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00090090CITY'OF CUPERTINO '.„-'• ' "' '' •' CONTRACTOR INFORMATION: -- ' - - ` - -- ' BUILDING DIVISION ' - ''. PERMIT � �;' '. ,-. •- . �'" BUILDING ADDRESS' q' i' PERMITNO. ^' OWNER'SNAME'. F — - APPLICATIONSUBU_KfE [• - 09 4 15 J NONE. _ e t' - SANITARY NO. - CON I ROT NO. ARCHITECT/ENGINEER 1, ° • BUILDING PERMIT INFO' 'a' i 'L• f 'rBLDCFLFCr,,., ._PLUMB ) MECH . t - LICENSED CONTRACTOR S DFCI ARAFION1 mg. 1'.: r tion I hereby affirm that aIle ed 1 P pt fCh'1( .lob-DOSCrl _ _P j wld5 ti ]IMyO) fDiv.v'on3 n[me Br rill Rosi Coal and ny ester inlllf aadofIn1 „- Dot cl.° r n Date - Contractor WATER HEATER - - ARCHITECT'S DECLARATION c' • - + . , 1 understand ny plan, had be pool a: public roe nls . - - r " ,� - Licensed Profensiawl -: 'OW'NER-BUILDER DECLARATION 'S• I hereby affirin that I a opt from the Contractor's License Law r the following .(S I 70315p dP'f'' Code AY oil, or corrry which residues p t t : puu, iilm,rdi demolish,it claim any stru t prio to to t uaance. also reports the...IT tfrr such drarit to fla a signed statement 4 tied he T In s' a top ' t nI Contractor's E L' (Choice, 9 _ - ' Ft. Floor'Area �' 'Valuation ' (eon n,nein,wth Sectio. 7000)ofUv's' 3 film Busidsand Paul ws'om Code) ,S 4 .: - - ni dot he is exempt merefrnm and the baxix for the alleged exommurn. Any violation- - +,j - ` ' of SccfUn 70n 5M1Y a. pPl'ntfma 't hl rethe ul Pl' trurdvilpenahy -df pest.,are m,n l ve I e d d,nam (seam . APN Number . Occupancy ylp ❑i ae nfine pa,perty.rrmy emphy wth wabcsvth la comp,.o. tin - r will do de, voi and (he quaddir,t'intended m, rrifficared C .ve .mv. 9144' Nus . Id Pr f o. Co1 Th Contractor', L se Low dee, et pply t - , •t egmred Inspections remer 5f property Whob Id p . di e n and who J h k himself S or through h, aw, ped'ided l t inch,imp'n'remems amt , aterall If m biking Id - l t - "' — FINALr RLUMAI'NG ENERGY _- aflaredmrnote, a ti central I, lid now Ywror completion the owncr h Id will move the traded f proving ohm he 1'd of build or improve rorpmsesaf:ale). - '1 - .50E ' '. r''{506 - GAS- TEST- ❑ I. tc; owner a11ire piapany am eseW,roely amWtdng wnh'hee i.�d eamirrames lai" 507 '— FINAL - PLUMBING l t Ih p l t(S . 7044 B d P f :.' C d 1 Th C la t' Line L does t apply r - - I property 1 , hu IJ improves thereon,i and ele c6ifor Tuch projects with a confetti Imersed par 'ualt to the11l1II-- Contractor L' „^ 0, , .cL El Ian exempt neer Sec B & P C Io this ' Owner Utc WORKER*S CGMPLNSATION DECLARATION V ' _ Ihero-by fill. J,p Ie fperjury Troch11 61 kr - .• r 11 and will. t C tf t f3Convert LI If o f We, k omlwn rot n a pi d f by Section l]IIO I' the Labor C In, for the Pert roar fm kf n whichth': poinnit J . +,(„'- I ' Y/ - -El I have and ill maintain Works,', e. 371Hy Ire Labor C 1 f the .performance Pc m of the k7 o'd cd pS 1 T 'Issued My WakersCompensation u lnroc carrieradd Pol y bei aa., t ID IiVI/_l) (/L r . - lt L ©/ Car ier _'PolcyNo. CERTIFICATION OF EXEMPTION FROM WORK FRS n'. 1' COMPENSATION INSURANCE + 4 V (Thissection neednotbeampleiei fol Icnnit's for ane hundrcdddlare 1 - f.C sorrily firdin he pry ne of the k for which i 1 p .' 1 u shall t pltoyy any p any nner: m hewme 6hjcet m he Workers Work... 'Comp :esti . Law, rdf(LifiSnart. Dues„- • -r- - _ -' .ARilmme •' NOTICE TO APPLICAN9 If, you nnld -, becomesatiate, Labiamym '- - fonhwith cmply with such p orthis p it eallhe dertted invoked. , - ` CONS TRUCTION[.ENDING AGENCYof m Ih t .m ann Iandmgagecyf it pafarmancc Zak - - lot whichpe wh'ch th:l permit I, found (Sec 309'!'Cv.0},. Lea*'f Lender Name Lentler'a Redress- Iroad, mm l lae-ad this ppl t d mormthnhd'admi information correct 1 agree 1 c ay with all city slid county ordinances and sta,6 laws 'oWf 6 mholding construction, and hereby colon I ti v U Buis com y entor uponl .. the b toned popery for mpect purposes p ^' '. - ' • ° (We)'g In .ave mdcnnfy and kne, hantri (lie City of Cupertno agabro hab I t'uq didgunions.d I, and expenses which may in any way iscma tgv nst said !' . - r' City to consequence ofthe granting ofthls permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT -' •SSny. 'Issued Date SOURCE REGULATIONS _ Signature ofA limn Centractor Dme g PP r ' Re -roofs HAZARDOUS MATERIALS DISCLOSURE , - - -. Will rewppnt er dl h' ad a nateriW future bpal ;Type Of Roof - y th Capent Co Code.redbythaCupon' oMunic'pal Cale Chapmr 9.1'_ andthe 'Health and Safay 129 a '• Code. Setlni 25532(a)'. - - - �` k,.. - � C] yes +.o No All roofs shall be inspected prior to any roofing material being installed- Will the applicant or fmm'v Nodding acupant neo equipment at device, which If a root is installed without first obtaining*an ins inspection, I agree to"remove P b' emitiel? fps air contaminates as . "- b me Bay Area sir Quality Management ixvia0 .- ' 'r;: - ` °,. all new materials for inspection. Applicant understands and with . YevON. ,,. t • ,will.comply' allanon-point source regulations. ' 1 have fwd the h ct,inuffind, mall,mls re,riounwat, urdcrr Chn,ter 6.95 or the - - CClimminflealth&SafayCd S t 255052553A d255341un1 ,1 dth't - ifthebude'ngdoesnot rently have a tenant, that h is my repnshality to rely the . •+ � acppam f the equifvnmm, wh ch nus re et p t e of a Cwn l came of ' m ”- ' oae p. .y - Signature-of,Apphcant• - Date ' r. -"All roof coverings to be Class "B" or better own rmanmm,.dag I D,rte OFFICE r I -