Loading...
05050158 CITY OF CUPERTINO A. BUILDING DIVISION PERMIT CONTRACT OR INFOyRMATIO.N , BU ILDING ADDRESS: TRIPLE A PLUMBING PERMIT N005050158 OW NER'S NAME: PERMIT MUT DATE HMS_ DF.VFT OPMFNT TNG' ONE: SANITARY NO. C OL NO. (6SQ) 964-49-AS ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 a�ipp LICENSED CONTRACTOR'S DECLARATION wC I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description iW with section 7MK))of Division 3ofthe Busirvand Profession Code.and my licenp if in full room and ;'q= Licenac Lic.11I REPLACE WATER LINE (METER TO HOUSE) Contactor-I lov-1K, 11 �11fiffr1rWr I ARCHITECTS DECLARATIDN I N1 >? I understand my plans shall M used as public records t/�@t�pl ,6u FINALE,,,, LE® ''o t; Licensed Professional 3 OWNER-BUILDER DECLARATION y 1 Mreby affirm Nm 1 am exempt from the Contractors License Law for the 00 following mason.(Section 7031.5.Business and Profession Code:Anyeity or county ' ae$ which rent.a permit m ennsWct,alter.improve,demolish,m repair any W.enum AAO F_eprior to its issuance.also requires me applicant for such permit m file a signed somment Out M is licensed pursuanuo the provision of Nc Contractor's Usense law(ChsN.,9 Sq.Fl. Floor Area a sea Valuation %F0 (commencing with Section 7(100)M Division 3 of the Business and Professions Code) ' i Nat he is aempt therefrom and the basis for Ne alleged csnmptioa.Any violation of Section 7031.3 by any applicant for a permit subjects she applicant to a civil penalty of ctrl moe Nn five hundred dolas s500). 3 er0 0 u ane Type I,a owner of the property,or my employees with wages a their sole compensation, will do the work,and Ne swanre is nor intended or offered far sato(Sec.70a,Business and Profession Cox:The Contaemrs Liaise Law dW not appty to an owes,of Required Inspections property who builds m improve thereon,and who docs such work homelier through his own employees,provided Nat such improvements am not intended or offered for sale.If, however.the building or improvement is sold within on year of completion.the owner. builder will have the burden of proving Nat W did oat build a improve for purpose of ..le.) 1,as owner of the property,am exclusively contracting with licensed contractors to convect the Pject(See.7044.Business and Professions Code:)The Commam rs Lb case law doe not apply or an owner of prolat"who Milds or improves thereon.and who contracts for such projects wish a eonuaeems)licensed pursuant to the Contractors License law. ❑I amaemptunder Sea. ,B&PCfur Nisreasun . Owner Data WORK ER'$COMPENSATIONDECI RATION 1 hereby affirm under penalty of perjury one of th following declaration: 1 hsm and will maintain a Certificate of Consent o alf-insum for WorkertCompen- - 55tion,u provided fo by Smion J700 of Ne Labor Codc,rat Nc Performance of the work for which Nis Permit is issued. 0 1 have and will maintain Worker's Compensation Insufanc,at required by Section 3700 of Ne laMr Code.for Ne performance of Ne work for which this permit is issued, My Work Cn,glpensatin ilgpsuance comic,and Policy number am: p Cmrier. IvJ�r Y� �n f Policy CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thusection need not M completed if the permit is forone hundred dollars(SIM) or loss.) 1 certify Nat in the performance of the work for which Nis permit is issued,I shall not employ any person in any manner se,u to become subject to the Workers Compensation Laws of California.Da¢ Applicant NOTICE TO APPLICANT:If,after making this CeoiOcam of Exemption.you should become subject m the Worker's Compensation pmoisim,of the Lahr Code,you must Z, foMwith comply with such provision or Nis permit shall M deemed revoked. z O CONSTRUCTION LENDING AGENCY 'Tr I Mneby affirm that there is a construction lending agency for Nc Nrfurmamc of Qi the work for which this permit is issued(Sec.3097.Civ.C.) ft) Lender's Name 6. Lender's Address 5z U O 1 certify that 1 have read this application and more Nat Ix show information is D, f come"I agree to comply with all city and county ominamms and sum laws relating to pU Wilding convection.and hereby authprire reprebotativu of Nis city to enter upon the r W alow-menuoned property for inspection purposes. (We)agree m save,indemnify and keep ss did,City of Cupertino against H raj) liabilities.judgmcas,costs and expersa which may in any way scene against sod City UZ in sequence of the granting Nis permit. ^ APL CANT UNDERSTAN AND WILL COMPLY WITH ALL NO''-POINT Issued by: Date S E U ttt ATIONS. Re-roofs t pure or Applicant/Con or Dam HAZARDOUS MATERIALS DISCLOSUR Type of Roof Will Nc appiicam m foure MtiOng occupant sure or handle hazardous material as defined by the Calandra Municipal Code.Chapter 9.12.and the Health and Safety - Cale,section 255J2(a)? All roofs shall be inspected prior to an roofing material beim Installed. ❑Yet Nn P P Y g g Will theapplicant or future buildingoccupant use uimens or devices which If a roof is installed without first obtaining an inspection,I agree to remove it havmnus air conuminans u de0ncd by she Bay Area Air Quality Management all new materials for inspection. istrier? ❑Yes 01/ Ill...M the wardnusmverialsrequim=nm under Chapmr6.95 of dm Califor- d Seemosm 5.25533and25534.1uMcrsund Notifthc Wilding w tenant,thatitis myresprnibilitywnoulythemeupantofthe u est nortuissaanccid.ccnftcam cull e�/ Signature of Applicant Date or Fent Date All roof coverings to be Class "B"or better x Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building De artment OB ADDRESS: PERMIT # nv SGS G/S` OWNER'S NAME: 5 PHONE # GENERAL CONTRACTOR: bi tA #IaSD I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 60 SUBCONTRACTOR 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 Au rahna Roofing Septic Tank Sheet Metal Sheet Rock Tile 1,l Owne /Contractor Signature D to CITY OF CUPERTINO a REPIPE/SEWERS/MAIN SERVICE ® CUPEkTINO PERMIT APPLICATION FORM APN# h Date• / �3 Building Address: wner's N me P one#: ntractor: Phe: ` License #: RXZ Phone: , `� Cupertino Business License #: J wilding Permit Info: Bldg ❑ Elect ❑ Plumb ,Jpb Description: Resi ential loommercial ❑ Cost of Proj : Qty. if Applicable Fee ID Fee Description Fee Group PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING BPFIXTURE Pbl . Fixture PLUMBING BPWS VCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING 7s� L� 7- 3 �