01080126CITY OF CUPERTINO-
INFORMATION:
BUILDING DWISI°N ]P]E1RM➢ ll .'
;CONTRACTOR
' I BUILDING ADDRESS: - -
1. i; I, ,a •, 11, - `.,.
PERMITNO.'
-10412'—S--BLANEY--AV -----------'--
WATER --HEATERS ONLY --.-----
0-1080-12.6--.----------------
OWNER'S NAME:
-
APPLICATION SIZE DATE
HAN C TSAI
970 E. MAIN ST, SUITE 2
008/27/2001
(PHONE:
(415)566-2209
SANITARY NO. CONTROL NO.
C ARCHITECT/ENGINEEk:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
_ LICENSED COisTRACrOR'SDECLARATION
Job Description
I hereby affirm that I am licensed under previsions of Cbaptcr 9lcommencing
w'lln Section 7") of Dinixmn3anne Bllxmes. one Professions case, and my Bttnse
REPLACE 40G GAS WATER HEATER
is in full force and effect.
,-iccnae Class Lic.0
_ Date Comore,
l ARCfIi'rE='S DECLARATION
,.
I nod—bind my plan ,hull be used as puh]w records
- I.iccnscd Professional
OWNER -BUILDER DECLARATION
I hel'chy alum Ihrl l Din CRntpl loom the Crnaacmi s Lease Iaw for the
t' following reason, (Section 7031.5. Business and Professions Cade: Any city or county
improve,
$700
which requires permit m comtm<I. rite, demolish, or repair any siren e
$-priorms Ilha.ppli for suchpiamit
Ilehance,atmrequires Lneensignet h,pa,nl
o
- thmarecrlint, ,i Sectio to the of Diium of the Cc lRum's License LawlGhaple )
Irnhathe ipgwllht sCWe)
�s�pt� p1 5 r . �'
- 3P5�11'� 1,"-tJV
- Valuation -�
-
nr that he 7 therefrom and
themerore antl the basis for the
TehasisotheaRuedde enMPtafAnyviolation
Any vi
thB element
_s • '
31.5 b
of Seninn 701 L5 byany applicam for apermit subjens rhe applicant ncivil penah
subjects to malty
ralmn lna nennna aalmrafssn).
50JPN1`€ TftL' • PLUMB I
IENERGIDccupancyType
01, as uwncrufdm - -mann •hi to ccs wlJiw'---their sale core
Amps Y Y p Y agesas pe,
.- ._ _ -1 ... -..
_
................
704n.
will do the -work, and the ilrunure ie not intendedoroffeied for sale (Sec. 7(Wy
nndioc,I and'Pmba.ian. Cade: The Contmetnr's License Law doe, ren apply In all
'Ag
507 - FINAL P73U1$fWGpeetions'
of p",caty Who builds or im""c, Ihcrenn, and who docs such work himself
or thr
rough his own employees. pmvided that inch improvements are not intended or.
offered for sale. If, howevr; the limlJing or Impmvemem is sold within one pear of
_- '
cotnpinion, the ownenhuildcr will hwe the burden of preying that he did no, Wild ar
'r
0ovic
-
r=FO
1 aavin"-it.seafswort,
rP 1, tr Cather of Ibe pmpeny, am udusiss contracting with licensede to
tl—�aV�'l -
ontr cte
n (Sec. ]to a, Business and Professions Coded The Co
a Contractor
mslmel theLaw
does hercoms
Litt me Law Joel not apply las an owner of property who builds or improves IM1to he
and who romans for such pmlens wish a cumrsmgs) licensed pursu:un m the
- - SEP I 9 20 01 .. ..
1
01 Ctoa. sa License Law.
❑lam eeempl ander see. ',n&Pere, n.i. rea.an
... ...
Owner. ata
p�//'��
BUILDING
WORKER'S COM PLNSAI'ION 1)TCLARATION
1 It ... hy .[Firm undo, penally of pct'lury.onc of Ihe.follawing declarminnn:
0 1 lmve'and will maintain a Ccnifcmv of Consent m to f -insure for Worker's
Cnmpcnsminn, as provided for by Section 37W of the Labor Code. for the
performance of the work for which this permil is issued. ,
01 have and rill mainuin Worker's Cotnpenmtion Imu duce, as required by Section
37W of the Li Cole, for the proombrantt of the work for which ,his permit is
sued. My Workers Compensation Inunance carrier and Policy number am:
1
CIani .. :•PolicyN.': �,�-
y ter, t 7
CERTIFICATION OF EXEMPTION FROKWORKIe So
- - - -'
.
INSIIRANCE_i1,.
^ <fThis lection riled nm M cmnplmed if'o' period is for one hundred dnllnrr
' - 1 tc, .. r•'G YNiYI"` - - , --
cenizY That in the, the wart fur which this permit a issued,
'f
-
Cor not employ any n in maof
Cali in any manner :o as to become subject to the N'mkes'
Comicant nn lases of califomia, Data
Applicant
II: is C<nin of Exemption..
Niomm
the We"C
subjectyou moLst
u j toCorkNosadion s o
prey sof the LaWr Cute. you must
Incomes
Workers Comms
with a, t is
Gmhwith comply with such provisions nr this permit shall be deemed revoked
comply
" " ' 1 CONSTRUCTION LENDING AGENCY
I hereby im ml that is a ca®witian lending agency for the performance
Ihe'wmk mrwhich issueA
of this pnnil is IS<c.'31N7, Cis. C.)
, .. ...
Lenders Name
-
Len,W, AJdrexs
1 certify ilial l have read (his applicmian and sure Ihm the abase mfor notion is
"
nares, 1 agree to rod, a xitit all city nnJ county oNinanes odna city Den relating
theimingmnumed mopertyeeM1yfptnicarepresenmtivesof@iscity loenmrupnn
the able pmpeny fns inspemike purposes.
�� ,tom'^ f
1
�n Us'\
V0 agree I.
(\Yclagreet save,; Ae<phar Cityofarr,a nnlg in
Yj y
N ��
and aifyand
liabilities, indignant, , costs and a,inthe
which may in any way teethe agoing said
said
in, of his
of the gaming of this permit.
City in CANT
UNDERSTANDS
APPLICANT UNDERSTANDS AND N'ILLCOMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
Issued by: Date
Signature of PpplicznVContmctor �. .' Date
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
wB In pplcaal rut n ud g ee p 1doneor handle ltd li...... ;.a
Type of Roof .. -... _.
as Je fnnlb ,l1',
y Cupertino Municipal C d Cha 9 12 d the Health and Safety-
Cildii Section 25�32(a)7 ,1 �
❑ry
- .. . •
❑yes 11 1
. All roofs shall beinspec[ed prior to any roofing material being installed.. _
Willlhe apple nt ml Mang bysup t ay an Ai 1 ale which
smith dusnirflndwrmrnnaseeOmeb)theB,.,aci iiraralilyMani,whicl
If a roof is installed without first obtainingan'ins ectiod, I agree to remove
P g
Di,vin7
❑yea
- all new materials for ins !ion. Applicant understands and will comply with
P PP P Y
t o,Na
all non -point source regulations..
1 Have read the hazard], 'ectimamaterials requirements under Chapter t195 of the
ety Cla], 25505.25533
05.2 ad 25534. untl<rsmnd (hal
if uil ingdos of curentlyhavetiate tenant, that it is my responsibility mnotifyin,an the
if Ibebuildingages notcuncnllyhaven,t
nccupnm o[thr requiremenls'Which Ina.Y W mel prior to issuance of n Cenifirnm of
tre
a<npan<y...
"
Signature of Applicant Date
All roof coverings to be Class "B” or better
Ou,mrorarmnn:m ,sent' D„<
OFFICE
z