02010127 CITY
I suumF c DPEROrvNDPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22093 WALLACE DR CUPERTINO PLUMBING 02010127
OWNER'S NAME: APPLIC TION WR DATE
CASTELLANO MICHEL J 10297 S DE ANZA BLV 01/ / 2002
PHONE: (408) 253-0618 SANITARY NO. CONTROL NO.
O-O❑ARCHITEC(ENGINEER: BUILDING PERMIT INTO
r u t, BLDG ELECT PLUMB MECH
us
LICENSED CONTRACTOR'S DECLARATION
0 5"r, " I hereby a1Brm that 1 am licensed under fcha Chapter (commencingJob Description
oN""—o yr°alai°"'° p REPIPE & WATER HEATER & SERCICE .
w with Section 7000)of Division 3 of the Businessand Professions Cade.and my license
Y f ix in full force anJ ofRU.? -
m a License ss l.. 7 Lic.a OS
aau ua.i u Dam ^^�' S DEC A
F a.O g ICnEcrs�t my plans shall Ebe used publcArtcords
c2
c 0 Licensed Professional
OWNER-BUILDER DECLARATION
^—a 1 hereby elEnn that 1 am exempt from the Contractor's License Law for the
F $5000
z a following reaun.(Section]031.5,Business and Professions Code:Any city memory
E s which requires pemm a tit conswa,"Ire,improve,demolish,mpair any restrvcmrt
to cooor to its issuance.also requirtuhc applicant forsuchpemmmfileasigtedsmmnater, _.-
fenb6islicnserslpuk"Antothe Provisions oftheContmcmisLittnul-aw(Chapter9 „e,1,.3..C.,OG..G(lot6Ua,- Igtr Valuation
(commencing with$CCIIOn]u0U)Of Division of the B settees and Profession Code) = , G`tU11I LG'IIYYYY „�A s 1'c C,lta:lt i'l,'.•^
or that he ik ek<mpi thciefmm and the basis for the alleged siemFtron.Any violation -- " ' -
-of Section]031.5 by any applicant for a pemtit subjects the applicant to a civil penalty
of methanrove hundred 10.1(5300). 202APNUNI3Jl3RFLOOR PL MBING" Occupancy Type
01,as owner of the property,or my employees with wages as their sole compensation. 301 — ROUGH PLUMBIN
will do the'work,'and the re:mancone is not immndee'°r offered for sale(Sec:](104, -- -- ------ -- - -- --
Business and Pmfosions Code:The Contmcmr's License Law does oar apply ro an 502 - FINAL PI]t94Brk8l[dspTdN&iRGYti ,
owner of Property Who builds or impmveu thereon,and who does such work himself 507 - FINAL PLUMBING
or through his own employees,provided that such improvements imcros see not intended or
contrition,
ontr it for sthe.'ICAowever,the building or urea of proving
n sold within ane year of '-
reove for pm owner-builder will have the burden of proving thm he did not build or `
improve for purpose of We.).
01 as w a c tof 0 c p , e pent' Its ly at in r with licensed contractors to
tproject
on. t the p of t(S ta .e. a Ri ef code)'1'h<Contracmr'a
License Law does not apply to an owner of paraperty who builds or improves thereon '
-aroLutho.contracts for.such projects oath c tmcmr(s)licensed pursuant to the .._... -
Ccotracicse. L
01mexempt under See 't ,B&PC for ration ([`•'' P. .:-lion
re, .Data
WORKER'S COMPENSATION DECLARATION
` I hereby"firm under pcpahy of Perjury one°f the following declarations:-
❑ 1 have and will'maintain is Certificate of Consent to self-insure for Worker's Q�
Cron,n>fion, as provided Poli by Section-3]W of the Labor Code, for the
performmoae of the work for which this permit is issued.l,
01 have and will maintain Workers Compensation insurance.as iegaired by Section -
37W or the Lahor Code,for the performance of the work for which this permit is
C-ed-MYW Worker's Compensation Insurance y
tea _ ame'1(3o a Ixrnrt:,. � . , _,......
... fS'. Pr Na.
I CCRTIFICAT NOFEXEM1IITION FROM WORKERS
--, ;-COMPENSATION.INSURANCE •"• 's'` _,
'(Th.&a n ncee not b<completed if the pent t is for one hundrtd dollars ,s' •s ' t ,I I'.j '
(SIM)or less.)
rl ccnlfy that in the performance of the � k f which 0 p .rt' issued,'1
shall not employ any person in any manner so as to become mhlcct to the Workers -
C°mpcnsai°n laws of Califumia:Dore
NOTICE TO APPLICANT,.It.attali snaking this CeniOr t<ofd Labor
iode.)onmuld •" 't'r• ,.,,
hcc°ine comp y the such pr C°m ns or t is pnbi t shah
of the Leber Cade,you must
0 O forthwith comply with such provisions or this permit shall be deemed revoked.
-CONSTRUCTION LENDING AGENCY '
rcor affirm th t th s a issued(See. lending ag .) !o the perfurmance
of the work for which J,n pcimri is issued(Sec.309],CLI.C.),
d.Q 'Lender's Name... :. .....• '...'. - . . -.._ _.. ._.. e.... .__ .. _ _ _._ _. ._ _�_.-.._. ... . ..... .... .... ..... .. . _ _..
Z 1-enJer'.c AJdressr.,•.• 1 ; . S�-t'll .,
_ U I ceniry that 1 have rtwl this appllcaiion anJ store that the above informaiun is -
k'.F ctirr<ci,I agree m comply with all Qoy not county ordinances and state laws relating
to building construction,and hereby aurhorue rcocsemalocs of this city to enter upon
the above n croutned property for inspection puryoics. - _
p,
(We)agree m m
save,indenify and keep harmless the City of Cupertino against
tq Iamht judgments,cons and expenses which mav in any way acatims,against said
City equ nee o the g nt ng of th perm t
SOU CAR (LAIR OcN S'AYDW LCONIALYW1'THALLNONPOINT Issued by: ( Date 1�
(5 UL
Sq t r pficarro nt et - -11-;'D te. ' Re-roofs
HAZASURE
Will the
pplica orRuOmb ildio occLgmst relmhmtdl h Nose mated I Type.of Roof_
B p
u def ed by thenoMunicipal Cod Chapter 9 12 and the Health and Salary
Cale Sect n 25532(a32fa)
( AS's 1 e II�.4I r4.. l v,'d
0Y "�l' ( t All roofs shall be lnspected,pnor.to-any.roofng,material being.installed.--, ,.
wsBthe applicant orfuturebuildmyoccupant use equipment ordevices`which If a roof is installed without firs[obtaining an inspection, I agreetoremove
,mil aead. sair cot nnantsg fin Iby'theBay Are,Air Quality Management ,
Di t T /rtp('Co all new materials for inspection.. Applicant understands an_d_wil_I com_ ply with
tall non-point source regulations ,.,;, ',
OY
t I have read the 6amrdn.6nat"W,rcquircrests under Ch,me,6.95 of the
Califainia Health&Safety Cafe,Sections 25505,25533 and 25574,I understand that
-'if Nebuildine Vas not ensJwmv`1v",uv
namnan6 thu it is my rtsponsibilitymnaify the• he rcqui mbe(netprim mlosanc<ofaCeniGc9te°fowneos as `Z_� "C) Signature of Applicant Date _
_ ccupan ^
tnoriaee age , Dam„s All roof coverings to be Class"B”or better
.. ^,. .. ,'... :.... .... . .: ._ ... ' .- :. ,.... � OFFICE. ... _. ... . ... _. ._.... _
. .