01090071rII
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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO:
18830 BARNHART DR
01090071
OWNER'S NAME:
APPLICATION SUB DATE
BHARDE
09/18/2001
PHONE:
SANITARY NO. CONTROL NO.
z❑ ARCHITECnENGINT:ER:
BUILDING PERMIT INFO
E
BLDG ELECT PLUMB MECH
i LICENSED CONTRACTOR'S DECLARATION
Job Description
I he
❑ hereby affirm Net 1 um licensed under pmvisions of Chun., 9 (mmmmeing
with Senior ]000) (Di'sion Sof Ne Business and Pmressions CWe,endmylicense
INSTALL CLEANOUT & SEWER PIPE.
is m mn rnrre aoff
S
O Lich
nnec
La
gARCHITECT SDECLARATIO
I understand my plans shall be uad az public rector
OLimnsed Professional
OWNER -BUILDER RATION
I nearby .(Sero Nal 1 o.. the License taw for the
exempt scam the Conions
<so
following Inas (Section ]031.5, Business and
1. Co
❑ de ion Code: Any rimy or county
'mpruv d
$1400
perm t o c n vox aha ate.
whichrequires.I.i it 1 fi repair uny stmnurc
•�pd t u u tt alw N vpplc t( such it miense
tt ra Law (Chapter
- Nai h fcenseit puns am to the p rro s of the Contractors Law pi law sack (cracar)
Coder
with Sati n]Ooan The J fee ButnestvMHri.Any
/-� . �� , a• �, y,
` Valuation
or a therefrom and the bases for the
or Nam
that . Any vi
A Silicon
:�„}"4,'y. r3 i3" �U•.]. /_.-t7� t{,..l l,> tU
io 7 3125 b subjects th t
l meson of Section 703 125 by any vpplicam for a pcmtil subjects the Applicant m e civil penalty
'
,or not more than five hundred dmmra ($-ea).
10 8'PN R & WATER
”' " '' Occupancy Type
°Las owner of Ne property, or my employees with wages as their sole compensation,
will do'Ne work, and the stmemrc is not intended or offered for sale (Sec: 7O ;'
'Business end Professions Code: The CWharlm s License law does not apply or an
301 - ROUGH P R1U'Y'Pm IMp actions I' "
YValfv
owner of pmpeny Who builds or impmvea thereon. and who does Such work himself
nnhmugh his own employees. Nem such im art not intended or
302 - TUB & OR SHOW ERI
_
ended ant is sol
,cRertd fm sale. If, however, w l love t or improvement of Prov n sold within one year of
no year
completion, me owner-mluderwm nave mebnmenorpmvmgmmnedid notbwmpr
-- -" ' " - - '------
502 - FINAL PLUMBING ENERGY ^ '•'
improve for parpomofoOka.).
506 - GAS TEST
tlL as o(the pSee.7am eacluattacPurfalgn,
507- - FINAL PLUMBINGLicense
muctther
Codcusedcomranorsm
d the project (Sec, 1006, Baines and Profusions Cade:) The Conthelcon.
I 7
- Lice se Le d al I t o Wilds or tmprovs m
apply owner f property wh
-
.and who contracts forh projectsIIM1 I cmo th e e
ds) i censW .pumuvm ro Ne.
f
s
ClournoL V
- - ..'..
01 acres
°mem<emPt drS ' Bk PC(onhrs mason
.-! 1,, ,(;
, ,• ,.
Dam
WORKER'S COMPENSATION DECLARATION
' "YY
I hcrtby affirm under penalty o(p, jury on of lk followin8 declarations:
O I h and 'll'm t C mficat f C an on aelf-mxurc for Worker's
Co p atim... powidicri for by Section 3700 of the labor Code, for the
pefformenceof Nc woh f h ch Nis precut s iscomad-
froke'land WI rimintilm Winklull. Compensau n lrklmmote puegwrcd by Section
3]00 of the Labor Code, for the pefformance of the work for which this permit is
- Issued. My Worker's C mpenuunn Insurance canner end Policy numbers-: "
Cunvt s> e.: d.I. {.••IPob N'm
OF
�.4�n'Tl°"''�.,' t;t �,i'�m.tl'i.�i:41^f`.P vi. "%•.:'II•"
CERTIFICATION E%EMPf10N FROMFROM WORKERf,
" '
.. _,... COMPENSATION INSURANCE'; I:
_.....,_. ._.. ._.,._ .......-.
ON,
ITh aionneedna be comleled if de tis faros, hundred.
p � perml dollen
._...-_.
-----------
�'.' • I .... .. _._
clank (y•thet in the peeformence of the ark f which Wi perm t is issued 1
shall not employ any person to any mann yd as to become subject to the Workers'
_._ .,.. _.., e _, .......
Compensation laws of Celifdmia. Date'
�..
1
.Applicant ....`. I" - .. .....
'NOTICE TO APPLICANT If, after looking his Ceuificme.fE cmpuon,you should
i ,• ""
became subject to the Worker's Compensationp isions of the labor Code, you must
t
fdrihwilb comply withsuch provisions or Nis permit shall be decmed revoked.
r
CONSTRUCTION LENDING AGENCY '. ".
i . I ,1't
.'
'1 agency for the perfomiance•
Nat there is aisk.
, .
ark im ich d (S" 097 C
I of the work for whsh th pe t s issued (S JmM], CivC) '
'
p ' lintler'v Name • ... - ...... • .,..c � .f.
.. -• . •.. -. _ ., ._ . _
Leader S Address' ...
'•.1 unify that I have rcve this vpplicmion and sec¢ Nm the above information is
'oi:em
"
I ag a to romply 'N 11 imy'and c u ty b' antes d I t 1 s relating
'
I mbuild gco stmc[io do by.uthonz ep se t rives ofth tyt nmr Pon
� the ebo m: met d pmpeny f .pectin urpo ,
(We) 9 - io se mdemnlfy ane ep h Icss the C iy f Ctipent o ag nn
1 cab 1 [ ea 3 eg ts, t o ns h ch y n any y cm eB soar rte
City W e of th i' o i pet, t
(/-'� —
APPLICANT, N RST A ILL COMPLY WTfH `NONy
Issued by: Date _ �C2
i8namre of Appli UC tor`,':" 'r"",. "Dme'j`Ii;"
Re -roofs -
p' HA R US MATERIALS DISCLOSURE -
.: ' wn the liunt or fumue Ni Id nB ompant tote W handl nvaamons mat et
L Type of Roof_.. -�' "
_-"s.;.
u dcfinW by the Cupmmo M n t 1 Code CTapt 9 12 end th H IN a d Safety
r •"- -
-I•:.
•I:!
Code ❑Ya255321a)„ ., , j d
l "�`iJr
C. y'o. - 14Nc,
i,,
All. roofs shall be inspected prior to any roofing material.being Installed.
Will the applicant or f tune building occupant use equipment or device, which
em t h Nouse defined by Area
If aro of is irisfslled without firs[obtainin an inspection Ia ree to�i'fimove
gB
cmiiem .ants a theBay Ail Quality Margam m
Dumcr'r
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations.
I have areal hnudo x metens rcgm25533 endo Chapter Q95 of the
ai rl,
Safety 2
Cah(omia Health &Safety Cale. Seniors 25505.25573 and 2533x. 1 understand that
n
if the buil' Joes note have a mwnq Nat it is my responsibility to notifytheNT
of a mqui hich must be inn prior mo issuance'of s Ccnifica[e of
-
Oc
_ ` - - l':9"'
4
.Signature of Applicant , • Date _
All roof coverings to be Class "B" or better '
Ownerm enntDao-
., ... • i
OFFICE -. .. ...