02060003 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
! BUILDING ADDRESS: PERMIT NO.
10230'' JOHNSON AVENUE02060003
OWNER'S NAME: APPLICATION SUB DATE
LONG TRAN 06/03/2002
4. PHONE: SANITARY NO. CONTROL NO.
K'Z .ARCHITECDENGINEER 'BUILDING PERMIT INFO
0 0 >„ s _ BLDG ELECT PLUMB MICH
Z s - I' 7 L=j L_J I_.I
LICENSED CONTRACTORS DECLARATION
5Fiw " Y Job Descri tion
O Z C t°� l�hm0y.fain shat I I ena<d.Mer pmvisimm of Chapter 9(commencing - _ption
.. - .
p, ,w'ns« an 70061erD mnJnlN Baames anaProreaa'nnacode.anamynren REPLACE APPROX.`"!70" OF
4 " 'MAIN SEWER LINE
a y is full tome and,ff"L, ( J
z oM'c Clogs [ Lic. t 7—
Lie cY _
U jf1 7 CaFFF
n
�D.Gc' '��- ARCHITECT'S DEC ATION
lz lz N g 1 understand my plans shall be used as ptialve records •
'u«nae.Proreaamtul.,
OWNER-BUILDER DECLARATION
m 1 herebynaso.('Brat that 131.eBasin from Nc C snits o :Any c Law for Ne
which
following reason.a Permi(Sectt t 7o3 L5,Business and Proova,de io demolish.
Code:Any city stmenuy'
O
which q epnmu1 crewnift w mfor such
orrepair any ssrocmm OO
n3$.�pno ' r issuance, N pions of for•vchpemm�o 0lraugnedsm¢menr.
Jlrmhelsl'nenounSsmnsoethe pr monsoflhf'heIeml.LcenuWw(Chapmr9 e _ So. ppt- orppea ' Valuation
(cn a s 'msnon70110) foi1wiisoate IgIITineyandProfeaaenscadc) s.,:"";j3',752'506.�'..'O.<5.1:wl.tC+'lF.+`
or that he is exempt therefrom and the bums for the allFged exempdo0 Any violence ^
of Section 9031.5 by any applicant for v permit subjects the applicant to a civil Penalty
. of not more than five hundred dollars(S500). AIN Q�t�omp�'' r. t +T Occupancy Type
106 & WATER. `
0 h as owner of Ne property,or my employees with wages a,theirsale cmr oration,
TIBING
' 'will do the work'and the structure it-am intended or oirered-f.r'sale IScc"7044 "' --—' - - - -- ----'--"' - ------
oBu loess a dProfcsi ons Code The Contractor's Lmnrse Law Jas not apply to an
301 - ROUGH PL 4ain4C�spections :'I"`
owner of property Who builds or,mpmve.a thereon,and who does such work himself
.. or through his own employees Prov de I that such improvement.,are act intended or , .__S.O 7_..-..._FINAL. -PLUMBING. '
_.._ __ __._ _. ..._
completion,
o le forsale will
ave t br burden
f proving
wIJ w Idid one year or ;
crosipRt ror pu ..:el-builder will have the h J n of proving shat he did not build or `
improve for puryose of aaleJ. �
}, O I tr woe of the psee.7 am Business Y comma ng a N licenud consranors to -- - -
construct censtheproject(Sec Ito a Business end Profess,om Code)The Consmaor'e F,..
I'Lmenu Lew does not apply loan owner of property who builds at improves thereon, -
r
an
TNn O lel li(Dr Snen p!leg6.wllfl.a fOnl2etOr(a)Ietnitl p til l lh ._._._._.._. ..._...� .__. �. ., _. .. — .. ......_....
C tmm r' LI a Lo
pam e enps under Sec 11T_ B&PC,f this raxotni ..
CDt
WORKERS COMPF.NSCON DECLARATION F' LE
r• 1 h by ef0rm ndn pe hY of Pe 1 rY - 6 Tithe following drelarsnons:
t ❑ 1 have and will mans a Ctrific.1a of Conseil'in self nsue for Worker's AN 1 4 2002
S Co p Bion, oe proud d for by Section 37W oFthe-Labor Code for the
'gporm Ice of the work for which'his permit is issued r;,
O l have and 4ill maintain Worker'a Compensation Insurance.as required by Scedon BUILDING
3700 off-the Labor Code,for see performance of the work for which this pcmdt is
i anis. Warkei enc urance cmrrierand Policy number ere:
Isiued:My Worke7i Campenuoian'Ins
< 'Carp
' ' 9f s CLRTIFICATION,OF EXEMPTION FRAM WORKBIjS; .+,t,a !t i fl,'.! i!' 1 r'Ad 1.,t,.. .. ' '
COMPENSATION"INSURANCE I
I
h (Ths seml'nn need not tie completed f 0e pertnit is for one h'ndred dollen '' �� - ''' s `'' ' f ' I''-""'
�; t I can fy Nvi Ih Performa cc bl the drk f r which Ihu perm i s' M I
sh 11 t m 1 an ars n
Warfare
C soon Laws C I f ' ¢
pen
.Apo. P Y P permit shall bo deemed revoke -
1NOTf AP LICA r1T 1< fc ina�hi, IhsCen fc' fLv n
p y y p y mann r u so be m s b oh
ou should
`
he
m .0)ecunN W ke1 Cmpe p 'you mum
�.Q fonhw,N coat -nh such rc d '
'f -----
4 CONSTRUCTION LENDING AGENCY' f '"6' ''
I hereby aftimideaffiere o e construction lerefingo,ency for'he performance +. .. I •
lesh k fb h ch N pe t' o suet(Sec 3097 Civ C 1
Q -I.ede Nam 'I ':+ 1 ........... . .. .._._. ._ .. _
U Q 1,cid sAdJrc
M'y.
have
, 'L.I it �:,t Ic nfy lh oil hoe JN. ppll a ds'allthe,N h e' f t
c sect I g o on,
a he II cit,andcountypmordinancesvd tele I relating
V io bu Id g wn n and , on r<prcsensauv of this enymcm rupon
} (T7 the bo m nen gepcny for i(yTZ'on puryo
t.. O:i•, liabilities,
tsa dmnipeand kepharm( fsh &Y of Cuperagai agenm
rn cityineon dgmeona c sI. and ng.111swhich may m any ay . against Sind
V Coy i quND of theg to f'Ns - /mss_V/
'APP44CANTUNDBRSTAND$AND WILLCOMPLY'WITH'ALL NiJMPOINT ' rt
soURerRECULAIInN Issued by: '' Dat
ofjgnam.or Appheano/Cminsewr T' Date 1 Re-COOTS `
HAZARDOUS MATFRI DISCLOSURE
t.` Will Ne apphc m or future W Ildin c pant xore or hatMle hmmdoua mm I Type of Roof... .. .. .._.
u defaed by the Cupcmn M m iPal a Chept 9.1Z ad'he Heil h and Safety { •��•"� �n"`•",� "�_- .. �•"�
Cod Secs on 255JJL) _ r !, t F � - "A t i ;.,1.'_ 51 '•I !i 4v� Y::
11, r
If a roof is instbe-inspected prior-[o,any roofing matenal.being installed •
All roofs shall be
;,1 wane pp11 t fnmrebaM p t q p which ei'without first obtaining an'inspection''I'a tee to remove
'e nn hazard nigement g
Dst et ' ,,. all new materials for inspection. Applicant understands and will comply with
r r r _. .... -
contaminant'nant ar e e t Are Au s Ma
❑Y<6', Nn - - '- _l. all non-point source regulations.
1 have road Ne hazardous matenals not, ens under Chapter 6.95 of the
Cabfom'a Hcalsh&Safety Code,Suoions 25505,:5533 and 23534.1 understand that
i if6 n Y resmoibllit mnmif,the . ...._ "_. ... _. ,..._. ...
ppuildin a resnoocuerensl nmeaam she et it my p y y
& to.(the mit c f e,Cenifcam of
Occupancy. gn .•
p req Ircmensa Ilan ma ne me'p on .Signature of Applicant Date
O> _.
caro amhortoda t Date All roof coverings to be Class "B" or better -
l. ." --OFFIC
t t E