02080140 CI BUILDI c DIIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20009 STEVENS CREEK BLVD ABLE SEPTIC 02080140
O E: APPLICATION SUB DAT
1i 'TSWEET (WORLD OF MUSIC) 520 REED ST. 08/23/2002
g PHONE: (408) 377-9990 SANITARY NO. CONTROL NO.
O,4zo ARCHITECT/ENGINEER: / BUILDING PERMIT INFO
Lk' BLDG ELECT PLUMB MECH
" b u I—I L_J
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S�2 LICENSED CONTRACTOR'S DECLARATION Job Description
OZ-o (hereby arTrmthal am licensed under provisiunsof Chupmr9(commencing REPLACE EXISTING SEWER LINE
FgCw
lbso, pp''''11000)of Division Sof Ne Busine:yki Professions Cade dmy license
<se Z� is in ful�ce and effect.cscJ
K el 0 u Licensee Class-n-r--r- Lic.p
Date /i'yL_ Com
w 0 i+•In s� ��'jAµCHITECT'S DEC ARATION
C O g 1 understand my plans.shall be used as public records
F�to
ipo O Licensed Professional
n K OWNER. DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
F Z following reason.(Section 7031.5.Business and Profession'Code:Any city,or county $8300
se F 0 which requires a permit to c,anstruct.alper,improve.demolish. repair any structure
to aim port .r ' also req line n
applicant for such Permit fl lipped statement - _.... -_.._._.___. ..
that he s licensedpunttoth Provisions of line ContmcwrsLicense Law(Chapter 9 .32`/flOF3 r®�a , ,., Valuation
(commencing with Section Vk)of D'v son 3 of the Businessand lmfy.sons Code) �, x'� } ) sa,X174, -it ,
or that he is exempt thcrefrom:end the basis for the alleged exemption.Any violation -
-of Section 7031.5 by any applicant for a permit subjects lie applicant to a civil penalty PPN '� O
1 of not more than five hundred dollars($5w). 10 6A NSWEr'R & WATER Occupancy p y Type
❑1,as owner of Ne property.or my employees with wages as their sole compensation, 2 02 - UNDERFLOOR PL JMBING
"will do the work,and the structure is not imcnded or offered for sale(Sec.7844 3 01 ROUGH PIRFAJ3BrI$f4ifspeC[idns
Businessland Professions Code:The Contro —acwr's License Law does not apply an '
owner of propcny Who builds or Improves rwoon,and who dace such work himself 3 02 - TUB & OR SHOWER _
or through.his own employee.,prov tied the such Improvements are not intended or'
off�dror sale:If.however.the wilding or iinprdvemenf is sold within one yea of - - . S02 - -FINAL--PLUMBING ..ENERGY
completion,the owner-builder will have the harden of proving that he did not wild or 506 - GAS TEST
improve m
ppns of
-- - - m ,. _-e . _ _. .._ .- - - - - - -507 -- FINAli`PLUMBING ;-
f]a ve owner aGbe property,am Business a comrofessi with licensed eonraaors is ..
onswn the does
project(Sec.96Y1,Business and erofcaions Code:)The improves
Contractor's
License Law does nm apply loan cis w of property who wilds se improves Neuron,
:. and,ww.conwas.lorsuch.Projecss with o canuunar(s)licensed pursuant w.Ne
Convannrs license Law.
- _ ❑l am exempt under Sec.' ,B&P C for this reason IC lRs A .fi 11 �'®- •!r
OwnDate If� II<afl Gs+al lig
WORKER'S COMPENSATION DECLARATION
_ c I hereby affirm under perulty of yerjory one of the following declarations. SEP 2 0 2002
❑ 1 have and will maintain a'Cenificvo of Consent to¢IGinsure for Worker's BUILDING.Compensation, as provided for by Section 3900 of the Lover Code for the pUILDI1tlG
performance of the work for which this permit is issured
C)1 have And will maintain Worker's Conspaustoion Imomnse,as required by Swion
3700 of the Lahti Cale,for the performance of the work for which this permit is
:.
issued.My Workers Campeniution hrsuance cerin and Polley number urea, _ - _ -_ •�,_. •'
AM IC Tu vlM CR4
CERTIFICATION OP EXEMPNON FROM 'QRS' / .r ly t t .5 i is,
.. .... _. _ _ COMPENSATIONINSURANCE'. :.'. ' ------
(This.sciumn need not be completed Hthe permit Is for one hundred dollars l„• ,.
(51001 or less.)
I certify rM1m in the performance of the work for which this,permit is iomal.I
Shall not employ any person in any manner so as to become subject to the workers
Compensation Wws of Caliilmor r.Dam
NOTICE NAPPLI -. - . __ . . _ _.. .___. .... .. .... . .._ . .. _ ...._
PP
CANT:IL atom making Nis Civions of the
Labordyou should
become h comp y the Worker's Compensation ionsortix provisionsll the Ienwr Cede,you must
Q O forthwith comply with such provisions or thi spar- scall be domed invoked, -
:F" ^ CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a cunnruction lending agency for the performance
r of the work for which this permit is issued Sec.3097,Civ.C.1
00 -Lender'.Name •' _. ...._ _. -
_= Z Lender'.AdNess
V 1 certify thoc(have read this city
and
and orae rw the above information is
rda U noWildi agree to comply with all city and courtly ordinances s end nee taws enter
own
U theaboVngconswnioropeand herthyauection representatives of this city center upon
the uho(we)agree
to property for ify an lee purposes,
(we)agree to save.indemnify and keep harmless the City of Cupertino against
tr W liabilities,judgmen cos d expensei which may in any nay accrue against said
T..) u Ca In consc4 f r gra u U1,
of f 'i permit. rl D—
APPLIC I I e R NI ND Lf PLY N'ITH ALL NON-P NT Issued by Date
sOURLe G NS. ' O
Igmalum of Applicem/Com nor - a.e Re-roofs
HAZAR US MATE ALS DISCLOSURE
Will the applicant or future building occupant st re or trundle hazadoas material . Type
- ot,def ed by the Cupanino N opa�� Chapter 9,12,and the Health and Safety , t
Code S❑ctim MS33(ai '�/ ; tJl . 111 'f :AY'
Yc, u' L�Vff"" .T' r.
-,_ ...Allroofs shall be inspected prior-to any roofingmaterial-being installed.. . .
Will thapplicant ofour m wildr pant use eq p t Je,up,s which If a roof is installed without first obtaining an inspection;I agree to remove
ems h aril it co a nts as de J by th Ray Area Air Quality Management
Di tn<t all new materials for inspection. Applicant understands and will comply with ,
°Yo - all non-point source regulations. ,i, A•.
I have mad he hazardous materials requirements under Chapter 6.95 of The
Califomiu Heapb&Svfe Cade.Sections 35505,25533 and 25534.1 understand that
' if the building ev nn entl M1mveamnma,fwt it is my fespmsibiliry to fully she
occupam t equ a •m icM1 m be r nor to ixuanc f Cnifiate of
i
icee () Signature of Applicant Date
ser m anrwrizm agent ate . All roof coverings to be Class"B" or better
' OFFICE"'