02070045 CITY OF CUPERTINO -BUILDING DIVISION PERMIT CONTRACTOR MORMATION:-
BUILDING ADDRESS:
10062 FIRWOOD DR qATER HEATERS ONLY PERN13T070045
OWNER'S NAME:
OONEY ROBERT R AND SUSAN M 70 E . MAIN ST, SUITE 200 APPLI(:A]dO�61 q,,A 02
PHONE: SANITIA�RY�NOU / L UCONTROL NO.
(415) 566-2209
p ARCHITECT/ENGINEER
u;fF BUILDING PERMn INFO
y<i BLDG ELECT PLUMB MECH
1--'t C7
C S n Z LICENSED CONTRACTOR'S DECLARATION
oz_,� lh<rebyaflianlhaion3I am ofenecdum",anvi,ion..im- pter9(commencing REPLACE WATER HEMP
FyFy wiNs«tion](g10)ofDivisionJof the Business and Pmf<ssi°ns C°Je.aM my license
x ] 's in full((gara an B
6« a License Qa(ss �/ aaVq�pl99ec .5 2
'J.J.a O-t+ 3 AHCHITECI"S AIJONJ
}E 1 understood my plans shall be,used as public mcords
R y O O UccnuO Professional
i OWNER-BUILDER DECLARATION
i hereby affirm that I am exempt from the Conuactor's License Law for the
Iollowiii,no on.(Section 703 1.5,Business and Professions Coda Any airy or coonly $700
ts-D which¢quirts a permit to consumer,cher,improve,demoliah,or repair any structure
n 3'_< poo t 'tsissuance.also"ones thapplicant fsuch partner to file a signed statement
Oat he Is Wanted Worm nt I th Prov s o s f theC ntuctr.License Low(Chapter 9
(commoner g iths C 70110) fD J of the Bus dP f..tonc code) 1 �� -3-Llg• oeaY ]' Valuation
ter
bar he s exempt th from and the bas's for the alleged a empi un.'Any violation ''.l sf�•i 4
of Section 7031.5 by any applicant for a persoi subjects the applicant to Advil penalty s
ace
afnosownt noon,rortheeonertmdouyemploee 502 '��gQAET PLUMBING ENERGY Occupancy Type
1.as owner or prarxnr.or ter emWlnr«x with wag a,as dous°le cumpen,amm, 506 - QAR TEST
wil I do the ark,and tharacoma is not intended'or offered for sale Saw.7041,' - -
13 s- s. and Profess ur Cod The Contractors License Law docs nota Iv to an
Pp 507 - FINAL PLT� nspections" --_ --
owner
Of p his employees,builds ar w derl s thereon,and who dos such work hdedor
of a ugh h o p JW Oat such ccommcm sold are not mended or
lf
'nR_A.f 1 If h- 'heWildin, -p e t is sold did one year of
c 'pl t nth b 'IJ - .. __.
will have the burden of that he did not build or
pnry ng __.. _.. .a...
improve for Pt ryasc of sale.)
d 1 - e f the P Pent <c ly mbaci g with 1' sed tractors m -- n
sm-xuu r th project fS 764 Business d Profiesome,Came I The C lienar sLic --
i.eJense Law does ho cunt apply t woe rp P'9' htb Itl W thereon �Otl�ttA�.,.,
Curt mcmr,License law. W I Is with a.contracmds).bcensed pursuant to the -
- Ol am ase. t under Sec.
. . ,B&PCfor k a.on Aura<oa'2ao2
Orion, 'Date
WORKER'S COMPENSATION DECLARATION
" IWom,offrmunder.penalty ofPcriary one afthefallowingdeclarations BUILDING
. ❑ 1 have and will'mainiain oCertificate of Consent o,self-insure for Worker's
Compensation, as provided far by Section 37W of the Labor Code, for the
Performance of the work for which this permit i,issued,
have and will rismi um Worker v Compensation treat...,as requited by S«tion
" y ,eice of N work for which this p<rm t s
ics ed M Worker,r',C m Ntopl u c � Policy number are
Of the labor Code,f 'he K
LWIC�OMP�Sq I'yYo.:
Carrier
EON INSURANCE:
: I-- Rg'i's t, '� [,aA�i` a t i .s
TION INSURANCE' •= .a
(This stt o _ _ dollars
c, ....--
'tion need nil he completed if the permit Ia for one handfed dollars
.(EIUO)or lcsc)
1dnify than in the perfomunce of the work for which this pemut is issued.I
C 1ofClfD
II of employ y pe Ii y an a to be mm Workers,
me object the Worke
Co Pest to -
Apple t
'N(YL TOAf PLICAYT II II ak gth' Candletoob v -
E -'
IndiaW kefCm <'^Ptiod You should
Z become object In
O '.fnnhwith cote with such
P m a the labor Code,You must
Z O ..P Y wn .,lW ovnsmns or this Permit shall Be doem<d rcvak<J.
CONSTRUCTON LENDING AGENCY
a t I hereby affirm that tht a construction lending' mta
agency for the perfoncc
of the work forwhich th
h ' pc itis issued(SS .309],Civ.C.)
y Z Lender's Name —
n
- Isndcr'i Addre.a t ,
4. O 1 certify that 1 have rend this appliatian and.stute that the aMwe information is i
O�' F correct:I agree to comply with all cioy.and county ordinances and state Jaws relating
,V to building conuruction,and hcmby authorise reprtsentaivcs of this city to<mcr upon
the abovementioned property for inspection purposes.
(otairgrcetu,ave.inJcmmy,aiid keep harmless the City of Cupertino against
V'
rn Ii;tbi li ties,judg tents,coi and expenses which may in any way accrue against said
z City in consequence of the Stamina of this permit - -
APPLICAYrUNUERSTAN05 ILL CO)IP 'WITHALLSON. OI, ]� ,
w1;RCEREGULArIo.Ys.� J` Issued by:
//p Date
- s g glare stt AWphhanUeantmemr 2—
A Re-roofs
C frOW b eap _(a ZARDOUs lATEOccupa DISCI OSURE
ode b
Wlly PPIpeR future
Municipal n Wg9a Occupant t handle haeallo n ' .Type of.Roof .
/Cad Ch 9.12. d th Health d Safety ..
v
❑Y
Stf t' ' t
All roofs shall be ms ected priorto any-roofing W dth 'i,c t home b 'fi g -p ru egapn tordevicev which P ,P Y g tllate[lal being Installed
emithar d ria^'contaminants as defined b)Ih BayA.,;;rQuality Management If a roof is installed without first obtaining an inspection, I agree to remove
Distnn
❑ye eye. all new materials for inspection. Applicant understands and wi11 comply with
I
>' J h all non-point source regulations: - -- 'd - - -'- -
. h re tJ t 'ale requirements under Chapter 6.95 of the - - -
Calif Health&Safe"Code.Sections 25505 25533 and 25534 1 understand that
it the building,does currently have a tenant.that it is my responsibility to notifv the --
Occupant of the rte menta which m t be ma prior to iuwnce of a C nific a of - - _ --' -
<cupanty .
.. •: 7i Signature of Applicant
Date
.; authonzcd�g«t. Date .. __- -...
_ All roof coverings to be Class "B"or better
OFFICE . .... . ..