00100109 CITY OF CUPERTINO TRACT
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BUILDING DIVISION. , . PERMIT '` CONOR INFORMATION,'
BUILDING ADDRESS:' ° PERMIT NO,
"WATER SYSTEMS• PLU ING )07.001.09 - '
*•� APPLICATION SUB DATE
i •. OWNER'S NAME: .. ,. ,
44 - HEPPNER" I_hl" 10,/1.7/2000 '
/ PHONE: , 1 ` _ SANITARY NO. CONTROL NO.
0 O Zp ARCHITECT/ENGINEER} - - T , f3, BUILDING PERMIT INFO ,
W rt F' i .•., BLDG ELECT PLUMB ' •• MECH
LICENSED CONI RACTOk 5 USCI ARAI ION - a -
$z=o LI ny Ir m t 1 1 a p fell pt y( Is ', + - Job Description t
HmE+w '
with S t 7000)of Division 3 f,hI BalinQ,,andP Tcsi n,Cal, alon,license j4l
-t '.- f]If J eO
nt
0 J LivenC� � 3fo— 1 'a��O 4S NEW GRS TO STO!JE 'fOP-
O>?3 a1 Ilene ' C turner
ul ARCHUEC1'S IJhCLAR NOON
} I andetserand at,41 shall be nnJ as public records
0 Lien',ed prafic"s.aril - y >
OWNER BUILDER DECLARATION
=
u�1 I herela,idffinatbar I pt 1 t the C nl 'I Liccr,e I.,ov bathe v '�•
C S frill gr (S,,Ii,,a7(FIS Ba I [Prafe,sain,Cd At,cit, "cranny
q
which rvqoiresap L to clartmet; It p..I,dentolkli,or relesni-liny:t Ire _
ce priorto its4 theapplicartf h perinnitt fileasigatial.tN nl
that he licensed parsuran to the provisions oftJoec I t License Law(CI try Sq. F+t'FloorArea I ' Va]uatlon'a
(w w np w'dt Srcl on 7o0(g of o vi.t a 341h,Business a td Pr,fes.'ons code)
nr that he is cxason WemGont and the basis forme duetted exemp(mn.Any violmian
-of sea on 70315n5aY IPI''mrnra prand(sublcls the applicant
aev'I penally
'nranta etitn live lanneoreddollars($500) " - APNNumber: - ;""; Occupancy Type
❑I,nsownerufihepropTty;ennyetnployecxwimwngcsaxthelrsele Co III cotillion, ";yl'' -
will do the k J the t t is not fireadvit or offered for sale(See 7014
B : oa Proeailans Code The C I cl Lealse
'Law does hot.apply to or
- Required Inspections
n" fproperty Whobuilds p sd d h h workh' If
m lth h. enptw provided br.rich' P al
,
t taterdeda - 106.• SEWER & WRTER .
offered f -If,ho thebuilding pmvemcal i sold within one year of s,
cotpll d 1 11 III d bNn Ip g that held not holder ���. — -
mp rip p . 111. UNDERFLOOR PLUMBING
Ll 1, nnep ar s u r e ommnrt to 301 —=ROUGH PLUMBING
construct me project(Sec,,W44,Bua,aac,,a d Profei .Crile)The Cortb ler. 302_— TI IB' '$- OR SHOWER
LicenseLr d not apply loan ownerof property who bn Id p _ s th en '
and h t I:J h rejects-swim v contmctnrfx)I¢ee...l p nl t the ', -_
Cat L Law. �50'c FINRL. F'LIJhIBING•-EhIERGY
of xenptiaderScc. B&PCfor thisroarer 50Fy : L3AS TEST.. -
Owner owner Dale 507 FINAL -PLUM
„WORKER'S COMPENSATION DECLARATION -
.+s
I harach,Ob...i ,ad,,p mhY rp 1 Y if the fidlowinjdcl pt s
a
Cl I h' d 'll r Ida C n'I ace f Consent tolelf-jisar, lot Workers, A'
Ce t pen.ma n as prosided for by Section 3700 of the Labor Cal for the
,,foorare,orm kia,,fielhilai,p l i,k,r,d. I -..
;. ❑Ih d 'll nt' W k ,C,naptorinjorin.wnmis heoplaitc!by Section - 1 ^/
-37N)of the Labor Cod lot the perforthance of the work far which this porn t is
- sued My o '.C pc salon Inwmnce cvrr a and PoI ey numher.tm - - O •r
ff -
X crier:• AFL role>N,. , HY)07 .. - -0 - ..
RTIFICATION OF EXEMI TION FROM WORKERS " sf d `
COMPENsxT ON INSURANCE
c r+.
i
(lok,calfbaLedrial,e co nplemdlfihe permit isb hmulrcAdellats ' .Jt - ,
($Iap nr le.a.) -
I ccredy Ihat In the fae,fcanaalra,at the wak fit,wh ch this perm t'x shed,I t -
'hall am etaploy any person in any manner eo;is ,,becaneobject lo'the Workers'
Compensmion Laws of Callfemia.Date - -
Applicam
NOTICE TO APPLICANT If,after making this Cw'Iic"ne of Exemption,you should
hectare aublaa ro theWorker's Cpn provisions r the Labor Code youair"
forthwith conply with trialp ca or perndt shall he deemed revoked. ` a - `
z � ions - � t.
CONS rNUC❑ON LENDING AGENCY
ti ..
I hereby elfin that there isacoodractron leralingageneyforths,perl'onn nce
F > of the work for which thispcma t a rwred(Ses,307,Cis,C.)
tn. Lender's N:me
Leat Addr..
V Iccrlly flat 1have l this ap,h,cancira d sidethin heah.,ic infictanner
correct,I ab- in carply viih till city J counly onfi1 state laws retain
V 'tolbrild k coat,......i,and hereby ralanin,elarewitudivI,of his city merle,apart -
rY Lit the bo -( JI p ly forne,prociiian halpow,
(W 1'b I d a 1 iy Ik Ih „0 Cly ICP f against r i
fn ZI lianll 'add,, I. a I p 's h toy Mary way ak'inst,sad
U City N h 6r.mt hi period - - - f� s
APP .N1 STAB WIL C 1PLY WITH AILN N- INT e C/
u oNs 16 17Cb Issued by:` Date.
'Si• m "PI ic,nt/Coor aor.VOW I Dam Re-roofs- ,
HA'LARUOU ATER ., ISCIASURIi
Will the iirpr�anlernaum utpaalwnren'handle n,vtamnstmr`"nl TYPeofRoof - - -
a.del red by the Cupert nn Mu aiCp Cn Ch ipter 9 12 mA the Ilealth'md Safety
Cale.Section 25592(x)'+
Cl Yea, - C:1 No All roofs shall'be inspected'pricr to any roofing material being installed.
^Wiltneappueatat,errmmebuilaiognceripamasecyuipmenadeviasItart If a roof is installed without first obtaining an inspection;, agree to remove
II ll hurnNon,air conmminants as diehard by the Bay Area Air Qnulity Man6gcemnt ,
District? - all new materials for inspection. -Applicant understandsandwill comply with
°Yr'. - '0 No
" alLnon-point source regulations.' '
Ah r h d ,2,'x11 y nix had,,Ch pl -6.95 of Ino'
ift Cd Sec' s 550525533aad255341 d ,t dmat
f dy I n I Ih t t'. -y hltyt ft"In,ms a n beme atios.uu aof n Cc I cote of,
0"6Signature ofApplicant ' o%Dateagent - Dale All roof coverings to be Class,"B"or better-
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OFFICE