00090023"'CITY OF CUPERTINO .+' '-' "' - -
BUILDING Otvts�oN . ` - pER1VIIT CONTRACTOR INFORMATION
EULLDINOtADDRESS
. • - ,t .,_, , PERMIT
I. OWNERS NAME: •, ",- ,K i � c: r p APPLKATION SUB DATE • � "
1011`3' AKADOR`;OAK CT' T0M',S 'PLUMBING 00090023,
IONE'. - - - SANHARYsi CONTROL NO, _
't :'KEVIN''CURTIN 1224E."SARATOGA SU SIi RD09/07/2000,-
G'K Y ARCHITECTIENGINFEH f' , N - - "" BUILDING PERMIT INFO
- z m ° a yy ,. r - BLDG ELECT' PLUMB MECH
N� (409)067-601.0 .=1
G
bZ LICENSED CONTRACTOR S DECLARATION .: ' Job
OO I he by notion tit 1 d p' , Chapter 9 (I mme 6 - _ Description' -
with Section 7000)TD 3.1the Bl dP 1: o:C le „dmylccwc
S�K6 Lie,,Class tl11-t % `L #:. Iw {31 UI„ }. .1 C • .
i l O
3w° Dnte—CrOi.0 ltmrnbr - t f
ARCHITECTS DECLA I(l1
e
° I d r d y pw .:I n he Cscd pnnl-reca}ds _ k, RF PIPE r r
C p O
isfeetsed P ,Ices 9na1-
e' je o • OWNER BUILDER DECLARATION } I
w
1hereby about finif.I ant ctworpt firmor the C d t License Lercmc
full n
mE ... ru (Settles, 7031,5 Brionce, andBrioPI :Cd Any 6I,rya -
O -
'fair rcqu'rc P t t .d talar p demolition pa _ ny 000ti a _
pr, t 1sarial e,ure: the ppl atom uchry.-un rle a"bods wmmeno _
min t P tome p n fil c l t L Ica pte I Sq. Ft. Floor Area Valuation
(cit con,with Sect ]000) f U 3 f Ih Basin'_ d P '. Code) a- i•
` f or ththe's a,,carldm efnn and the ha'. for the alleged owmaavn.Any"laima
of Secdion903L5h n o'llwm for ren subjects the applicant it call penalty
Y any Pp Pc J I P P Y
APNNnmber -
arn, ,temanrvelandedaolhF(s5om. _ Occupancy Type,
°l as owner onhepttpeay(army emi,layce.wth wa6ea r, theirsole c r,ounseion, ) - - $50001
will de the work: and ,he structure s not a,elided or offered for sea Sac 7144, - -
imp
1 i
Business and P 'fess -'il d TheContractor s , nor Io in
- Yu - - a Required
equired Ins_pectlO_
ns t
owner of property who Holes or'n,p,aycido, ad,] ho Joe, tms,If'
or through s(pmye« nden that such ,ma Ihummed r 3/A232024.00
come leale hw,he buildingmr iuupmsoarwrtbuildingla ,h y of
completion, the owns -builder havethbIfpng that hedid at bIJr
in"i fr,"upn.e, '202•-UNDERFOOR PLUMBING
L
❑ nit PPerry, s , licensed arae, I -
-
e
30V- — .,ROUGH- PLUMB INO
mewed the pr6eal (Sec. 7044 Bus ne d Profession Code:) Th Contractor s —
'
'License
Law
d e. nl imply t of Properly who builds P t •Econ
and wit a ,tracts for such P ,ects with a on reater s) f 'd p,knato to me SOL FI NRL. PLUMB I M1IG ENERGY
Cal, License Law 507 F.I. NAL -PLUMBING
° 1 u a_xampd ander Ser , B & P C for Nis rears n - , -
f •
Owner • Date", a
WORKER'S COMPI:NSAl10N DECLARATION - - '.R'r+ e'
Ihereby afirn and"Pe,a,yofpc0urybm ofthe Goll 'n6delarmunde - r '^ a '
❑ I h J II d C , l al f C I , If a for Wok 's
Ciampumation. s provided for his Scow. 3700 af the - Labor Code, for Ile -
pannnance of the wok I,,, mehthis pe ,I is sm
°Ihave and will bourbon Workers Conp : I 1., ,tired by Seeuoit - -
00 o nnfor
-] My Labor Cele e...Ir edurancee of the d Policy dimmerthis
an permit is
P
1
smeJ. M) Workers Compensmion Insurance carter and Policy numncl are:-
' .a
vdl r we Iz o Io o:. d
i, imnc
Cnn'ier:
CERTIFICATION OF EXENTIPTION FROM WORKERS'
COMPENSATION
IN
SURANC17
(this i need not be contrived if lite peon t is for bure hundred dollars d' • r ` -
..I tod fy far in he pefformer.ofN work for h' h his pe d is :wed I ••S _ ,',2; '•Ss
`shall are employ any p to any numare, a, tot become wobject m Ihe Workers'
Compensation Laws of California Erse
Applicant t -
NOTICETOAPPLICANTIrafterm,knb this Crti .I f LAcropflo.,y should t �h
a . becomeson)e. wee Workers Co, ... Iran prai of the User Code you nus, t `
forthwith comply with: 1 praysons m,h' perm, shall he AeemeJ rev tIt y ", -
Z wit . �.
CONSTRUE rIQNI I NDINC AGENCY
tS?
I Ibloda,di Oat II re Q o I d 6o6e YI d da
pern c _ tit kr 1'ch ,h p t e ssueJ (Set.
3097Cv. C)
Te ,
Name
a•
a z Lender's Add .. `/SI •yit
U 1 codify that I hddl- lepl d d ,are thealocalhavi of officeIs \ •/A Y. - .
tz F
-correct, I agree to comply with all city and county obfirropoes and statelaws relating
U tobuilding eaustructon and hreby authorize representatives ofmis city it) enlerapon
} CA
the ah onp pttylrine , npN':
Ey py
(We) agt : 1 'fy, Ikeep h :: Ih ICry fCape
n a6ln
nra
..i V1 I 1 J6g I: I 1 P 'Y ,any e aid
yagulnst;
Cit m en
City 9uce nosh 6 ant ,8 nosh permit -
APPLICA NT O�IDERSTANDS A DWI L COMPLY WITH ALL NON -POINT t ,
sotJyi2/C'EVEwcE AgWlgtdls I - by: Date
Sirt�+rt� a pP— sl} canUC I I •I. DateL,RC-rOOfS
(/ HAZARDOUS MATERIALS DISCLOSURE _
Will the applicant bf imam handling . gam slide ertr pl h-basmeabbas reaeHal Type of Roof
as defined by do C.pabin. Munisi,ed Cade Cmjg.m, 9.12. ;.d the Health and Safely
_ Coda °Yes25532fn1' El Sin w.1 ,. '
.All roofs shall be inspected prior to any roofing material being installed.''' I
W'll p anpE - l r n dd s p' F - 1n 1 i I s wmmt If a roof is'installed without first obtaining an'inspection„I agree to remove
emit hazardous u m to to is der od! by the Bay Area A' Q ality Management - - -
Dia� et all new materials for inspection: ,Applicant -understands and will comply with
Cl i°` ° "° all non -point soiirce regulatllons. '
1 , u read tit hazardous i I ,u rennms dnde CI pt 695 of Ihe
.Calif H hl & S f ry C d feet t. 25505 255n to..255)4 9 un l nony t ,
,f tit b Id'n6d v , IIYI es 4ntdhad,.my ep nl,ytoomfy tha . ', w,
ace pool f,l l' t h dp-int ss f Ce dircme nl �- -- '
°CePtney Aj `- Signature ofAppllcant -- ;'', 'Date; v
Orn,litorzeand 7Date I All roof coverings to be Class "B"- or better '
OFFICE: ;
r.s., 'V.