25530 1 dcemnd N
fdie buildingda .currently lar tears thn t yrcspo 'blty. sit cthe -�l
O� t of the rl is ht h most be ,,pro t pP i A [Q (i /y
-' y Signature of App-scant., Date Ow TO u orized C!
age nvl, p, +: Did All roof coverings to be Class aB.,or better
>._
- "-OFFICE... . — --. ... ... . . . _... ..