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01030141 CITY OF CUPERTINO "BUILDINC DIVISION PERMIT CONTRACTOR INFORMATION ; HU ILDI NG A DURESS I ' PERMITNO. s-•'' - - . 01030141'. . OWNER'S NAME. ( - APPLICATION SUR DATE 03/26/2001 , PHONE: - - r" - SANITARY No CONTROL NO: OaZ ARC]11'TF.0 FiENGINEER: � _ - � ~ '' RUILDINGPF.RMITINFO ". O O _ •, t .. '• BLDG ELECT PLUMB 'r MECH ��� - - - I � r• I-1 _ �I ISI' ISI h` LICENSED CONTRACTOR'S DECLARATION', . ,+ Job•Description ,. p y 0 1 hereby,affirm that lan,licer.darde,,devikidid, f Ch Pt 9(' nen ag = C<3Cro -with Secion]WO)of D' ,ion3oftheii s 4, - " aYs xmfull f d cffiec, GASrREPAY',R, At lmya ❑d CI:. _ _ Lord rgk�O W F Due - Cmaroadur - W 3 a m ARCHITECT S DECLARATION °.g I understand my plans sholl he used it,public mennlx wpp� LhusedP fess aty OWNI k BUIL DI R DECLARATION I Irced,y.f5m, an I a.cantata from the C I'cl Liocda,Law fade f < follown,brion Notion 709158 mr,,andP T:' Codoc Any city or county $ ❑ which ox,me6,a R t l a t o ltd p IF.....l.n n 'm y annual, afailed,pcouiltofilea,i,relidittermet ' In,he : Ipunanott theproAkinclofo C t t I laace.I (Clrpa,9 S,q. FL'FIOOr Area + Valuation (cum ewmgwth Solon OnW)ofovis' 301the Bmem d Prof e..'mis Code) - ' or that he is exemptl f d the basis for th ll g dpl Any tlation of n tl ne thanSr a It�lresii deli`s N5500), nJ6el,ate aper n�a no e l penury- APN Number . . - .Occupancy Type ❑i,;,,r"e,pane t 1 to t .mdt will d Ih. k and tireyi rn is iintended g 11 d l "I (S 7044 y 1 ZI L4 'Rus d Professions c d Tn c t t L' L I h'pply la an " - •Required Inspections-' o.wmr nfpmpe py Whohu Id: improve Rover,and who , act,work h melt rid,la,evadmpleyeds.providedmet cinch are,ewemeno me mel intended at .10F✓v SEWER WATER.,: , offered for sche It,however,the bonding or improvement],sold within one year of - continuum, lot vner-haddr,will mvemehard,.of living their hedid mnbldldo` imp f PEPf'al ), 20c' , I_INDERFI_OOR F'LUMBTN� C, . i .. - "DI nn p r exclusively ' t t"g withI Icontortions d .q, i -01` — tROUGH''PLUh1BINGG' laustmcl the project(Se WA,h]I h a' d Pr..fe,a,a'Cade:) me Ciand ors - ;�02, — TLIB' A OR SHOWER . ic : I d t p,ly t r of pnipeny who hingep 'ds the and f h p e,with a contractors) ed p r:aam t to 5©2 --FINAL PLUMBING 'ENERGY Contractors license Law. . _ - _ 711 mu exempt trod«sec. _ .B&PCrnrthi"i "m ... Opp GAS, TEST - - Owner Date 507 .-;,FINAL PLUMBING' WORKER'S COMPENSATION DECLARA5ION > t IJ I herby ollrn rade,pomltyoflx.lp ad of lot following dalur.tuar , ❑ 1 have and will maintain u Certificate of Consent to self-impure for Worker's Compens5iion, a, provided for by Seaton 1700 of be Tube, Cede, forhea q• - ., performance of the work for which this permit is Issued. D l have ad will,.man Worked,Coup -i In, its q- dbySection^ " 3400 of Ihe Label Cddc par the performance(it the work for which this pert t is. wed.My Worker's Compen,ation lierrance currier and Policy number are. - •• , r _ - - Carrier: Policy No; CERTIFICATION OF EXEMPTION FROM WORKERS' r ' COMPENSATION INSURANCE (This sec(ma need not he a 1plated fthe permit Is fine and hundred dollar ($oa) 1 cenify shut in The pe,rmmauce of the work for which this permit Is issued,1 ,hull not employ any person in any maoner so as u,become subject in the Workers' Cmu'lucarvic IIt's of Clildrusit.Date '� r ', Applicant T NOTICE TO APPLICANT Ifaffeirnmor,thisCenificate,of Exemption you should 'hucnmewhjeam bit W furs C P . t powkiiacofflbc Labor Code,you least Q JF it vim comply will, wh sovidmoorde,pc til dull be deeme+l evoked - - V] -ICONS TRUCTION LENDING AGENCY 1 herth, ffafl tl a elutln 'Wallpaper,fortin, ulcureaund W. y of the work for which This penouti,votied(See.3097 Ce C)'- 'I r e i Lender's Name •P V z Lender's Address r ' I nlylhot I h' 111 pIIcE fat than M1 f y - k Lz f� correct.I agree to comply with all,cify and Smany ordinances and state laws refuting tub ldfny aambuuon and h reby�mthiar,c wpm.enmtives of thfx�ty to enter upon - - •'',,, W Ihe clawn-rarmicandmi p p ty l r I pet a p p F' ! • s (W)-beet indemnify, adk ,haradiii,Th Cy, ICaperton g ta FI V) liabilities,judgment,cosI d expenses Much may' dry Y cmarguilst ad CJ z City in consequenceof[lie gmnfng of,this perion. 1 1. ) _ .. APPLICANTS UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT I SOURCE-REGULATIONS. - ASs6ed by: - Date •' �� - Si,natumofApplleonJComraan, J Date' Re-roofs 'I - .'h •:,,_ HAZARDOUS MATERIALS DISCLOSURE Will the apphum found building v t ww,orn fle nomadnomalim,mulSer] Type of Roof ' , .. as defrel by FeCapertind Municipal Cod Chpt 9.12.and the-Hwlth and Safety -Code Section 255121a). a, Dy" El No " All roofs shall be inspected prior to any rooting maierial being installed. - --Will the apprcart or future building oecu,ma a,,equlpment'or device,Which If a roof is installed without first obtaining 'am inspection, I:agree,Ia remove mit hemrm d ,air C na m NI -amount,a.deemed by the Ray Arr Crudity Management - - ., .- 'Dlnridlt all new materials for inspection. Applicant understands and will comply with, .. DYea D N'. all non-point source regulations. •I have lead the hamrdnas matefilib requlremene,under,Chapter 6.95 of the - CaliforniaHealth&Safety Code,Sections 25505,25533and 25530.I understand that iflhehuildingdoes mecurrcntly have a mmmn,that isnryresparivalitym imanythe S• + )oecupam of the reyu ocraids which const be met Prior to canned df a Certificate of po Occnmcy,•• . • - '• Signature of Applicant Date' - - ownprrranmo,izalagent I --Date - All roofcoverings�t6beClass"`B"'oebette'r, " OFFICE