01090060 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10140 CALVERT DR. 01090060
09/17/2001
PHONE: SANITARY NO. CONTROLNO.
I
MOO ARCHITEC rENGINEER: BUILDING PERMIT INFO
m U BLDG ELECT PLUMB MECH
ya
P,i LICENSED CONTRACTOR'S DECLARATION
Ln Description
g,n 1 hereby aflirrn char 1 am limnsed m
under prorisns of Chapter 9(commenescrp
cing
w w;mSection 7000)ofDivxma3PfdwBaaineaaand Pr°fea.in2n.Cwe.and mylicense REPLACE SEWER LATERAL.
is z in full forts and eRcc %p)a License Lic,a
:o�u Date cltntmviar
a o vFi I ARCHI I LCI'S DECLAR ON
g I underaund my plainshall be,sed as public records
a'3T
i a p O Licensed Professional
LL OWNER-BUILDER DECLARATION
n I hereby alarm that 1 amempt from the Convacmr'.s License Law for the
z 6 following reason.(Section 7031.5.Business and Professions Code:Any city or county $5000
Y O
which requires a permit c construct,abet,i iprove demolish.or repairany strustructurectu
or
'hat he ficrtimacdp t.nu rM1 of io f@ Contractor's eL tv (Chaps 9 p �I�a r. Valuation
. t ci g with Sectiontherefrom
an The x J the l Business dPro@s ions Cad) s, v,f�., L.3'; s' gC1 L-� :IV V s•R SY,_lis.'
1 or that he is exempt ch rnGnm and the basis for the subjects
the a manna.Any violation
-of Section 7031:5 by any applicant for a permit subjects the applicant to a civil penalty
of nor mom than five hundred dollars 65001 202APN SRFLOOR P 'BING Occupancy Type
❑I,as owner of the property,or my employee with wages as their sole compensation,
-WIVdp the work;and he swsure is not intended or offered fon We(Sec.7044,'
Buaideas and Profesamns Cade:The CPm urw*v License law does not apply to an 502 - FINAL PSM2,111QG6ENORGY
weer of property Who builds m improves thereon,and who does such work himself
or through his own employees.provided that such improvanents are not intended or. 507 - FINAL PLUMBING {
pffaml for sade.R hari the bu Id g or ropmvvirmor is sNtl within nye yen of - _ -- .•0. -
completion,the owmanbuildi '11 have to Borden offspoing that he didnot build or
tmpo e for pirrimseor 1e)
01 Liao nor of the property,am exclusa ly ecintracting with licensed contortion,to
❑cwI.avct the project
(See
Sec 70W B ncand Professiam,CWC:)no contractor's
L tl apply c r a progeny I wildsimproves thereon.
W h contracts for such prof t t t rtsl licensed pursuant t the
Contractors
om t License
m o ,S
_.._
B&PCfor this
Distant
are t •,.. O
WORKER'S COMPENSATIONDECLARATION
I hereby affirm undw penalty of pdjury dye of the following doclmatiltm�
1 have and will'imaiwn a Comficain of C moom to self-insure for Wmkee,
C mpemiltorn, as provided for by Section 3700 of the Labor Code, for the
perfon ase.of the work for which this permit is issued.
❑I have add will maintain Worker',Compens5iion lawranm,as require)by Scciion
37M of the labor Code,for the'performance of+he work for which this'nork is
"hued My workers CompIchraiation In,wa ce carrier and Policy number im:;
ca„e 'fl�O(L '; 6PI cy rJ Ch-
e CERTIPIOATION UV E i,MFI'ION FROM WORKERS a� s•f•'s 4 'T .. X 5.4 F1 'w'4••y "'t '''
! - COMPENSATION INSURANCE'.]
• I .
This ton ieeind be completed dine perms for one hundred dollars )!ton v -1}J^-- —... .._...
(s I(pl Lir lest] - t
I ' nJym I 'm pert" q 'nn 'rkrnn m'p< t awtal _._ _ _
aAall of employ y je y a as lobroom bJ l to the Workers �r
Compo soiinn laws bf Cabfymu Dam " "
Q'O 'NOcIt. R _kiniCrlfate pt y should
became
subJ ttoheWor Compensation p aof lie Lobo Cod you must
foh \h pIY with hprovisions
-
or this permit shall k dremed invoked. ,
CONSTRUCTION LENDING AGENCY
rtbY aRim that them sec t f lending gen y for the performance ,
1 ,.„, sol da; ork lilt which the Pomo is u d(Sec 309] C'v.'C) '• '
.❑ 'Lend s Names: _� a.».:...... .. ...... »_ o...• ., .. _... .,
rs Addmsz ,_
(� O .'PJ '• t is ica rat::haat ,.
l I«nate thin I have rtad this city
and on and cute that a about information ion is•
�•'C ortct.I,game 10 comply with all city dad creme ordinances and scary laws reeding.
>i:W !so he sildingmcuwnion,andhembyaection kpresemarives of this city mercer upon
.E.Q. the ahoy o)'agme 1.ned property for inspection and keep
pupoaes., _
E. Q. (tlthdgret msave:indemnify and keep harmless the City of Ca against
% , liabilities gments,costs and penses whit may i any way acerve against said
City in o quece of the g', , goflhis t.
SOP NT STAN AND W �h Y WITH ALLNON-POINT Issued b l
y Date
ore of`ApdipwWCwIpcmr,;;): -, aDam'. Re-roofs
- - HAZARDOUS MATERIALS DISCLOSURE'•'
' Will th applicant future'h'Id ioccupantt hamlle Irwindou.material 7 Type of Roof
defined by th Cupen Municipal Cod Chapter 9.12. d theHealth d Safe,, • ........-' "-"'•"'^^ � _ -- --
Code Stan..35532O )a r 's•' "• + 1
r k ' r .1, r'i J•e t
❑Ya ^ _ " A11.roofs-shall be.mspected prior,to any,roofing material being installed.,, _
Will the applies.,or future building eapant yse cgPpment or do,im,which� If a roof is installed withoutg p
first obtaining an ins ection;I-agree,to"remove
tort hazardous air contaminants as defined by the Bay Area Air Quality Management
�! _ _ all new materials for inspection. Applicant understands and will comply with
1i y6 oY ";�V•° ! - , all non-point source regulations., PP
v+ '1 havewe'h:rmadous materials requirements and Chapter 6.95 of the: t.r:
Ctlifomu ah, afpycodo.s tr x25505,25533 and 25534.l undersund that
ifthe but ,n nrcmrzmlyhave town.that it is my rexgroodclity to notify the
neaps f r a (mems which us,he mat pr a of a Centficwe of
Piton
-
Oc
. ,.,.: °taw
Signature of Applicant _,.. Date
'G rwh..hmd.,cm,, .Dace All roof coverings to be Class `•B" or better. "
OFFICE . . .. . _ _
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10140 CALVERT DR. 01090060
09/17/2001
PHONE: SANITARY NO. CONTROLNO.
I
MOO ARCHITEC rENGINEER: BUILDING PERMIT INFO
m U BLDG ELECT PLUMB MECH
ya
P,i LICENSED CONTRACTOR'S DECLARATION
Ln Description
g,n 1 hereby aflirrn char 1 am limnsed m
under prorisns of Chapter 9(commenescrp
cing
w w;mSection 7000)ofDivxma3PfdwBaaineaaand Pr°fea.in2n.Cwe.and mylicense REPLACE SEWER LATERAL.
is z in full forts and eRcc %p)a License Lic,a
:o�u Date cltntmviar
a o vFi I ARCHI I LCI'S DECLAR ON
g I underaund my plainshall be,sed as public records
a'3T
i a p O Licensed Professional
LL OWNER-BUILDER DECLARATION
n I hereby alarm that 1 amempt from the Convacmr'.s License Law for the
z 6 following reason.(Section 7031.5.Business and Professions Code:Any city or county $5000
Y O
which requires a permit c construct,abet,i iprove demolish.or repairany strustructurectu
or
'hat he ficrtimacdp t.nu rM1 of io f@ Contractor's eL tv (Chaps 9 p �I�a r. Valuation
. t ci g with Sectiontherefrom
an The x J the l Business dPro@s ions Cad) s, v,f�., L.3'; s' gC1 L-� :IV V s•R SY,_lis.'
1 or that he is exempt ch rnGnm and the basis for the subjects
the a manna.Any violation
-of Section 7031:5 by any applicant for a permit subjects the applicant to a civil penalty
of nor mom than five hundred dollars 65001 202APN SRFLOOR P 'BING Occupancy Type
❑I,as owner of the property,or my employee with wages as their sole compensation,
-WIVdp the work;and he swsure is not intended or offered fon We(Sec.7044,'
Buaideas and Profesamns Cade:The CPm urw*v License law does not apply to an 502 - FINAL PSM2,111QG6ENORGY
weer of property Who builds m improves thereon,and who does such work himself
or through his own employees.provided that such improvanents are not intended or. 507 - FINAL PLUMBING {
pffaml for sade.R hari the bu Id g or ropmvvirmor is sNtl within nye yen of - _ -- .•0. -
completion,the owmanbuildi '11 have to Borden offspoing that he didnot build or
tmpo e for pirrimseor 1e)
01 Liao nor of the property,am exclusa ly ecintracting with licensed contortion,to
❑cwI.avct the project
(See
Sec 70W B ncand Professiam,CWC:)no contractor's
L tl apply c r a progeny I wildsimproves thereon.
W h contracts for such prof t t t rtsl licensed pursuant t the
Contractors
om t License
m o ,S
_.._
B&PCfor this
Distant
are t •,.. O
WORKER'S COMPENSATIONDECLARATION
I hereby affirm undw penalty of pdjury dye of the following doclmatiltm�
1 have and will'imaiwn a Comficain of C moom to self-insure for Wmkee,
C mpemiltorn, as provided for by Section 3700 of the Labor Code, for the
perfon ase.of the work for which this permit is issued.
❑I have add will maintain Worker',Compens5iion lawranm,as require)by Scciion
37M of the labor Code,for the'performance of+he work for which this'nork is
"hued My workers CompIchraiation In,wa ce carrier and Policy number im:;
ca„e 'fl�O(L '; 6PI cy rJ Ch-
e CERTIPIOATION UV E i,MFI'ION FROM WORKERS a� s•f•'s 4 'T .. X 5.4 F1 'w'4••y "'t '''
! - COMPENSATION INSURANCE'.]
• I .
This ton ieeind be completed dine perms for one hundred dollars )!ton v -1}J^-- —... .._...
(s I(pl Lir lest] - t
I ' nJym I 'm pert" q 'nn 'rkrnn m'p< t awtal _._ _ _
aAall of employ y je y a as lobroom bJ l to the Workers �r
Compo soiinn laws bf Cabfymu Dam " "
Q'O 'NOcIt. R _kiniCrlfate pt y should
became
subJ ttoheWor Compensation p aof lie Lobo Cod you must
foh \h pIY with hprovisions
-
or this permit shall k dremed invoked. ,
CONSTRUCTION LENDING AGENCY
rtbY aRim that them sec t f lending gen y for the performance ,
1 ,.„, sol da; ork lilt which the Pomo is u d(Sec 309] C'v.'C) '• '
.❑ 'Lend s Names: _� a.».:...... .. ...... »_ o...• ., .. _... .,
rs Addmsz ,_
(� O .'PJ '• t is ica rat::haat ,.
l I«nate thin I have rtad this city
and on and cute that a about information ion is•
�•'C ortct.I,game 10 comply with all city dad creme ordinances and scary laws reeding.
>i:W !so he sildingmcuwnion,andhembyaection kpresemarives of this city mercer upon
.E.Q. the ahoy o)'agme 1.ned property for inspection and keep
pupoaes., _
E. Q. (tlthdgret msave:indemnify and keep harmless the City of Ca against
% , liabilities gments,costs and penses whit may i any way acerve against said
City in o quece of the g', , goflhis t.
SOP NT STAN AND W �h Y WITH ALLNON-POINT Issued b l
y Date
ore of`ApdipwWCwIpcmr,;;): -, aDam'. Re-roofs
- - HAZARDOUS MATERIALS DISCLOSURE'•'
' Will th applicant future'h'Id ioccupantt hamlle Irwindou.material 7 Type of Roof
defined by th Cupen Municipal Cod Chapter 9.12. d theHealth d Safe,, • ........-' "-"'•"'^^ � _ -- --
Code Stan..35532O )a r 's•' "• + 1
r k ' r .1, r'i J•e t
❑Ya ^ _ " A11.roofs-shall be.mspected prior,to any,roofing material being installed.,, _
Will the applies.,or future building eapant yse cgPpment or do,im,which� If a roof is installed withoutg p
first obtaining an ins ection;I-agree,to"remove
tort hazardous air contaminants as defined by the Bay Area Air Quality Management
�! _ _ all new materials for inspection. Applicant understands and will comply with
1i y6 oY ";�V•° ! - , all non-point source regulations., PP
v+ '1 havewe'h:rmadous materials requirements and Chapter 6.95 of the: t.r:
Ctlifomu ah, afpycodo.s tr x25505,25533 and 25534.l undersund that
ifthe but ,n nrcmrzmlyhave town.that it is my rexgroodclity to notify the
neaps f r a (mems which us,he mat pr a of a Centficwe of
Piton
-
Oc
. ,.,.: °taw
Signature of Applicant _,.. Date
'G rwh..hmd.,cm,, .Dace All roof coverings to be Class `•B" or better. "
OFFICE . . .. . _ _