05010004CITY OF CUPERTINO
CONTRACTOR INI'ORMATIQ
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BUILDING DIVISION PER
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OUILDINGADDRESS:
AAAA—DRAIN PATROL
PERMITN005010004
10 20E A
OWNER'S NAME:
PERMIT ISSUE DATE
CHESTER GOOD
2400 L B
ONE:
SANITARY NO. CONTROL NO.
(408)989-6005
ARCHITECnENGINEER:
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BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Chapter 9
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Job Description
I hereby affirm that 1 am Recruit] under provisions of (commencing
wilASce, n] of DiA.im3afde Boaincw Professions Code.and my license is
at`t�,
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imm�Nrt err s� /_
�r
REPAIR 4" SEWER LINE
Licenu Cl L/ u ..0 Iia
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Daxy _cs'�� Contrxto�(�QGd
ARCHI3EZ D RATION
m�nG%-5
sI' AdmY Plans "I heu Puhbe
Lkcnxd Professional
Oat NER-BUIIDER DECLARATION
I hereby affirm n 1 am exempt Wm the Contras License.,c Law for the
,
Co:
following mason. Permian ]1131.5. Bus and Professions Code: Any city nr county
o
Alter, dentalh Ar repair any tatement
which requires a permit to Lorca
Lim Permiah,
prior N its i eased p alae require the applicant for such permit m ole a signed susemcm
unit he
Sq. FL Floor Area ....
-. Valua[ton _
(commencing with Srsoon90W)af Divislon3Mthe Business and Professions Code) or
(cat
yvi
Any
Natio u exempt Nemtrom and for aper the Agedl exemption. Any violation Of
he Is
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Occupancy Type -
by any it subjects fee � � -
owhunreddontrmaPermhaaajeemthe.ppornntNamrvdpnaltyo
mom than five hundred dollen (5500).
notmomm3L
0 1, pe owner of the pmpeny, m my employee wish wage m Noir mle compensation.
0
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Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 1044, Business
And Pro mans Code: The Contractors Licen law does not apply N an Owner of
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pooMny who Wilds orimprove Hereon, and whodoessuch work himselfortlrough hisOwn
t� ffl��� rry -
ements kal for
n(oyear
11
fcompiffered
owna,
h..,.ltim buipmvidrOrpmchimpm
however, Ne building or impm old within am year of completion, ownm-
'u�t
�����®
purpose,
Wilder will have Ne Wrden of proving Nat W did Oat Wild ar improve for puryox of
provinismld did out
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u
nlc.).
0 I, u owner of the property, am exclusively contracting with licedud conuacwn m
construct..
The Conmr's Li-
construct One project (See. 7(1,44. Business and Pmfetiope Cade, trac
.. _. ryOa5
JAN [„ L
rue law does not apply N an owner of property who Wilda or imprem Neuron,and ,.-
who contracts for such Projects with aeomocmr(s) licensed Punuam m No Contractors
-
License taw. . • .
SS p tt {t p �l
❑lam exemptunder Sec. ,B&PCfor Nisrtpeon
_ Ipltt-,'�11 Ipj`TYpr 1117111pL1y IIBII`avp
®�
BUM
net Dau
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WORK ERS COMPENSATION DECLARATION
1 hereby a(Brre under penalty of perjury, are of the following declarations:
I have and will maintain a Certificate of Consent to self -insure for Workers Compen-
acts.., As provided for by Section 37M of the labor Code, for the performance of the
work for which this Permit is issued.
1 have and will maintain Workers Compensation Insurance, az mquimd by Section
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3]00of NC labor Code, for the performance of the work for which this permit is issued.
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MyWorizfpCOMNMionnnWr tariff And Policy, number number a:
me CtTLII Pgqlimy Na
CERTIFlCATE OF EXEMPTIONFlt-
COMPENSATIONINS DR CE
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(ITh, section wed notal completed it the Permit is for one hundred dollars(SIM)
or It..)
1 certify that in the performance of the work for which this Permit is issued. 1 shall not
employ any person in any mannermu Nheemom bjcct to dre Workers Compensation
Laws of Califomia. Date
Applicant
NOTICE TO APPLICANT: If, after making this Cenificam of Exemption, you should
become subject m tW worker's Compensation provisions of the labor Code, you most
forthwith comply with such provisinns At this Permit shall W deemed mmked.
ON LENDING AGENCY
CONSTRUCTION
` J/
is a c
1 hereby allithi that mere iso
3K lending agency rnr the Performance of
rad (Sec.
' Nr work for which this permit is issued Pere. J09], Civ. C.)
lender's Namc
\\1
LC 4c Addreu
,
j 1 certify, that 1 have mad this application and sum that the above inmonatiun is
'
' Correa I agree N comply with all city and county onlinances and sue laws relating N
building construction, and hereby authodm mpreenutivas of Nis city to curer upon be
I above-mentioned pmperty for inspection purlwua
(We) agree to save, indemnify and kap harmless the City of Cupertino against
i lObilitipe,judgments, costs and expenses which may in any way accrue against mid City
in comequence of the granting of is permit.
( APPLICA ERST AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SO RCF C AT10
Re -roofs
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""— -°S
i n of ApPlic On RDD au
Upa DISCLOSURE
AZARDOUS boding
Type of Roof
Willy applicant per fMuni building Wr or handle material
e.cupant r 9.1 Health
As defined by the Cupertino Municipal Code. Chapter 9.11. roti the HcaIN and safety
t
Jr &6umn15531(:)?
All roofs shall be inspected prior to any roofing material being installed.
r
If a roof is installed without first obtaining an inspection, I agree to remove
Will me applicant or future build^i°n�g use equipment or devices which
mit havardnvs air mml �Oyyyccupant
ntanonm azpe dQ^o Ne Be, Ana Air Quality Management
all new materials for inspection.
District?
0 Yes
1 have read the ha aodoutruie ials requirtmcnm under Chapter 6.95 of Ne Cahm,
nr Health& SafetyCode. Sectors; 15505.25533 aW 25534.1 undermost Nu ift a Wilding
Docs of canto tenant Nat it is my respomi6ility n notify Nc cupmt of Nc
mqO rtmen n' m pilar N its inecnt. c2run 'pang
Signature of Applicant Date
or
All roof coverings to be Class "B" or better
-o%
wnc u authorisd agcm Dr¢
.. 4 I
TYOF
CITY OF
CUPERTINO
•
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
APN # / U o/-jr—
Plumbing Permit Issuance
Date:
Building Address:
Cb (cuoL -(Oc PL
Re i e of Fixtures
PLUMBING
Owne 's Nam@:
� j1�S�e J
Bldg. Permit Fees- - -
Phone #: Iza
-3o 1
C�q��ractor:
�J F2Q i v,, flca ROt-
Phone:
/ 68S Poo a
License #:
Contact:
Phone:
Cupertino Business License #:
Building Permit Info:
Sewers
PLUMBING
Bldg ❑ Elect ❑
Plumb �—
PLUMBING
Job DeSCTI tion:
EargIR OF 41c' �C L
Business License
BUILDING
Residential ---j- — oul
tial ElCost
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of Projee :
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Qty. F
ADoli able,/ Fee TT)
PPP Tlvcrrinflnn
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PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Re i e of Fixtures
PLUMBING
BPERMFEE
Bldg. Permit Fees- - -
BUILDING
BPFIXTURE
Pbl . Fixture - -
-- PLUMBING
_ - BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING