01030099I
I
CITY OF CUPERTINO -
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...,
nmLDING DIVISION PERMIT
CONTRA@TOR INFORMATaION" x
,
BUIL-DINGADDRESS:
1042E-RNSON AV'
y .. r
WATER HEATERS ONLY
PERMIT NO.
01.030099
go
OWNER'S NAME.
APPLICATION SUB DATE -
"ELLIOTT DONALD'E'IRND R
rFA C - TR 500. AIRPORT, BLV `,
03/19/2001'1,:
PHONE:r'SANITARY
NO. CONTROL NO.
" " .(4,1'SJ349r3747,t:,
ARCfi I'I'IiCT/ENGINEER',
BUILDING PERMI rlist
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BLDG'; ELECT. .PLUMB' 'MECH
I,ICFNSLU CONTRACPOR SpECI ARAl10N
hereby aftom lhad 1 focused p s fCh t 9(
CJe
- ^ JobDescriptionI-
withS I 701lf D on3AbeFop .sadPnfrow
s nuditylcense
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in not I t and arras, _
Lice: CI': Lica •
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REPLACE'' -40 -,GAL -.WATER,, HEQTER.,<;.'.
Dale•: -- Cmmmcor.
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AR(HI'IL(;1 SDECLAIIAI'ION
I d f-1_has pl hall lw-:dit, pbl - d.
OceusedP .-
OWNC,iBUIIULRDLCIARALON al
I hereby rf II I I t f m C touched, L 1 far Ina
roll, g ri,iou.(Si . dPnf:.' Cd AY county
.
cnISB:
which q p n construct. II p demolish, p ya mtrc
n
.
'arillo Its hpe FIeI
1p
III" be : t(he p :roo , IIIt
on' Loans,p.merearllnY9
r.un gLi Section 7001b) f p' r I t B: I r I : Code)
.plI hp
SC. Ft. Floor AreaValuation
Valuatiro.n,
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oI n I d h basist In alleged Any iodation
'70315
70315by
,
.
R700fS
md uL„6a
.itp
ci'1vCi'lI
Y,applicantf aP tsubjectsthee1p:
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. of nm more than Ise h ndrm duller, (a500)
APN Number- - Occupancy Type
El 1, Is ownin of lh'c properly, or on, evneyeas with g: ' III a apari,alues,26
ri
will do the k had the t« Lir '. t eaded I,, ff re l for she sec 7044,
Business and Probe , Code The C I Larroo Live doe, not apply to an
` Required Inspections'.- ,
owner ughhisrw er buildspnbtxn J Dna n knedor
orlh through ply .provided0 t- n" p or
t: t',he
' 20,4 — UNDERFLOOR FRAME
offer I f I If, n th building r p tis Idwithinyear of
is year
'111
onpif I In Dict omen d rp mgmtl dd ,Donn Lir
�mprovefnrPtrpoaeofnnla).-
301 — ROUGH F'I�LIMBTNG -
303 ROUGH MECHANICAL.'
❑Ina.' of the 151111111: xi.' ly II 16 'Ihl'ce: J nonl,p'to
-
rio' I'bProject (s7044 B .. a d r f : Code ) rhe Canlnctnr,
. 304 — ROLJrFI ELECTRICAL .-
License Ii 1 d - t apply I r of property ht build p thcraon
c ntwhoc 6woseforsuch p i tit with' I mth) licensed p : nt to the
505,'—; FINAL' ELECTRICAL '.
❑lam aeampt t;nu sec . B di P Cfar this reaxon
- 507 -- FINAL_ -,PLUMPING' .
•onmerDate ` -
" 508-.—'. FTNAL-MECHANI,GAL '
WORKER'S COMPGNSA'1ION pECLARATION51.4-,—i
FI NAL., PLIBL T C. WORKS
Ihe, ein, allirm underpcnah,ol'perlurytnect fallowing-
❑ 1 have and wlll,mainwin o CcrlifiC.no of Consent m'sdr-insure for Wnrkcr'a
Cnmpme,ntinn, as-prcwided for by Section 3700 ed the Lab,ir'Code, for the
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performance n1'the work for which the pencil is issued.
0] hatociatc,sill mt'n1' N k Comp n.'f I c q JbyS len
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3700 of Ific Labor Code far due pcminnoth', of the work fo wh cb un, perml Is
-sled My Worker's Compensation locumncc carrier and Policy numher ore:
Carrier: .. Policy No.:
CF.RFIFICATION OF EXEMPI ION FROM WORKERS''�"
COMPENSA'fl(IN INSURANCE
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0In, section need not nn u,mpladed it me permit Ix For or, handred dollars
s..-
(SI[NI)
r
Ices fy thm'n me,perfarnvn. of the kf h'btb'pe' I':' ed,I
• ,hall nm amploy .nyper5on in any u re m Assn ne suhjwl to the Norkem'
+. '
Conse r m Laws ofC ld Date
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Applicant
_
NOTICE TO APPLICANT If, dtar naeng the Caniftc teor Exemption you,
becmne subject to the Warkers Cmninnsatfm, pmv s (it (lie Labor Code, you must
forthwith comply wilt such pn,vieions nnh1. permwev
it shall hednwil roked
O
CNSfRUCT1ON LENDING AGENCY
I nervy Uri an that there ons ruct on lending agency fer to v"Ib rranner
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of the work for wbeen 'lie permit 11 ''sued (Sec. 3097 Cie. C)
I '.
Lcndel'e Nunn
Lendcr', AJdrexs. --
nary that I have readth: andficatherand state, that the t abstention
fenreel, l.gree in enndy will, 1,11 city' d county I' e. I It la Iing
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t'Idogeonstne'don,andnernna,peand: prvSc nafvest nn -city menRntpnn
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Inc ah ( I J props ry I pecdon p r
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(Wa)aF- I ani 'fy dkephunfla Lath, Cilyriffulanno against'aid
, j Jgme ns, costs A enpl txh"perwhich may in any wry accrue against sail
CityIn
City in conkequenca ofihe gruming ufmie permit.
APPLICAN FUNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT .
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Issued
SOURCE REGULATIONS. -
by: Date
Signature of Apphwnt/Conttncmr , pate
Re -roofs
HAZARDOUS MATERIALS DISCLOSURI
.
'W'lIthe appy nt orm
r nre NOU goc p store handle lawardins houchal
TypeofRoof-
as Jelmed by the Cuperlinn Municipal Cole Chapter 9.12.end the Health and Safety
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Code. ScOina 25532(a)?
°Yes El" s
hereapplicant
All roofs shall 6e inspected'prior'to any roofing material being installed.:
• wR an Rune Fail nsd p- t equipment 'ty : 1'ah
milli d e a octan u :del bed hula Bay Areq Quality M mise Hent
,
If a roof is installed without first obtaining.an inspection„I•agrese to remove -
D stilet
°Y' El No
.•all new materials for inspection. A ltcant understands and will,comply with t
PP
all non-point,source regulations. rr '
Ili ed It he"I'don, a der Ch pier R95(it the
ladiRenin,
,
Halm & Safely C 1 Sections 25505 2553E 425594. I under,unal that
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fftghed
cnae
thoef
hao'chnyu reIns which unti,therne,ptrlo'r.o isnource ofeC eniffulnye
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Occupancy. - - , -
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"Signature ofApplicant :' - .'- Date
All roof coverings to•be Class"B" or.better `
Owner nr nndtgrt,.ea asnnt Dale ,.
OFFICE ✓�