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01090071rII i j3 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 -. .. ...