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CI'T'Y OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
Bull) OEsPEAR TREE LA
WATER HEATERS ONLY
PERMTrN®2100086
Gw,CkIshP+ATRICK ARLO E TRUSTEE
970 E. MAIN ST, SUITE 200
APPLICATIp'UYEIDUr 2002
oma:
415 566-2209
SANITARY NO.// CONTROL NO.
ARCUITEC rENGINBLR:
BUILDING PERMIT INFO
BLD(: ELECT PLUMB MFCII
LICENSED CONTRACTOR'S DECLARATION
I hereby al im mal l am a<onsm mdc,,rammanaf Chapte, 9(convictions
p
.I IA%C1S�I' )Uon
with Ssedon Jtl)(l) "Division 3 of the Business and Profession Cume. and my license is
REPLACE WATER
infull
FINALE®
,C%,,,andcffa'I.
Lkcne Class Lk.N
/ate C
Date— Comrwuv
ARCH ECrs DECLARATION
I undersand my plan mall he used as public records
OCT 17 2002
Liccnved P ..h ssional
OWNER -BUILDER DECLARATION
I herchy Motor that I am cxemPl Irnm the Contractors Liccnw Law for the
[[��
BUILDING $ 760
following reason. (Section 703 1.5, Businessand Pon esSiOn Calc Any city or county
which requires a permit in construct, alter, improve, demolish, or repair any structure
prior In it.s issuance, also requires the applicamn for such proof to life a signed statement
''me�qq,,
3SlI613JM"A1@fl
Valuation
that he is licensed pursuant to IM provisions aTthe COmmccons License law(Chapter9
(commencing with Sce ion 70cio of Division 3 of the Business and Professions Cade) or
Nat he is exempt therefrom and the basis for the alleged exemption. Any violation of
b UXPItN CCupancy Type
Section 703 t.5 by any applicant for a permit subjecu the applicant to a civil greatly of
not more man fn hundred dollars (SSB)L
506 - GAS TEST
1, or owner of the propert or my employee, with wages as their sole compensation,
will do Ne work. and the smucmWa
m is not intended or offered for We(Sm. 7, Bess usin
nS CCl10DS
and Pmfecinns Code: The Conlracmr', License law but not apply In an o of
C u1rC
q p
pmFeny who builds or improves thereon, and who does such work himself or through his
Irwin employees, provided four such improvements are not intended or offered for We. If.
however. be building nr improvement is sold within one year of completion, the owner -
builder will have the burden of proving Na he did not build or improve for purlxlse of
WL
of title properly, am exclusively contracting with licensed comms hr
i-
proJBId. Businry and Professions Codes:) The Contractor's Li-
m ther
,
ccne law does not apply la an owner of property who builds or improve, themon, and
cm.-does
who um racetbetsuch, wU with a contractor(,) licensed pursuant m the Contractor's
License law.
❑ I am exemp�l�^^��tler1�See. P C for this Mason
�DBaf&
W R ERC ON
1 hereby affirm under penally Of perjury One of the following declarations.
1 have and will mai main a Certificate of Consent self insmn for Worker'sCompcn-
,nation, as provided for by Section 3710 of the Labor Code, for the peformance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as required by Section
771X) of Be labor Cod, Tia the Krformance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Carries PMIcy NO.:
CERTIFICATE OF E%EM PTION FROM WORKERS'
COM PENSATION INSURANCE
(Thi,.ccrinn need nut be omprIld If the permitis onions, hundred dollars(51W)
or less.)
I eerily that in the rI nnanec of the work for which this permit is issued, I shall not
employ any Person in mmasr rocs pecan cWnrkcr' ComNn,alhm
Laws of Califnmia. U
Apo `
NOf TO APPLI I, oak g t rs ntlnae N L,empunn, you should
bcro subject m the workers Compensation P ovision of the IaMa Coda you must
forthwith comply with such provisions Or This Permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the Performance of
the work f or which this perm it is U,mcd (Sec. 31Y97, CO. C.)
Lender's Names
Under', Address
I ccnily thal 1 have read this application and sure that the above monmmian is
correct. 1 agree to comply with all City and county ordinances and sum laws reboring to
building CnnxrmcIon. and hereby awhorin representatives of Nis city u, cner urym the
above mentioned property Inr inspersion purposes.
(we) agree to save, indemnify and keep harmless the City of CuKr inn against
liabilities, judgments, covet and expenses which may in any way deems against Said City
V I
V
' consequence of the granting of this Permit.
6 SvyV/
APPLIC T UNDE A )SA D MP.Y WITH ALL NON.POINT
Issued by: Date l
SOUR 1: LATE
Re -roots
Type of Roof
o aIIAZARU SMATERIALSDISCLOSURE Dates
Will the applicant or future building rm'upam.Nnre or handle hacatduus macnal
as defined by the Cogent Municipal Code, Chapter 9.12, and rhe Health and Safety
Cade, section 25532(a)?
p San.}Hn
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will mea scant or future building ant usee t or device, whim
tip st.rnr equipment
mit huaNOus air contaminants as defined by the Bay Arca Air Quality Management
all new materials for inspection.
District?
E] Y" KNO
1 have mad the humorous materials requirements under Chapterfi 95 of the Califon
null" "Sofa nuc. Sectim,25N15,2 11-,12551 undcrstandmaiflM holding
Jces not canto M1uw: u mount, m fir• n sty m nntily rM acupnnt al me
m men nit mu ter orsm m -m facapan`p.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Own,orimda c D Lep