03010154 CITY OF CUPERTINO ."
BUI1.DING DIVISION PERMIT �CCONTRACTOR INNFORMAT -
IOV
BUILDINGADDRESS: AAAA—DRAIN PATROL PERMrr NO.
10344 B VISTA DR
sWNIiR'S NAME: 1701 S 7TH ST #1 APPLICATION SUB DATE
ALLAN AND SYLVIA NARA 01/27/2003
PHONE: (408) 989-6005 SANITARY NO. CONTROL NO,
ARCUI'IECTUENGINI:r:R: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
P'a00 affirm
that
LICENSED CONTRACTOR'S DECLARATION
y F I hereby affrm Nut 1 amo under Provisions of Chapter n(commencing Joh Description
yQ.iy� with Sernl Sermon 7(100) Dvalnn3o1 rho the Doi it Professions Cnde,and mylicense ia
b<<F„ in ruIBN&d f 'I. x Z3 REPIPE
zoggz LIc
I understand my plans shall medDas pub"e„°d JUL 2 3 2003
dOdu
LLo Licensed Pmfcxsional
y OWNER-BUILDER DECLARATION BUILDING 3 Y I hereby affirm that I am exempt from the Contractor's License law rut the BUILDING
ii S 0O following reason.(Section 7031.5,Business and Professions Code:Any city tar county
s� which requires a Permit In construct.alter,improve,demolish,or repair any structure Nd
prior tar its issuance,also requires the applicant for such Permit to file natured statement
Nm 19i.1W�
< he is licensed purmanrto the provlsiorsof the Commetm's Lice nee Law 9 Sq. Ft. Floor Area $ tion
�$ (commend ng with Section EXILE of Division 3 of the Haziness and Profession Code)in,
F_ Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of
not mom than five hundred dollars(551X). bC Occupancy Type
❑Lssne work.Ne the
strob or myemntendedwmhwagesasthel(Sec.
ode W,Business
will do Ne wort,and Ne attucwmisnot intended or offered for sale(Sec.7M/,Business 202 — bND
mid Professions Code:The Control License law does not apply to an owner of 301 - ROUGH CJ(vf§ �CL' Ions
property who builds or improves therrnn,and who does such work himself or though his
own employees,provided that such improvements are not intended oroffcred forsale.If. 502 — FINAL PLUMBING ENERGY
however,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or improve for purpose of 507 - FINAL PLUMBING
sale.).
❑I,as owner of the property,am exclusively contracting with licensed communist to
construct the project(Sec.7044,Business and Profession Coder)no Contractor's Li-
cense law does not apply to an owner of property who builds or improves themon,and
who contracts for such pmjccu with a c urractor(s)licensed pursuam to the Contractors
License Law.
❑I am exempt under Sec. .B&P C for thisVroreason •-
r Due
WOR K HR'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the following declamaions:
❑I have unit will maintain a Certificate o(Conum to self insure for Worker's Compem
sation,as provided for by Section 37X)of the labor Code,for Ne performance of the
work for which this permit is issued.
❑1 have and will maintain Warines'Compensation Insurance,m required by Section
371)of de IaborCale.for be Performance of the work for which this Permit is issued
My Worker'sCComrPewtom in.mnnce cannot and Policy admia m;
Carr is �?>� d•Vf0 Policy No,;
CF.RTIPICATE OF EXEMPTION FR0 RRUT
COMPENSATION INSURA E
oris mesion neem nm W completed BIM Permit is(or one hundred dollars($100)
or less.)
I eerily that in the performance of the work for which this permit is issued,1 shall not
employ any Person in any manner so as to become subject it)the WorkerCompensation
Laws of Celilminia.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become suhject to the Worker's Compensation provisimo of the labor Code,you most
Q z forthwith comply with sine h provisionsnr this permit chat l he deemed residua.
z M CONSTRUCTION LENDING AGENCY
(-+ � I hereby alfrm that Nem is a construction lending agency lir the performencc of
�i Ne work for which this permit's issued(Sec.R07.Civ.C.)
dQ Lender's Name
ham. z Lender's Address
U Q 1 certify that I have read Nis application and auto that the above information is
l4 r correct.I agree to comply with all city and county ordinances and sin¢lawn rdming to
�U buildingconswction,and hereby authorim representatives of this city to enter upon the
w above-mentioned property(or inspection purposes.
C (We)agree to save,indemnify and keep harmless the City of Cupertino against ^ 2
y liabilities.judgments,Costs and expenses which may in any way accoc against mid City ll// /
U Z in consequence of the granting of this Permit.
s.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. 0/- O�
"'iY� Re-roofs
licanoComranur to
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
III the applicant or future building tccupam store or handle hanNous material
efined by the Cupenino Municipal C c,Chapter 9.13,and the Health and Safety
de,Section 25533(a)l All roofs shall be inspected prior to any roofing material being installed.[Dyes
Will be applicant or future Wildingoccupent um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hamrdous air cuntamftants i1cfm ythe Bay Area Air Quality Management all new materials for inspection.
District/
❑Vcs
[have read thchamWinusmarrialsmquimmentsunwrChapmr 695 (NC Ca'tor
ria Health&Surety Coak,Satioau25N15,35333 and 355:W.1 unokrstand lhmi be Jing
Jrcs not currently hart a Icwnt tha it ix my respamiM1ility to nndly the scup 1 Nc
rcyui cru which mumMmm pnnrtu is:mance Era cmiricale of acuPane. Signature of Applicant Date
wner or authorimd agent Dam All roof coverings to be Class uBn or better