02090173 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19991 LA MAR DR MARIANNE & MINORU TOGAMI 020901173
TION"rOkYaNE & MINORU TOGAMI APPLICA09�GA/2002
j PHONE: SANITARYNO. CONTROL NO.
C�u 0 o ARCHIl-ECTYENGINEER: BUILDING PERMIT INFO
E u BLDG ELECT PLUMB MECH
t;< u u u v
LICENSED CONTRACTOR'S DECLARATION
oz=O 1 hereby alErm that I am licensed under provisions of chapler9 lcommewing, Job Description
F:Fw i Saari..7")af Division 3 of the Busamanand Pro ssions Code.and my ties. SEWER CLEAN OUT
<y y� iv' .Toed R — --
dleo i U License
Date ARCHITECTS D Irc`LARA ION
}S 1 undersand my glens.WII be used a public rtroNs
K:p O Licensed Professional
K oOWNER-BUILDER DECLARATION
As_toI hereby affirm that 1 an exempt from the Conuumr's License Law for Ne
K< following reason.(Section 7031.5.Business and Professions Cade:Any city or county $500
M x❑ which requites a permit to conswct,alter,improve,demolish,or repair any structure
3
that hytslernled pun to the ptovi6ions of the Contmctols License Law(Chapter 9 '3693 F4CF 4o;-boa- a, (l'3 Valuation
(c men' g with Saffron 7000) f Divisma 3 of the Business and Profession.Code) (;��by l y , l` :s a n i 1x1
or that he Is exempt therefrom and the basis for the alleged eaempdon.Any vid.bon -
--of Section 70115 by any Applicant for o permit subjects the Applicant to A civil penalty
tof not mom than five hundred dollars SSW). 106AP-NI90ftR & WATER "'•'`1'1 '', Occupancy Type
°L as awact of the progeny,or my employees with wABes as their sole compensation, 202 — UNDERFLOOR PL BING _
-will doorA work,and the structure I6 not intendedvr anered'ror sale'(sea:]00.1,-- - 3 01 - ROUGH P I$I 814aspections'l-' 'o.ri P.
'Buainess'.nd'Peofessions Code:The C.lualme,License Law does not Apply to nn
owner of property Who Wilds or improves thereon,and who does such work himself 302 - TUB & OR SHOWER
or through his own employees.provided that such improvoments am not intended or _
offered or a I e building p vee t -sold w Ihm oneyear of '-502"---'
completion,the owner hu Ider will have the burden of proving that he did not build or
improve for pAryom of ante). 506 - GAS TEST '
FINAL- PLUMBING _. .
°1 as of the p pony m exclusively contracting with licensed contractors to ,
construct the project(Sec 7(44 Business and Professions Cade.)The Contractor a f,.,,-
License law does not apply to an owner of property who builds or improves thereon,
._and.,whq contracts.for such proleca,w Ih.a coati-Achor(s).licensed p uant coth< LED
Contrucro s License L g?'�¶pp,,� nn t�
°l am Arnold o' er Sec " r 1 "' Bth PCf Ihn moron Li'�9'CH/?"��1�1v4
O .\ENSATIONOCC OATIOD� ot,T 012002 - - - -
�' I fallen anger It f .6 tie of to how,declarmiom: -
\_ ,gena ya,perl rY.o. 6
}a, ° I kart ' 'Pro tided f Cinific6le of Canseni to selGinsure far Worker'. BUILDING L®Lill^
Compcm.1 n, es Provided for Sermon 3700-of the Labor Cade.'for the 6i'Y.d Ih7�l
peifumourcebf the'work for which this permit is issued.
°1 haaa And will m5 tiWoke s Csimpensaao 1 urdnce Ai requited by Secaon
370(1 of the Lulmr Cad for the kilf6dnAn of the work for which this pentdt'i.
_ issd My Workers Compensedan Insurtnc<cam ltd Pol cy number rte
ei f.t_ 1 a;6'? t 'r!;
iCERTIPICATIGNOPE%EM ONFROM,WORKERS�: ��� yL+ie ,. 'IJ il.l lr.} yr sx: I
COMPENSATION INSURANCE
__s•v--e..::...:.::.........•,..:ems___...__;,_.__.
"(fTis'iectmrs nee]nnt he compl'eAifthe permit is for one hundred dollars^
r/(5100)ar less.)� l �
A 1 art fyyrihn si th performance k r "his is e4J
"hall not amploy Any rams pA an
r
Coto h, tis wsaf Celi A
.-A plicant
m subject IhlWorke! cnnstmt constructionlending. p y ..._.. - .. '.. _....
_..
of the work t, wIf tht t hold' •` `: I
O Q f6 h Ithc 1 Ih tun th
t
A 0 ID St i rl fel Ilon o
Z) I pan6al p n drCod you
p Y perm i hull deemed revoked,
o> TRUCTION LENDING AGENCY
I M1 rcby u0' nherc 'Y ncy f for Perconsole W C pc ud(Sec J(N7C CI
�sLender's Name ' � ' .. .—_....__.- _._._.-. _..__ .._ .._ .............------
z
_Z Lcnder6
old
e6 t dsil-, h
V Q s
.� .- I ndy lir t I have J Ihn ity Anduon A d 6I t sacce d a mf form o s
W [r to Ail I agree Io inply wnh all c city And c my,Nin va and 1 ai ws rclabng
t, gob Id - nntione on I Jh for
nmreposenmuves oft6is sly to enmf pan,
the uhwcr)a erto property for inepemion pugxtsn.,h
��yy l3t (s,jus! eciasxvc,mJntnnifyandk2ephaan.y.m.n C iyaCuperi,j Aw aid fi r Vl liabilities,judgments,costq'and in of[hi which may,in Any way Aceme ngainst acid
V'z Cily n consequence of it f 'moi g D I L CO
AND WILL COMPLVK'ITH ALL NON-POIYI'''
on I:A � .,' `, r Issued bye Date 06d
y.
Si arc of Appli'an t .s ,. 1 iDate i I�, Re-roofs
RDOUSMATERIALS DISCLOSURE
WII the o an m fititufe b lthng occ pant st.m haMk hAnW mea n] Type of Rooftt
ssd Oned by t penin Municipal Cade Chapter 9 17 and the Health and Safety' ! y I { _1 Y Fart v a .�1 g ,_tib i��
Cbde Sato 5321a) 1 P s y11 (( t t� i
❑Y .t s F t II �'J KtpP 'Sall v_ s ` Ygl. .vl.
/y\n All roofs shall be inspected prior to.any roofing.matenal being-installed.
;~ Will the'applicant or future Wit occupant use equipment or devices hick] r" ---
If.roof is installed without first obtaining a riris ectlon;I''a yee'to`ramove
m t hazardous i omm�i mots aa defined ny da Bay Ara An Quality Management. g P �i
Drspmt - _ '_ all new materials.for inspection Applicant understands and will comply with _
°Y r -
all noli- Dint source re Mations
t v ♦.: . �� `� u.r P
1 hase.rcad the hainrdom mnerinB mqummmenis under Cher pear 6.95,of the
California Health'&Safety Cade,Sections 25505,13533 and 25515.I.understaM Ihedl
y if the Wilding does not currently have amnant,that it ii my ieiponsibiliry td notify the
'occupant of the,requirements which must Wme nt.issuane of a Cem f.
pct`Y pre Signature of Applicant - -. _ g__ _ _ .-. Date _
' O
a th Tae .ge D. All roof coverings to be Class B"or better
_ 1.a
:s . .OFFICE-"
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