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05090123 CITY OF CUPERTINO BUILDING utvlslory PERMIT T; BUILDING B 'LDINGADDRESS: SAN JOSE PLUMBING PERMITNO.0 5 0 9 0 12 3 10327 BYRNE AVE OWNER'S NAME: PERMIT LSSUE DATE INGRID WEHNER 1732 HILLSDALE AVE 09/19Z2005 NE: SANITARY NO. CONTROL NO. (408) 296-1820 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH r---I 0 0 u00 LICENSED CONTRACTOR'S DECLARATION Yk W. MN t FF 1 he)eby affirm that 1 am licensed under provisions of Chapter 9(commencing j{yOb�yDgescrlpAion� ZtU . with Section7WK))of Division 3 oflM Business and Professions Code,and my license �J p J. ;y iy',nys in full force and e 3 / COPPER REPIPE j ? License s 4c. 1p1I05 9 F nF� Dale Con ! —T Con O, GtlOD CHITECI'S DEC ON I underal d my planashall M used az public records s O G Licensed Professional �n_{�1 I kLip""', ro es 'a 0 amex OWNER-BUILDER DECLARATION ComTION I�'Sy s1 r �s1 y H� j<2 I hcmM1y affirm Nat 1 dm exempt from the Cmnio nCor License Law co the B U g91 p""'',©I O O fallowing mason.(Section 7(13 L5,Business and Profession Code:Any city or county which requires a permit in conmuct,idun,improve,demolish.or repair my stmcwm $3625 prior to its issuance.also requires the applicant for such permil to file a signed statement u S s that he is licensed runoanothe provneiomofthe ConuacuriLicense Law(Chapter 9 Sq.Ft.Floor Area Valuation x~$ that M iacingwit ftmf man )ofdth Division a3 of for geincssmton.Any violation Code)or Q — that io u wmb mertfrom antl dr bass for the gleged exemption.Any violation of our. than vemyapplicantforapermitsubKctstheapplkanuoacivilpenaltyof ere Occupancy Type our mort man five hundred dollars C I,a owner of the property,or my employe.with wages as their sole eamperawim, will do the work,and the avuctum is not founded or offered for sale(Sea 7014,Business and Profcssims Codc:The Contractor's Lacers,U.does at apply to an be,of Required Inspections Property who builda or improves Nemon,and who does suchworkhimulf orthrough his own employees,provided that such improvements are not intended oroReuA for We.If, however,Ne building or improvement is to within ore Sees of comphnom,the owner- builder will have the burden of proving that he did nor build Or improve for puryate of sale.). ❑ I.as owner of the property,am exclusively contracting with licensed contractors to construct the pmject(Sea 7044,Business and Professions Code:)The Conuacmrs Li- ccme Law does not apply in m owner or property who builds or improves thereon.and who contracts for such projects with a conuactorfs)licensed pursuant m the Conlrumr's Lice.Law. C 1 am exempt under See. ,B&P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of perjury me of the following estimations:f I have and will maintain a Ceo fi.0 of Consent to self-insure for WorkefsCompen- ion,as provided for by Section 3700 of ma Labor Code,far the performance of rhe rk far which this permit is issued. 1 have and will maintain Worker's Campmo ation Insurance,a required by Section 00 of the Labor Cade,for Ne performance of the work far which Nis Permit is issuee. yWorkcr�mrms tion hmurance and Policy num r am. rtier: liry No.: L I I E ) ON FROM W E S' COMPENSATION INSURANCE (This section recd not hecompleud if fix,permit Is forme hundred dollars(SIM) or k..) 1 cmify that in the performaae or the work for which this Permit is issued,)shall not employ any permn in any manor m az to become subject led Workers'Comrerm aeon Laws of California.Data Applicant NOTICE TO APPLICANT:If,afuf making this Certificate or Escmptim.you should become subjcet to me Worker's Compcaaeon provisions of the La str Code,you mug .JO forthwith comply with such provisions or this Permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY [—t I hereby affirm that inert is a consuunion lending agency for the performance or a the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Z Lender's Address U 0 1 certify that 1 haus read this application end sum mat me above information is E-^ Correct-1 agree to comply with all city and county Ordinances and sum laws Moting m O V building construction.and hereby aumorrr representatives or this city to corer upon me ahova-mentioned pmpcny for inspection purposes. (,1 (We)agree to save,indemnify and keep harmless the City of Cupertino against N liabilities,judgments,toss and as,.which may in any way accrue against said City C)z nAnPPLtalequencc of No mou.,of this pcomit, ERSTANDS AND WILL COMPLY WITH ALL N -POI Issued by: Date E ULATIONS. Re-roofs ignawrc of ApplicaHAZARDOUS MATERIALS DISCLOSURE D4. Type of Roof Will the applicant or form building Occupantstore or handle havardous mawng az defined by ted Cupertino Municipal Code.Chapter 9.13.and ted Health and Safety ode.Schon 25532(ay! , _ All roofs shall be inspected prior to any roofing material being installed. (]Yes �Na Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it havasdous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District, C Yes 1 have real the hreardrms materials requinmeas under Chapterit.95 of the Califon ria Hcahh&Safety Code,Secdoa 25915.25533 and 25534.1 understand mat if me building a does not current tenant,that it is my responaihility to nodly the aces t of regal w be Ipoor miaaamcenr,Cenifeamafo"a rSignature of Applicant Date S Ow tar authored agcm If thdre All roof coverings to be Class "B"or better .w.., Community Development e 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPERTINO ell Building Department JOB ADDRESS: PERMIT # D or6 �0� 2 3 OWNER'S NAME: PHONE 11 GENERAL CONTR CT M # I am not using any subcontracto s: tgnature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE 2 CITY PERMIT APPLICATION FORM APN# 3 ( 2— 0 2%p Date: Building Address: Owner's Name N��,11 O Contractor: Phone: License#: s 3 �. ; Z72 ,--< Contact: ` / one: Cupertino Business License#: / 03 Buildin ermit Info: . Bldg ❑ Elect ❑ Plumb Job Description: rdential Commercial en of Project: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING tl PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING 3 Zs� ar g 3 . 37