01020014 CITY OF CUPERTINO - . (
BoILDING.DtvtstON . PERMIT CONTRACTOR INFORMATION:"
BUILDING ADDRESS, 5 ' P17RMIT NO. • -
22354 CARTA BLANCA' ST CUFERT,INO PLUMDING 01@^c@@14
..
OWN ER'S"NAME: - _ APPLICATIONS AAT ,D
' • HELEN "& GUELL„LU 102297 "S DE ANZA BL .I !E1/,5/2901
PHONI:i SANITARY NO. .' CON"IROI,NO,
(A08)283-0618 In
00 ARCHITECTIENGINEER: ^+ - BUILDING PERMIT'IN'O
- BLDG ELLCI PLU MECH
t
O m 7 LICf PMd)CONTRACIOId S DFCL ARAI'PON `- - 4 . •rt- 2 '
recess(....
1 povix s of Clupler (commencing9 ]Ob Description
r ( _ r'
O'Euo1 wthb f ]ll(10)of Dv,omSofine Bu.' dP f of C Ic ufJ ryleefse
� "efll� nttatf_'t3 1.If h e�p�° _COPPER REPLACE '&, CIRCULATING SYSTEM
f3 3 u y ,D:nc S c Tt - `
t- O ARCIII'i'hCl S DLU AHA ,
1 d .TJ mypl still he med :p Fl N'
Cx Licensed PI.. I r S )
XOWNFR]WELDER DECLARATION ,
ul�in I henchy 11finat deal I a ,l front the C 1"a LikerovJ`wbalm,
- -
C a y' full 'ng ren (Seelion 7031.5.Business and Professions C 1 Any city ier county
Q
' FrtO wh.. requires-" c, L r t th t h p demolish, ystructure
prfile
y .
"uj 3F ir t t I pal' tf Ip tt 11g Lrt m t
mato Ip : t ton nn c t f r L L (ch pf 9 n, Sq' 1
Ft.'Floor Area, _ �f�tlpp�@@
(c( B '0 5 t 901N)) [D ”. 3 rlh R JD fission,Code)
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r that he I,cs,anlu therefrom find be basis for the'alleged evre,nion.Any vnam da - -
(if Section]01156) Y 1pl tf ins (. b) applicant is the applca ac it ,rally,
Lt t m T h mreddollars f$5(0) `APN Number Occupancy Type
.°1,". twnernfinepmlx]r,nrnrempltre,wmwtse.nrmeir=alee„tnpet.arnn "32613@4@. 00
will J t
tl k and m (na ( t 1 1 H. I f 1 IS ](W4
Businic,,and 1 r f CodCodw The C f a 'lu : 1 d t apply m an •- Re ed Insppections
Tp I ny Whobuild r p m d n 1 kli self 202 — H N D ERF L OOR ,PLUMBING.
ooh ough In,own empin)ae,.Prov d.J(h t ..h'mpn,erne n,are mm mended or _
offered for sale.if,hnwe,et:the nnilmnk or improvement i,."aid.,if bbt one year at 301 ' i-ROUGH PLUMBING,'
completion,the owner-bdJder will have the burden of proving dmf he did not hold or -
mproveb,rparposeoramey 502 .-'''.FINAL,PLUMBING ENERGY ,
❑I fd .p (r .I : ly rg ter 1 tit in .507 FINAL�,PLUMB'ING ..w .
construct the p tett(S .l0aq Rminc s and Profess e n.C I J:The Contractor's '
License Last,does not apply in an owner o1''emerty'whei build,m improve,Thereon, N, - ' f
and win,contractsfar_ 1 profom.with ac T"omrta)•I I patio I m tlac
Com t License Lu `
°I a.eaemPl t orders e 11&P C onylon,rea,on
Owner Die
WORKER'S COMPENSATION DECLARA9'ION ,f
1 hereby affion undei,ppeally ofPcJ )InseI flul 111 ',dicb.1i. -
u'•.° I have and sVill maintain a Celleficale of Consent 10 irit-infoupfor Worker', _
Compensation; as provided f by Section 370](1 of the Labor Code, for the
pert mice oftheworkfou which the perm is',ued.
1:11 have and will m antain Worker's Compensation Insurance,as requited by Sedan .-
3900 all the WMtr Code,for The�perlormance of the work for which mis.pemtit i,
rear
CarracTlJZf`� (rfi f�l l/'•' c J0 Iervtdu0ePare:0 -
-, CFRTIrICAT10NOPCXCMYIION IROMWORKPRS'
VV✓✓ gt/'f' COMPENSATION INSURANCE
(Th„ f m need not he eranTleacciff the Per.it is for one bunilrcJ doll trs"
($100)or
1 comfy dust in thelu.di n ouw,of the weak for which this permit is issue],1
,hall not employ any person In any miner so as to 6eeome sable.(m the Wn kerv' - " -
ComperaterenLawsofCalifaperDam -
Applicant - - a
.. .. > '
NOTICETOAIPLICANf�z h K' km'c 11 PF pf you lead "bee (( deW ke, pn
,C :( p Lh C -y I
, . "et
O Q fnnhw'th comply with e ms or Th p rn d shall be be beenned Honked
CONSTRUC
'f10N LENDING AGENCY - r r.
I hereby xtl Tri(h t tb�,q (See
lending agency fnr the perfar Lathe work for wh.b th p t ( - . Sa 3119'! Cir,C) + - f _
Lender's Name
Len 1 Address - ,
'V yO� 1 vilify That Ih dth' Ipltan vote(hash h f "t t, t ,• „ - - '
w pi enamel.Iag�m comply 1111,111_ty d county d' -e LTi l latitsv - L
O r„) nhL lJngenn, nm"ndnereby embd prem.eve,trw,etrttemertpnt _ - '
e� W men toneome d p po ry a �n,pemi 1 a le. - y
ty y.
Ito (W)"g t 1 -rya Jk ela any
(h City fG l f b' ¢( I}. ,i
i..i % liabilities. fig t' f d -Inell, nay"n cry Y -e ga n,t iJ
V CT Q 111 ,doting of(hi pc nit - '
A LI A 17 peN1e.I4 fA S AND WILL COMPLY WITH ALL NON-POINT y,
�Vu NA
,:��� Issued b Date O"
Signature of AppWanhcn tsve - nate - .Re-roofs - ...
e HAZARDOUS MATERIALS DISCLOSURE
Will underlie or m( re building o6eacipme,, mhandle ba,andom,mmeial Type of Roof .d-=.e+
a,aclmed by the Capetian Municipal cipal Code Chapba 9 12,and(he Health and Safety -
Code,Section 25532(x)? - _ u'(
o-Ye,. ❑No ', t . All roofs shall be inspected prior to an roofing p p y ,,material being installed.
Wdl the applicant orNIUme tatildingoccusaltseepm"p t ai h`" _ If a.roof is installed without first obtaining an itispection,'I"agree to remove- `
omit l...d......i......perairamb a,der f ed by The tiny Aar.Aur Quality Maaagemea -
Di,lace all new materials:for inspection. Applicant understands and will'co nply with
" °Ye El . , - ' Ml,non-point source regulations.
1 have read�ihchaeaa]...matmfal,reynimments under Chapter 6.95 of the
California Health&Safety Code,Section,25505,25533 and 25534"I mach,stand that �.
fifthb "Iryd :nfutre0y h" annual,al d't y pn'b'lidyf b (ifY(he
,_ seam
e" p t i t q ire t h 1 moat he met pr or to "nomen, f C Yfian t - - '
Signatureof Applicant ' - -" Date t
own d 1 ee eg n( -
Date - t All roof coverings to be Class r`B"or better
OFFICE