02070127 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ';CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT
1031 NOVEMBER DR BOB GERE MASONRY N 62070127
"M1 'YELD WALTER JR AND DOROTIIY480 CROSSLEES DR APPLICAT61yf ff72002
Aaad
(408) 972-1285
PHONE: SANITARY NO.
LL CONTROL NO.
0 O O ARCHITECffENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
N i LICENSED CONTRACTOR'S DECLARATION
Ihereby arm,that Iamrcemedunder P kionsofChapter 9(commenclog REPLACE CHIMNEIOO
Ep Ej�INDATION
�y � 1
[i,h5o ]00 ' Jof the Business n,)QP fen se Ylicen0
s
:u '¢ License CtRf Lim.I T �Q
n 0 entre
i3 N
O� on cn,and my Plans shall be u�rca s public records UL
o o
Licensed Professional
o[ that I am exempt
m the Contractor's
��®���
1 hereby amen,nn 1 1. exempt from me Gnmmnoor :AnyLicense Law forme BU $6865
or z 0 fattening naso..(Section 7031.5.Business and Professions Cock:Any sally,or county
oo which rtquinsapcmtil to ronswn,aha,improved fammiitt or reWiganysurmem
e.30 - prior m its issuance,also requires the applicant
for such permino rile aligned vatement. F6
1Nai hash sed punuatl tomelimnIsms of the Can, s License Law(Chapter9
(commm ng th5ttliop"IOWJ IDvision3oftheBotiandPmfessoasCode) "�',r.`; 1:3j';I'-IS[Y13dr,�EBf y1 5?'1'. ?"•, • Valuation
or tire he is exempt thenfrvm and the basis for the alleged exemption.Any violation
-af Scnhoa 70315 by any applicant for vpemut subjms 0e vpplicam o a civil pmvlry
rof not mom than five hundred dollars(ssoo). 10 APN Nt�WNDAT ION Occupancy Type
0 1,as owner of the prorfamy.or my employees with wagcs as their sole compensation. 312 - CHIMNEY REBAR STRAPS
'will-do the work:-and the-sums i is not intended-or offered for sale(Sec.70141 _ FiNAL r, r _
Business`and Professions Coder:The Convenor's License Law does not apply o an I 1s
owner of property Who builds or improves themon,and who does such work himself
or through his own employe th ended that mpr improvement am not intendednyour or
-,ofieiM f sale.If,how the building r p m.sold within one year of - ` -"--- - -
i mnpl s th o her-W Id will hove the burd f proving that he did not Wild or
improve for puryose of sale.).
•• OI as owner of the Pm _...-_._._. ... ._ _ . ...__..__ .... _..... .. _.
prey,.m Barth ivdy comrocting with licensed contrarian to
consumer,the project(Soc. 1.an amines and em who
Code:)The Contractor's ,
Litems law docs no,apply to an owner wish
Propcny who W lids se impmvm t to the "" '•"" '� "
.vnd.who.A l-sca s fl-aw.,h.projttm wim.e.wmrutot(s)licensed punuanl o the
Conlm exe License law„. _ 1" t
❑Lem exempt under Sec, •B APCfonhis rtason ��
Ovmer" • 'Dale .' .
";'�-, WORKER'S COMPENSATION DECLARATION
I herby affirm under penalty ofperjury orie of the following dtthrvuom:
A D I have and will maintain is Ccnh@ale of Consent to uhf-insure for Worker's '
Compensation, as-provided-for by Seniors 3700 of the labor Code, for the
- perfomarnce of the work for which this Permit is hssued.
❑I hast nd will'mvhnuir Wvikcrs C°mpioraiuminiurance,as nquiied by Smion
_ ]]00 of the Labor Code;for the perfomtance ofthe work for which this pc'mdi is
< ssoed May/vWo kites Co pe s�o�nglns�urance camerend rP�olicy bu 'e d_ _
' CERttFICATION OF FJ(E FROMWORKERS s � v � 1 �
------------ _ _. ....._. ..._. -.._
;I{snf obis uaiod need not be complete it the permit is for one hundred dollen
(SIW)or hess.)
'l o ti fYNt to performance of ane_ s10bcrk for wnm thisct to
ed l
Comnot employ,any person m any rmnner so as m bccbme bub)cn io me Workers
C.mpcmati.n laws of California.Date`
N came subject
OA 1.the mli Circa,kinum is CenNcale of Exemption, , .ashould t .l
0 became ' pm Int suchpiC ions rthis proms ons of the Labor Code,you must
QO forth tlh core I Msuchp provisions or lhsperms shall be deemed rtvokcd. ,
Z
•CONSTRUCnON LENDING AGENCY •• "'
I•' r " I h¢by efTrm that dmor Is a construction letidmg agency fo the perfomwntt
gi.W,• -Le
� of me k for butch th pc I"1 s sued(S'c T09]'C .CJ
dders Nime - :-. -. s _..ase _.. .
;D Z- Lenders Address, . 'r .... v
U-Q �•,!J,,1 certify that 1 have sed This epplicethon end sure"ionic about information is
liw-F.t comedo agree to en Id,,with.11 try and county ordinances vnd.nem laws relating
OAU to building mnsminion:and herttiy eumarize represemNves of this citytn emerupon
the abow-mentioned Properry for inspection putppus.., _ _
[s ow (We) to.0 indemnify and keep hviNessthe City of Clip'erihno-again.
Vi
liabilities,)dg errs,cot d eppc s s wh ch may n any way ccrue agetnst said
U Z City n cons nee of the grin"ng f this pe t ' t�
APPLICI SDE $T A� C011PLr 7TH LL O''Por.. " Issued b Date
BD y19;1174 � y
Si Appn.n✓C aor 1. 'v rt / , Re-roofs
as definN by,me eupemoo Mum al Carde,Chapter.9.12,and the HetlN end Safety
NAZ Oug MAt£RIAU DISCLOSURE
vml Ill t re i
elle applicanor fvmWWing occvpium Aon°r handlehnallorisrw-1 Type of Roof_..
Code,Seahim 25532(4) v f 1 ._ r` •'t a , (; .: ..v r ; -; i . .. -.
_All roofs,shall be inspected prior.to any,roofing material being installed..-_,
son Or applicanto t rc Wilding occupant.use equipment or devices whim If a roof is installed Without first obtaining an inspection, I agree to•reinove
emit h zardous 6,come is u defined by the Bey Area Ali Quality Mimi...
�
Dame, _ all new materials for inspection. Applicant understands and will comply,with 2 - ❑rer. „- ,, ,, , _ `allnon-point source regulations:, - .
r I�haw rtadihe ha our memnsls regonmenta mide”,Chapter 6.95 of the
Cilifomia Hc61095afe, Code.Scctiom 25505.25533 and 25534.-1 understand that
rd,e6uildin doesno)cunently heventena.,.,bar itis mym,p°nsrbili,,"o notify the
occupier mail.m in ls Leh most be mel p or m i tie c ( .nificete of
�p Signature of Applicant . , -- . . Date
Data Ail roof coverings to be Class "B"or better
n•. s vl i . . -OFFICE