01040073 CITY OF CUPERTINO
BUILDING.DIVISION - PERMIT CONTRAfCTOR:INFORMATION-:
BUILDING ADDRL',SS', "' ' PER II'NO.
10680 DE.`ANZA 'BLVD. WATER HEATERS ONL 010400-:3
OWNER'S NAME'. - - APPLICATION SUB DATE B
LARRY ENOKSEN/ MAM TRX 500 • . AIRPORTr BL.V:-1 04/16/2001
IONS: - f SANI I'ARY NO. CONTROLNO.- . .>
415)34 -3747.
O O ARCHITF.C'p1.NGINEEk'. ' .ti BUILDING PERMIT INFO
z m BLDG ELECT PLUMB .MECH
4 LICENSED CONTRACTORS DLCI ARAM ION t
Z '- Job Description -
p,4t: Ibembyair rnthat l cep Carl,teJ(uammvne ng P . ..
oeIlhrs ( t,3oM1ba
lcarddeed.i crxccm. per.
w JProhxslonx Gxle and myl'cenre
REPLACE 30 GAL `W T
ER HEATER: '
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�e 3 LL y Dan, .Co reach,
ARC]IITLCT'S DLCLARAI ION
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r , J ypP Ilh uadrepuhlc opened,
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{a4�y Liarrecal l lobo'nnd
J o LL OWNHR-HUILDER DECLARATION +
u� 1 6 by fl fh,I Eternal 1 theC f f L I for tire
C z Q Boll % Ctuation 7031.5,Bassurs,and Ford v Code:Any 64yo,,poody
Sts x p
which relturcs a arrout toa t after,capture, 1 I o p'r apy'structare • ,
pr, I.t,r I'.o"ribe,l ap(,I'a tFor such pe' 'u file a signedtl ncd '
fhill h ' heated orroura unionFaMoor,ofd Connector's I' Lin,'(LI rer9 - Si Floor 'Valuation
•Ica me, ',gwth Sec, 7000)of D'vir 9 fIh BioncessProfession;Cade)
or the(l pt dood n W the to...f thealleged e pf Any violgido
ofS 7091.5 by any•ppl'caul for a vorritsubjects the applicant to a civilpenity _
nfnfratio,than five hundred enlm,Cs5an APN Number - Occupancy Type
111.as owncruf the property.(itm
r y emot
ployees with wages as their sole vnpensartot ,will d (lie work, d the structure :not intended or offised For sale(See 71w1, -
Baiac,,and P f x. Core:The C-ard,pa s License Line J t apply n,a, . - - Required Inspections '
al
t w fproperty Whob ld: 'np- Iacocca, I e n khma.lf :
�;rthrough h. ple"he provided h p enfant dean, 502- _•: FINAL.',PLUMBINQ ENERGY?
offAfar sale'If,h rp1tw t the ro ided i npmvemeot n sole r th (one year of _
complednmthe owne-nldlder will have the bnMen of proving than lm Ad not build Or t 506 — GAS- TEST +. +
improve for puipnseof.wlet L' -
ql a. onepr l ,r' I !vl) r g iMac" en,nfcmnm - � '507. —' FINAL ' PLUMBING ,
canourro the project(See 7094 Boston,,and Pr I..iso Cadc,)'Ihe Comrmmn'v
License Law does nm apply to nn owner of progeny who builds or Improves tberent.
and who cnnfracfs for such projects with a amtraclm(s) firmed pursuant to the -
Connectors License Law. _
❑I pratesrounder See. ,B&PCrnrnhi,,nawo
Owner FINgL
WORKER'SCOME Date ON DECLARATION E '
I heren flv n„der It f . ,`p f life fol) '' +
y P ) pip bJP-1 .. • ear MAY + '
1I and 'll ,o C I'fcat f3 IIs : f Work¢v - � 8 •����.. • a - - -
Con p :a1. n f s pis d J for by Sam 97fN1 ,f the pnhor Cade, for ,he -
everackne,of the work for which this pencon'. ued., -
01have and will man, ' Worker's C p l Insurance as reqdbySaioa soiLDING.
J700 of the Labor Code.for the performance I the work for h this p f n't is
tilted.My Workers Corecrsaion Insurance currier and Policy number are.
Currier: `• Policy No.: - • '
s CERTIFICATION OF HXHMPI'ION FROM WORKERS' _ -
COMPENSAHONINSURANCE.
' (This rection need not be comple,rd if the permit is for disc hurtled dellarx '
I mrfily that in life perJ'ormnnce Of the
work for which 11h,permit is ievard,1' -
xhall'not employ any person in any manner so as to blame subject,o the Workers' -
Cnmperisc inn Laws of Gd ifandin Dale t - -
APPlicnnt
NOTICE TO APPLICANT:If after dialkingth Cedificanne of Exenptnn )nu should
z
become renjuctl (lie W k 'C :ar ion Powa sleds Of the Labor Code,Yount sf
Q fnnhw,h comply with' h groviood.,Or this pe n1.)shall be deduced oproo A. 1 "
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CONSTRUCTION LENDING AGENCY Or � -
1 hcrdby olTnn II I th :tr r dog agency for rife pert rnwnee
f17
ofthe wrnk fm wti ch d,v perm i D esueA(sea]097 civ.C) - '�.
On Lender's Name -
D z Z Lene 9da ,
UO4•
I v,dify that Il etl'. Iyand and ,are the,tire be,,'nfr 'f
W. L~ corn, 6 l ply ,hall IY. ou c1. c ,J duce tyt " Prang
V -to building onxnuu nn p nil l achy amatio p ascot.then this u'ry, eaten poo - - - -
�y W the obovcmcgioncd progenyfor imp insiput nuation ,
Fy.py (W) g r s nil pe Ik ph l:.the City coCupertinong ' n, - ,r
r Z nnhifi JudBne ,, t 1 p t swhichon.,i, ,nY Y c go'nsf and '
V Ciny' consequence tNDER tho NDS gof this ranting ,. - _ b
SOURCE RE UNDERSTANDS AND WILL COMPLY WITH ALL NOWPoINT Issuedb
v SOURCE REGULATIONS. � y. Date
Signature of Applleanf/Contrac,mr• . , Date .,, Re-roofs -
• • - HAZARDOUS MAIERIALSDISCLOSURE '
Wlu meapplicancorlutge buildngcacaprmt stoic or handle huarNom rn:aedal Type of Roof
Code,
ole,,Sce by n n2be55C3n2pxa)rt?
'Ll`As h,o Municipal Gde,Chaplar 9.12,and the Henlnh and$nfoty '^'
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..
ON. All roofs shall;be.inspected prior to any roofing material being installed.
WathaPPIle rt r r n ldlugcacnp:nlawequipment f nswhah • If a roof is installed without first obtaining an inspection,;) agree to remove
hard rd tin hoe a dfiedby the Bay ArcoArQ 'l,p Mrurgcmeia - , ,
"hicn all new materials for inspection. Applicant understands and will comply with -
❑Yex °N° " all non-point source regulation`s..-,
I have read the hazardous orbitals heartenlx under Chapter(.95 of,he
ifflon string fee,
SaflyCJ have
a lanced.
e5115t itisryte,,o341undervtdif -
iftbebtil'of gdoesnolcurremlyieff inch be
it is to issuance oil a to notify the _ .�
,ccupuninf she rey,'ro L' I'h mei bone,prior m issuance of a Cen'1 rate aL _ - '•- '
Occupancy - "
- - - Signatur•e,of Applicant: 4- 'Date
✓:z
owner or onnsdrhed agent Date A11 roof coverings to be•Class "B"or better. -'Y
OFFICE