05080142 FCITY OF CUPEWrINO
BUILDING DIVISION PERMIT k CONTRACT�ORJNFQRMATION
BUII.DINCADDRESS: AAAA-DRAIN PATROL PERMITNO05080142
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C R E QF. MAT)PTT)
tONE
ER'SNAME: PERMIT ISSUE DATE
STANLEY BRUNO 2400 LINDBERGH ST 08 17 2005
: SANITARY NO. CONTROL NO.
(408) 989-6005
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
woo LICENSED CONTRACTOR'S DECLARATION
4 u+G I hereby+ffirm Inas I am licensed under provisions or Chapter 9(commencing Job Description
SZa with Section 7000)of Division 3 arrive Business and Professions Code,and my license is
n.iy in bull force andcrtea REPLACE MAIN WATER LINE
? License Class Lich
p Dau Contrmmr
ARCHITECTS DECLARATION
c1 undersand my plans shall W used as public records
U
(0`G Licensed Professional
3 OWNER-BUILDER DECLARATION
<F I hereby,from that 1 am exempt room de Contracmrs
License Law for the \
n o following mason.(Section 703 L5,Business and professions Code:Any city ar county
i m which m4uims a permit ser construct.alter,improve.demolish,m repair any structure $2000
uzi pnO to its issuance.also requires the applicant for such permit to rile a signed satemem
site,
thalheisliecowdpursuanttoBeprovisioneaftheContractor'sUccnwLaw(Chapmr9 Sq.Ft. Floor Area aluation
YI (Commencing with Section 700(8 of Division 3 of the Business and Professions CoJe)or
i that he u xe
empt IMmfmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by any appliam for a Permit subjects the applicant to a civil penalty of Occupancy Type
oat more than Eve hundred dollars(S500L
❑1,as owner of the property,or my employees with wages ss their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7W.Business
and Professions Code:the Contmcars License Law dos not apply to an owner of Required Inspections
property who builds or improves hereon,and who does such work himself or through his
awn employers,provided Nat such improvements are not intended or offered for sole.If.
however,the building or improvement is sold within am)car of completion,the owner
builder will have the burden of proving Nat he did not Wild or improve fm purPose of
sal.).
❑1,as Owner of the property,am exclusively contracting with licensed eanaacmrs to
construct the project(Sec.7044.Business and Profusions Code:)The Contractor's Li-
cense law does not apply to an owner of propcny who builds or improves thereon,and
), who contracts for such projects wit a comiscuu(s)licensed pursuant o the Contractors _
Liana law.
400
lam cxcmpwndv5 c. .B&PCfwthiampon mr Dau�J
WORKER'S MPENSA 1 N LARATION
1 h mby affirm under pempy of perjury one of the fallowing declarations:
1 have and will maintain a Certificate of Continuo alf-insum for Workers Compass-
-arm.as provided far by Section 3700 of the labor Code,for the pertarmantt of the ._..
work for which this permit is issmd.
❑1 have and will maintain Worker's Compensation Insurance,m myuired by Section
37W of the la W,Code,far Ne perf rmamec of the work for which this permit is issued.
My Workers Compensation Intimnce artier and Policy number are:
Cartier, Policy Na:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu action need not W ComplcaJ hrhe permit is ler one hundred dollars($100)
or less.)
I Certify Nat in the perfamimc of rhe work for which this permit is issmd.I shall oat
employ any Person in any manner� yuyuo tie Workers'Compensation
Laws cmdoi,Califoom in au 3
Applicant tea- h,5 r✓
NOTICE TO APPLICANT:If,aper makin�s Certificate of Exemption,you should
became subject m the Worker's Compensation provisions of the Labor Code,you..at
.J z forthwith comply with such provisions or this Permit suit W deemed reveled. -
z CONSTRUCTION LENDING AGENCY
F� IWreby affirm that there is a construction lending agency for the Performance of
x 7 the work for which this p.it is issued(Sec.3197,Civ,C.)
Igl QLender's Name
11 Lender's Address
az
U O 1 certify that 1 have read this application and show Nat the above infannadon is
E' correct.1 agree to comply with all city and county ordinances and sole laws relating to
0 Wilding Construction.and hereby mrhorn<mprescnutivcs of this city to enter upon the
}W show-mentioned property for inspection pupv+w.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
F r%j liabilities,judgmcnls,coals and expenses which may in any way,sena against said City
U z in consequcnec of the granting of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 7-a +`
SOURCE REG TION
✓s � 4 Re-roofs
Signatw of ApplicanVC tenor �� to
' H ARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicantor future Wilding Occupant Chaptstoicor handle Health
sd WCL]
az def neU by the Cupcnibo Municipal CoOc,Chapter 9.11,and the Health and Safny
odu.Secma 25531(a)? All roofs shall be inspected prior to an roofing material being❑Yea � P P Y g ginstalled.
Will thea rant or future Wilding If a roof is installed without first obtaining an inspection,I agree to remove
pp g s esu equipment lu devices which
it ha>ardous air conaminanu az defined bby y the
ive BBay Area Air Quality Management all new materials for inspection.
7iaHCaIih&Safcy,Cuda,
T havemad theWnardousmaterialsrequiremcats underChapter6.95 orthe Califon Sceums25505,25533and25534.1undcrsmodlhalifthc Wilding
rs not cunenlly have a womm Ino it a my reep"nsinliry m notify rhe aecupant or the
alamcnls hmu Wmct 'or res issumcc ora ccnircate or spam Signature of Applicant Dale
Owor aurhomeJ agat Data All roof coverings to be Class"B"or better
• - Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: � �2P7�d 64 PERMIT#
/Ow
OWNER'S NAME: S lx�: k� PHONE o 9V60
GENERAL CONTRACTOR Z FAX # /
J",
I am not using any subcontractors: 7
•gnature Date
Please check applicable subcontractors and complete the following information
CONTRACTOR 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
I �
E� CITY OF CUPE XINO
EPr /SEWERS/ IN sERv�
= CUPEi�TiNO PERMIT APPLICAT FORM
APN# 3 �5 ®�— O Date:
Building Address:
Owner's Name: Phone#(4VZ5-3 5'7.17
5
Contractor L hone: License #:
- V2A1N 4.
Contact: Phone: Cupertino Business License#:
Building Permit Info: J
Bldg ❑ Elect ❑ Plumb LI
Job Description:
Residential Commercial ❑
Cost of Project: ��
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping Sys ern Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING
4. 3 � � � 1