01010043 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
HOLDING ADDRESSPER '-
1.0039 GREENWOOD CT WATER SYSTEMS PLUMBING M0110043
OWNER'S NAME: pI$t1
SEVILLA ALBERTO TRUSTEE &• E A 3844 HEPPNER LN APPLePTP1l1%°��01
l PHONE: SANITARY NO. CONTROL NO.
(408) 266-8222
Q ARCH]TEC1717NGINEER: BUILDING PERMIT INFO
< C BLDG ELECT PLOBB MCCH
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7ffHOlaCohEDn S'D CONI'RACfJ R'ffSAlnDrR_E
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LARATION
I hereby rt Pirelli or chapter 9(
, ,tn
cnfing Job Description
f, n eaneminyan,n
r •rex $ REPIPE AND ADD NEW GAS LINE
Liver C 36 Lf.#AO I
Utlle CommoLL G /�1i^ ARCHfTICISDEC
=
`
�:—ny O g 1 undrnmnJ my plain shill be uuJ as public reconls
Licensed I'rnle,innnl
S o OWNI:R.If IIII.UriR UGCLARNHON -
u"7 I hemhy offset that I an exwnm freta the 6mlrnuou's License Law In,the
following ninon.Notional 7131.5,Business and Prote.ainne CNe:Any city ar comp,
which nummar,.Ix.it as con,bli Iac,imp dervolid.or repairy un chose
pati t I req the ,Ilimm far suchpe it a fle.agreed! er,rowin
-
Ran he is licensed pursuant tthe provisiosiv ofthContractors License Law Chapter S FL Floor Area Vat I�tion
(co e lf los t 7W(11 I D 3 f theB a d Rol Code)
that he is exciter therefrom and me basis for the alleged exemption.Any
q'violator �I
or Suellen 9031 a
.5 by any appl Load for permit serject lac applicant ho a ci v it finally
of nma
nm Ila five lfomed dollnm($5W). - APN Number Occupancy `JP
Y e
❑h.a,owner oche property,or my employee,so th wage,ax heir stale cit e,n,rtmn. 1 36914027. 00
rill do the work,and the sltucum is not amended nr offered for sale(Sec.71111,
Rmious,aad Pn,ressmn,CNe:The Commnm v Liccru Law does an,apply or an Required Inspections
owner of property Who builds or improves thereon,and who cors such work hi mself 106 SEWER & WATER
orthroughhis own employeesprovided thatsuchilapruvemonls ore not intended or
offered Int rale.IL however,lox I,Nding or itnpmvcmem is old width to year of 202 — UNDERFLOOR PLUMBING
nmplclion,the owner-bnibler will huvc the burden of proving Ill.,he are not build or
I<k
aetprove ret pltrryase ofsale.). - 301 -ROUGH PLUMBING
Ol.as owner of the property,an exclusively controlling with licensed councilors 302 — TUB & OR SHOWER
nsrmm the torquer(Sea 7144,llusincsa and Professions CNe)no Conlmctrt's
License law dtxs nm apply In an owner of property who huilJs or imprvveuherenn• 2502 — FINAL PLUMBING ENERGY /
and who aomraClx for.moan pmiecl.with a cammcmr(,] licensed tumutm m the e506 — GAS TEST
andwh cautious
or s
❑fret exempt under Sur! .n&rc Ea 11,is reason 507 — FINAL PLUMBING
Corr, Date /
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjmr one of life following declarations: '
D I have un t will not ain a Cmifcate or Cmlunt to lair-intim I'or Worker',
Compansation, u, provided too by Seldom 371X1 of the Labor Cute, for the -
perfonnancc of the work for which this Ixnnil is issued. _
131 have.sed will mairnain Worker's Catenation I rstrance,as required by Section
37W of theLabourCode,for thMy W es Confiscationlee,conference of the work for which this permit is
nce
Curmrier:�"t75f V.
VkG1 Iblacy No: t3_7 policy number
t/ CERTIFICATION OP HXEMI'TION FROM WORKERS
COMPENSATION INSURANCE
(This section need net be completed if the permit is for one hundred dollar
for 1 W)or Insd
I cervi fy that in the perfornance of the wink liar which this permit is issued,1
shill net enmplay tiny penton in any ntunor,on ,,to heroine,able,, ,,Jin Worker,'
Compensation Lowe orcnrromir.Dae
Applicant -
NOTICE TO APPLICANT.if.after making this Cmificae of Exemption,you should
O Obecome bjecl In the Workers Conmpess mion le m�i,inns of the Labor CNe,you must
mfonhwilh comply with such provisions on this permit shall W deemed revoked.
wis
F 4 CONSTROcrlON LENDING AGENCY
a I herby rob rnm In,,them 1,a coast...0.On lending agency roe he pmlinumma,
w of the work for wall,This permit is issued(See.9097,Civ,C.)
IY Q I,ad,,',Name ,
= Z hander's Address
V 0 1 certify that I have read this application rationale that the above inlonnutlon i,
k, F comet.1 agree to comply will,all city and county onlinance,and slate laws relating
0 V mWilding amorsolle,and hereby eutheriee apar,vnlulives of this cllym enter upon
�] the uhnvcnnnnioned propady far,Inspcnlun fume—, _
Q. (We)lognn to Savo,Indemnify load lac,handexs the City nr Colvin aagainst
1n liabilities,judgments,host and expenses wash may in acv way accrue uioinn.said `
V z car i.1conagne URST of gra iANDinif ofWI.LCO.
APPLIC Tl' DERST SAND WI.L COMPLY WITIION�IO/ (rd
S An .tA� 99�� Issued by: Date
nl/[\ S fauffMAppp1�9+uwnV ontnca; i Dam Re-roofs
HAZARUDI All RIALS DISCLOSURE
Will the appl lot mtaletel Idmg oeregain'tore ,,Imarme maanlon,material 'hype of Roof
as defined by the Cotonou)Municipal Code.Coapts 9.12-1 of the Hcaltb and Safely
CNe.Seclion 25532(v)?
°Yef a ElNo All roofs shall be inspected prior to any roofing material being installed.
Will meapplicaut or future Willing occupier use equipment or devices which If it roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contantimnts a,drained by the Bay Area Air Quality M.anxgancnl
District1 - all new materials for inspection. Applicant understands and will comply with
j °'C, 0 N all non-point source regulations.
I have read the Woun s maerim,requirements under Chapter(05 of the
California Health&Safely CNe,Section,25505.25533 and 25534,1 t ndemmad that
Hire Wilding J,x. of current havcalenam.Gita it is my responsibility to nmify the
oceupam nl hu r u rem, hien mull be ref prior m is
of v nificatc of _
ossa n §ignature of Applicant Date
out initial a eel All roof coverings to be Class "Boo or better '
OFFICE