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04010070 CI'PY OF CUPERTINO �. �^ -'"' BUILDING DIVISION PERMIT CONTRACTOR INFORMATION „ A�,oe.::1 Bun.DINGADDRESS: ROUNTREE PLUMBING HEATING fftTND04010070 1 04qc; CZ 1-17 LNT7A PT ITT) 0'ER'S NAME: PERMIT ISSUE DATE L N ' PHONE: - SANITARY NO. CONTROL NO. 6502980300 ARCH=CT/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MICH _op LICENSED CONTRACTOR derp DECLARATION Job Description LL wF I hereby a)Rrm That I am or Business under and Prones oris Code. 9(commencing P ?ZW with Section]OW)ufDivision Jof the Rusircyznd PrafessiansC dc.anq license is 5t in full % G,i'G Lica G✓�`�d� REVISION--PLUMBING UPGRADE ,,,tea Dam Contr me NO NEW PERMIT ISSUED #03120107 ''' ARCHITECTSD ¢ids Iunderstand myplans ahalllknacdai amkreeorda CONTRACTOR: RUNTREE PLUMBING (#20970) >dU C G Licensed Professional 5 OWNER BUILDER DECLARATION a S I hereby affifm that I am exempt from the Contractor's License Law for the Cc o following mason.(Section]1131.5.Business and Professions Code:Any city or county K m which mquiru a Permit h)constmel,alter.improve.demolish,or repair any someone poorm its issuance,also requires the applicant forsuch permilau rile a signed statement < that he isW:ensedpursuanttotheprovisionsoftheConlracor'sLiccnselaw(Chapter9 Sq. Ft. Floor Area Valuation yi= (commencing with Section 7001of Division 3 of the Business and Professions Coo)or y $ that he is exempt Mention.and the basis for the alleged eacmptian.Any violation of $6000 Section 7031.5 by any appliant for a person subjects the applicant m a civil penalty of APN Number Occupancy Type not more than fin hundred dollars(SSW). P Y YP ❑1,u owner rf the pmPeny,or my cmployhu wish wage u Ncir sok compensation, will do fie work,and Ne so m u e is not intended or ottcad for sale(Sea](11,1,Business and Professions Cade:The Conlracmrs License Law does.1 apply to an owner of Required Inspections pmpeny whu builds or improves thereon,and who doessuch work himself orthrough his Own employees,provided Nat such improvements sac not intended or inffered for sale If. however,die building or improvement is sold within one year of completion,01 owner. builder will have the burden of proving that W did not Wild or improve for purpose of sok.). ❑1.as owner of the property,am exclusively convecting with licensed contractors to construct the project(Sec.70at,Business and Professions Code:)The Contractor's Li eerie Law does not apply to an owner or property who builds or improves home,and \� who oanoacts for such projects with a conose ar(a)licensed pursuant m the CanlrimWel License,Law, LiI am euverapt under Sec. .B&P C for this reason r Dam \ WORKER'S COMPENSATION DECLARATION 1 hereby affinto under penalty or perjury one of the following declarations: \\. 1 have and will maintain a Certificate of Consent to surf-insum for Worloes Coupon. satinet,Or provided for by Section 37W of Ne Labor Code.for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as aquimd by Senimn 37W of the labor Code.for the performance of the work fm which this permit is issued. My Workefa Compensation Insurance artier\an�d Policy number arta o n cam":.ZUri/P/ gdl"n.No.:�^/�' �eA(i<�i •OL CERTIFICATE OF EX ON FROM WORKERS' COMPENSATION INSURANCE ('thissoctihm need not bo completed if the permit is for one hundmd catboat(SI W) or Coal I certify but in the pe humamcc of the work for which his permit is issued,1 shall not employ any oetsan in any,manner so u w bccume reel to Ibe Workers Compression Laws mf California.Dale Applicant - NOTICE TO APPLICANT:If.after making this Cenifici m of Exemption.you should Wetmore$Object to the Workers Comr,cmadon provisions of the Ichor Code,you must .J O foMwida comply with such provisions or this permit shall be themed mystical Z " CONSTRUCTION LENDING AGENCY ., Ihcah firm that then is a Constitution ending C4 ya gagcrmy for Nc Performance of W 7 Le work for which anis permit is issued(Sec.3(MJ],Civ.C.) W Q Lender's Name Lender's 4' ndcr's Address - oz V Q I certify that 1 hawply rod this application and dile c el and shore information relating i$ C)U cording I agar in ctcn.and with all airy and county ordinances and sec t laws r upong ler QO abovengconsned!construction.and hereby auNorixrtoses. tins of this city to enter upon the above mentioned! I.cony for imnify ru purposes. � y (We)agree to save,indemnify and keep harmless the City of Cupcnino against � I rq liabilit ,eA'/'cru.costs an PO mass which may in any way accrue against said City t„) z in aon$e cng(OfN g,a flhis permit. '-' APPLI A IN Ent DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Sou EGU "41-0 y / Re-roofs Sig urc o A Iicaml oro tort am H OUS MATERIALS DISCLOSURE Type of Roof Will th¢application or rumm Wilding Occupant nam or handle hvudous material as defined by the Cupenima Municipal Code.Chapter 9.12,and the Health and Safety e. et 25532(01 lYea ga All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which -If a roof is installed without first obtaining an inspection,I agree to remove emit hear ous air contaminants as dclined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes P. ve I haCall Ne havardn/s materials morim mmu under Chapter 6.95 of the Cxlifor- niaHeal adelycupe, chin 25505,'15533and25536.1undcrsmndthmiflW Wilding does n ally h( Nn it u my reapruihililY m mufy IM oceupml of Nc mqo kewhm h s aclpnnr uissuancenfacan;BcamofOccupaacy. Signature of Applicant Dale D 'red age Dne All roof coverings to be Class "B" or better CITY OF CUPEWFINO i�nnom� ' .ii!pp.�1�'l /'�� /gy(�pp r�>r1�� BUILDING DIVISION ff vt C�tVI'41�t4C�y4�IL\�Q�M�011 fj BUILDING ADDRESS: ROUNTREE PLUMBING HEATING- @ CT"°04010070 OW NER'S NAME: PERMIT ISSUE DATE LONG ' NE: SANITARY NO. CONTROL NO, 6502980300 ARCHO-ECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH 0 0 0 0 u o o LICENSED CONTRACTOR'S DECLARATION U n with I hereby affirm that 1 am Ilanud under provisions of Chapter 9(commencing Job Description Section 701U).f DiA,a n 3 of me nieincuand Profession,Code...' yeeensc is g z in;��;,',�"c;`„ae'`r�f; c3C L;c;a 3 - �✓ �JrV REVISION- -PLUMBING UPGRADE .., �t=tl Da cum, toe NO NEW PERMIT ISSUED/$$03120107 I ARCHITECT'S DAG s understand my plans shall M used I abbe reca,d, CONTRACTOR: RUNTREE PLUMBING (#20970) eau 0 G LianuJ Pmressianel g OWNER-BUILDER DECe Cmu ON . `�<S 1 botchy affirm that 11. arsine from tW Conunnord Liccnu Law o fou tW .p O following ma.,on.(Section IDI I.S Business and Pmfcs,ions Cade:Any oily or county K$ whim tribunes a pcnnit w cnnslrvct,alter,improve.Jcmnli,h,or mpairany slruv'tum poor to its issuance,alsu requires the applicant forsuch Permit to rile a signed statement a that he is licensed pursuant to the phvirionsnf,hcContrictor'sLiecnuLaw(Chapter 9 Sq. Ft. Floor Area Valuation y:O (commencing with Section 7")of Division 3 of the B usines,and Prorasinns Coda)or i 3$ that he is,umpt therefrom and the basis for the alleged e,empticn.Any violation of $6000 Section 7031.5 by any applicant for a permit subjew the applicant to a civil penalty of APN Number Occupancy Type not marc than five hundred dollars(5500). 1,as owner of the property,or my employees with wages as their sole compensation, will du Ne work.and the swcture is not intended or offered for age(Sec.7 4 .Business and Professions Cadc:Th,Contactors License Law does not appy to an owner Of Required Inspections property who builds or improvers daemon.and who does such work himself or through his m-n employees,provided that such improvements are not intended or offered for sale.If, however.the building or improvement is sold within one year of completion.rhe owner, build:'will have the burden of proving that he did not Wild Or.improve fur Fattener or ale.). p 1,as owner of the property,am exclusively contacting with licensed contractors to conawct the project(See.7Ba4,Business and Professions Code:)The Contractors LL rt,e law does not apply to an owner of property who Wilda or improves thereon,and who eontncu for such projecu with.eonuaaor(s)lic,nud pmati nt to the Cimarron, License Law. ❑I am excmp,under Seo. .B&P C for this teason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declamations: ❑I have and will maintain a Ce driam of emuent toself msum rot Warkers compere adman,as provided to,by Section 3700 of the labor Code.for the peAmmancc of the work for which this permits issued. I have and will maintain Worker's Compensation Insurance,as required by Section 3100 of the labor Code.for the performance of the work for which this permit is issued. My Workers Compensation Insurance artier and Policy number art: Carrier:?u 1Z 11" 9^`_e/ 1 ;y No.:w C 'tet- �L \7O/ CERTIFICATE OFEXCKFr1ON FROM WORKERS' COMPENSATION INSURANCE mons arction hired sum W eomplemd if the permit is(mone hro died dnllus(SI00) or less) 1 trinity that in the performance cilia work for which this Permit is issued,1 shall at employ any person in any manner sa as to become subjecno tW Workeri Compensation Laws of Califomia.Dam - Applicant NOTICE TO APPLICANT:IL ancr making this Comficrm of Exemption.you should become subject to the worker's Compensation provisions or the Labor Code.you must .J O forthwith comply with such provisions or this permit east be deemed revoked. 'z "' CONSTRUCTION LENDING AGENCY (-.�.. I hereby aMrm that there is a eonstrvelion lending agency for the per(mma c or D: the work fur which this permit is issued(Sec.3097,Civ.C.) [sl A Lenders Name ,=,z Lenba's Address O C) 1 certify that 1 have read this application and sure that the arrow,informa0un is U, P correct.1 agree to comply with all city and county ordinances and sum Iasis relating to 0U building construction,and hereby archaism representatives of this city to enter open the W almovom,ntinned property for inspection purposes. Fly (Wer)agree to save,' dcmni fy and keep harmless the City of Cupertino against N liab;litics,' g c�ts,casuen penaexwM1iehmayinanywayaeemcagainstsaitlCity 1 G� in cone fdt g [this permlt. / U Z APPLI AN E0.. rn DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU LGI Re-roofs $igJam uaoA rcanv am em, [.nate H DOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle haallous material as defined by dac Cupertino Municipal Code.Chapter 9.12.and the Health and Safety - Code.section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed. Yen ISYNa Will mea applicant ru urc building occupant use equipment or devicea whim If a roof is installed without first obtaining an inspection,I agree to remove nn s p a Air Q emit M1a,ardnus air contaminants udcrined by erre Bay Arca Air Quality Management all new materials for inspection. Distriet7 �u ❑Yes 1 have ad the ha,ardoes materials requirements undo,Chapter 6.95 of the Carron. nix Healdddd}}}}�� afcty Co c, c 15505.25533and25534.1undcrsmnJthuirdae Wilding daa�curly h , derail u my respo,uinihty m notify rte necupant of the ' mgetr iswhic n a,elpdor ,issurba.f.Cumdnate.ratrufsky. Signature of Applicant Date o>� r..ed ase Da, All roof coverings to be Class "B" or better M0 CITY OF CUPERTIN# CITY OF PERMIT APPLICATION FORM 7 0 CUPERTINO off 0 ( o APN # �7 _ _,D' Date: Building Address: Owner's Name: Phone#: L 0AIA s 2�e ✓ G e • 2 �d'. v,7 0 0 Contractor: License#: Contact: Cupertino Business License#: J Tl-'7ic-r�l i.c/�t�sJ/f i0 Building Permit Info: .Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: Residential 0 7 tW,5 ~ merc `Sq.Ft. Floor Area: $/Sq.Ft.: _ /� �-: Cost of Project: � r }i!u � Occupancy Group Type of Constructi Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax —Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL L BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING -2,*1'� L �2y z 3 � r159 SO1of3 /