01020018 CITY OF CUPERTINO ,
umt.mNcbtvtsurN PERMIT CONTRACTOR INFORMATION r
UJILDINGIAlRESS: PERMIT NO. -
j� '1619 ASTER LR ` `BUDGET, ,PLUMBING ''s 01020018 "
- OWNER'S'NAME: APPLICATION SUB DATE -`
.STOJANOVICH 'ALBERT W "AND CATHE 28695 ROANOKE ST,- 02/05/2001
"'• PHONE: ` - - SAN[PARY NO. CONTROLNO,
. ' • (510)'303-7847
C ae a ARCHITECTIGNGINLCR' 1 - ,' BUILDING PERMIT INFO
�r BLDG. ELECT' PLUMB MECH
LL
a.to w i .a --1 I_I
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LICENSE COM ICAC rOR S DECLARATION
o Z._o n ny B t a I I f nwd d p ren pt t g., Job Description
wlhS 1 'IOW) ID '.'nYefnc 11 dP f nC de,and nyln '
iet.°cme, i n l,ica WATER.'HEATER ' REPLACEMENT
v Date Cnmm
ARCHITF.0 IS DECf ARATION
"Oy 11 ndemm�d nY pl trill be us d :P hl'c mmNs r s -" -
' as
p�0 LI WP [ lel
S= OWNI ur Bxcend II DECLARATION
u3 r I n nr.(S that L npn Ifo Connector's r Law for me ,
y
FI a Q
following (SI 7011'S P 1 I P f:: Cute:e Y In crony - -
fc C .wh h 1 1_ I I I t p p p 1 h p y.Inmture
L�1 C .pr t t I. 1 .Ifo ppI If such soundI I I .'g d I I n
a
thathe .r dl pursuant to the provisions ofContractors License Law pChaphor9 Sq. Ft. Floor Area - "' Valuation
(c e g mScott
7Wm ID' i tm B dP r, :code) -
Car M1 x prtl i f n andoe basis for the alleged ese orpl' .Ap vulafo,
air Ser -70TI5hyany ,die Ifratwnout objects the ofpficanat d,ilPenity `
at nor ance than ire n ended dollar.($5001. - APN Number - ",Occupancy Type
i °I ae ownto. p pe if r PI r th g n I . p ll n. 36624014. 00 "
will I thek I thet intended offered f sale I (S 70ni -
r Ba d Professions c I. n Contractor's Il Law d c-riot apply III al _ Required Inspections
at Ero,ona,-Wn a l t p 0 n Id I J e k h If ^'
o;lnifIll,else c pl.yee, pro dedthat Inch ,npr°.emon.are cut Intendedor 502 — FINAL PLUMBING ENERGY
offered for sale.If,however,the building or ilop ruvrailcar is end within one Youf of - .r
oundelion,the°aver-buildar will nave thr burden of proving the,he did not build or 506 — GAS TEST
mpease for prrpo,ca,al'). - 507' — FPNAL' PLUMBING
°I.as owner of the prol an exclusively cn ocal g with limn,ul contractors to - -
cons?r°crtbe project(Sec.7044,Husintes and Pmd'ne,wns Code:)The C°Imacmr's .. - .
License Law does ao(apply to na owner of propcny who build,,,im,prr o,thereon.
and who continues fur Inch p,elect,with a coram Pu(,)licensed Pnrsnalm to the -
Contractor's License Ln o , ,
°1 um exempt under Sac. ',B&P C fonliis iccson '
Ow Lief" I Date , „•
WORKIRSCOMPLNSATIONDECLARATION - Fi1V.aar*A, E17 ;
II by ❑ n P d, 1, f[w,jury Ila ill gdeclarations: -
❑ 11will t Cif t I Consent t II'n. r Worker',
/�
r� 1 1 Comp f p 1 d f by Section 3700 f the [.,be, Coded e the - -OCT,CU'5 2001
Pef if the work if,, l heli, t d _
CI 11 ad II urination Workers Cono,creation InIanner,asrequiredbyStsclion
1 he LithanC he,t rtfoepettI t flus,work[, fifth Kis P fl is
filled.
My Worker's Cull'sulatill.
rl nI'll' Policy numhuBUILDING .
-
Currier: - Policy Ne.:
t CERTIFICATION OF EXEMPTION FROM WORKERS' '
- a COMPENSATION INSURANCE r
" (This section need not b'a conplelcd If The Permit is for one handred Ill
G1001orless]
I ceiipl that in the n Ili
itonnor s work foe which this permit a issued,1 _
Ili II t e nPl y any p y un tee so es to bcu,me subject ,h Workeus
Date .. ..
Apps L - -
NOTILPTOAPin,
II C. S g,h' r tl t fl Labor
Code
lould
Q � be hJ to s a W A C P t P l e d uubor Code yn m.(
�frnl lh co nPlywnfo ubpr,'e rothe puntshull he der,neU 'c.nAeA:
z ..
E"I HCONS INUCTION LEN DING AGENCY
a
I hotel,aff that there .t f leading agency for the Peror .
W of the work for which this n poris issued IScc.rt197,Co.C1
-Led NI
z Leader',Add ss
0
V I
fIo doltf and
d.P't that h 1 ,
l b in keply edIfoall city and' 1Y -f I t Intn6
to building m¢tnedmM1rapsen,.tvc atthis
city trrmmc
A. the luess- tinned ,.Peyto,inp purposes,
g'cc} s adarri ry and keep harialI . fire City of Criterion gal
Vliabilities j :,,a1 hdh 'yt any way accncasaid
r A ' .• }
,
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V z
City
in krusequenerrfn gmnng of hispent.. - r
SOURCE
ANT UNERSTANDS AND WILL COMPLY WITH ALL NONPOINT. IULIONS. ssued by: - Date '
Slgnalun.1 Applielln Il..setor - Dale -Re-roofs - - - -
HAZARDOUS MATERIALS DISCLOSURE ' C
- W'll,me applicant f o binding occupsenstoreor,h dl ha7afslotts lnnulal Type of Roof -
as delleced by,he C.,wrino 1,19ce,ulC Chapter.12,adthe Health and Safety - r -
Ca$Section 2592(+). • • -
°Vex °"° ." All roofs shall be.inspected prior to any roofing material being installed.
W:u theapplicant rt building p :o equipaccal or devices whiel, If a roof is installed without first,obtamm inspection, I agree to remove
amth Lid la v ,de dbyth B3Area A Quality M"8 n, g an P g -
'Dist t - all new niaterials for inspection. Applicant understands and'will comply with
❑Y: ON. all non-point source regulations.
I harocrend the four ,rd :rancelin,nerfareannint,order Ch.pier 6.95 at 4 _
California Herld,&Safely CodSections 2550525533 and 255141 anderstarefilhat
ifa 'b 'Id' ylncynot 0yhuver,enanr,thmlkey reeprrCn'Ity tolodythe 0
` occupant of Inc on increems which rule,,be act'1101 in Issuance of a Conifinne of. _
a
Occupant,' Signature of Applicant • ' . Date, -
t
Ow call on, Date. - All root coverings to be Class "B"or better. ,
s.
OFFICE sr ,