00110144CITY OF CUPERTINO -•
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JmILDING DIVISION - "PERMIT
CONTRACTOR INFORMATION:
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IlU1LDING ADUkiLSS: -
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SI IDQFT
PIiRMII'. No. _
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OWNER'S NAME:
APPLICATION SUB DA'Z'E
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fONL': .. .... _ .' ".,,.
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SANITARY No. CONTROL NO,
AkCHITECI'/ENGINEER:' -
- BUILDING PERMITINA1 -
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.BLDG ELECT, .PLUMB MF.CH
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LICENSED CONTRACT'OR'S DECLARAT[ON -
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w Job Description -
1 hercny vftirm that i am licensed under provisions of Chapter 0 Rommencing
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withScetion]INMB ratDivision 3oftM Btsinc,s and Pont csxime, Cade. undmy Iacamc-
1,minB andeRee`
mDatennc
lassor.
class Limb
WATER HEATE'RREPLACEMENT, -
Dom
5 DECLARATION
ARCHITECT 'S DECLAic
I undcruunJ mnY plans shall be uu•J us public recorJa ' -
maraN
is
Luen,ed V OW oil i.
"OWNER -BUILDER DECLARATION
1 herby affirm that 1 ant exempt Bam the Comnown's, License Law for the
"Wooing rca... a (Sectinn 7031.5. Busincss and Rnlca,ions Coi Any city or county
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which requires a permit to canmmn, ul¢r, improve, demolish. to repair any noncom-
Prior m its issuance, also equimn the applicant for such permit to file a signedsmtement
Sq. ft" Floor Area
Valuation
that he I,ncensal IF an.. it, to on, provisions Or ]to Containers Lit: nseluwlCM1amer')
(commencing with Sectinn 7(X)b of Division 3 of the Busincss and Professions Ctde)'
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,r that ba Ix cxentpm flo nfnan and Inc h.sis Part the allegN eamunition. Any violaina
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of Section 7031.5 by any applicant far a pemtit .hj.,, the applicant to a civil penalty
APN Number
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Occupancy Type.
moot mem moan II five Ilooddy0an (55110). y.' ,
01. ax owner of the property, army employees with soaps as their talc compenaainn.
a
will do the work, and mltn structure is not Intended or nlfered for sale (Sac. 7Mq
;Business and Professions Code: The Contractor's Limane Law does am apply to an
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.. Required -Inspections
of property Whit hailds or impoves thereon, and who docs such work himself
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rongb his own employee,. provided shot mcli impm tureek am tun intended or
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504 —' FINAL PLUMBING ENERGY
, howethe building or impmvemem k s,dd within one year of
i,ffv.d for Bale. Ifver,
imnpleli he nwnc,lbuudeF will two the hnmeu otmovie, elan he did tun build on,
"1 GAS TEST.'
mprove for parlsom of sale.). ..
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507 — FINAL. NAL_ PLUMBING
❑ I, to owncr'di'the Property. an exclusively contacting with licensed contractors to
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cnnswn the Project (Sec. 7014, Business :and I•mfessions Ctde:) The Comracmrs
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License Law 'Joea not apply w an owner oI property who builds rar ituprwcs them i,
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x with a rommnnrlsl EeeeJ Partner, is be
.ad wino lainaclx for suchPoleam
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Contractor's Ciccone Law.
• 1 tun exempt under Sec, t . B & P C to, this roan....
WORKER'S COMPENSATION DECI.ARA'I ION
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' I herchy affirm under prnulty of, purimy one of the frihmi ng declaretiona:.
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❑ 1 have and will oil tinmin a Ccnifcme of Consent In self.Insure for Worker i
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Cant,modion, as provided for by Section 37W of the labia Cute, fill the
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re,hoomance of the wild for which this pemtit is isnted.
O 1 have and will maimain Worlecr', Campenution Insurance, as required by Section
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3700 of the Labor Code; fnr elm performance of the work for which this permit is
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issued. My Walker's Crnnpensation Insurance cagier and Policy number are:
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Carries " -- Policy Na:
- CERTIFICATION OF EXEMpFGON FROM WORKERS'
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COMPENSA'1'IONINSURANCE .,
(This eminn need noa...R ed if the Permit is for one at dollen
ot M c
($100) rar lens-)
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-I certify that in the porronnwmc ill the work for which this Nnnit is issued, 1
shall nm employ any person in any Inner so a1 to become subject to the Woddn'Appl
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Comitant ,Laws art Colifomia. Date
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NOTICE TO APPLICANT. ,after to ung io hold
CcalOmm of Lal
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m dv,,m,
hettnnu ,object mthe Worker's Cnntpetrsmion prnvis sof the labor Ctde, you must
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faahwith comply widi such Provision or this pemtit shall be boarod revoked.
- CO NS'I RUCTION LENDING AGENCY
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1 heaby afthm that there is a I,... metion lading agency for the perbrmantt
of the work for which this Permit is issued isms 31107. Civ. C.)
Lender's Name
Undds Address
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I comfy that i have mad this upphistion and ante that the aMwc lnfommont is
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correct. I l,ma In comply with all city not county oNinances and score lawn mining
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to buildingcoa.Inuou.n, and hereby ruilmnae repressnnowtx-Phis city to enter noun
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the above-medioned property For inspection purposes -
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(We) ugram m n e, Indenmifyfind kccp harmless the City 'If against
liabilities, oil mums, casts and expense, which maul in tiny way accrue against said
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City in emmwquence of the grunting or this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT.
Issued by; r .
SOURCE REGULATIONS.
Date' "
Signamm rar npprc.duCentmcmr Date
Re -roofs
HAZARDOUS MAT17RIAI S DISCLOSURE
Will the applicant rar future building ecdupold store or hvnJle hamtJous material
Type of Roof •. •. -
rodefinedbytheCupertinoMunicipalCode, Chapter 9,12. and the l lcdth and Safely
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Cade, Sealnn 25532(.):' - .'
0 Yes :' 0N" - •- -
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•-All roofs shall be ih. pected •prior to any being installed.
meappimantmlumttrc building maapant use equipment or devices simian
roofing material
If a roof. is installed without first obtaining an inspection; I agree to remove
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,i1 atumm. air contaminants as detinet by the Bay Arca Air puahl, M...Indmnt
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•. allnew materials for inspection.. Applicant understands and,lvill comply with -
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all non -point source regulations. -
I have read the hvarJous materials requirements under Chapter ass of the
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California Health & Safety C dc, Seen... 25505.25533 and 25534. 1 undmmnd that
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ifmnchuildingdocs on uurrcntl y hale bmnant. thin it is my renowibilitymnoti f me
occupant of the requirements which mu.a Ix met prior to issuance of aCeaittcme of
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Signature of Applicant ] Date .,
roof coverings
f All I g s to be Class."B" "B" or better
Owner otvnnhn,iiul agent, Data
OFFICE
• NOV.2lR000 11:54RM NETCLERK INC. „;,x, NO.243 P.1 '—
TO:EPERMITS
; i 720 Dubuque A've., South San Francisco, Ca. 94080 Yt?P1t1jI
'IjGove,., , _„�� rnmenfi Services: 888-330-1777 Application
.".s; .:',''::.r...� Fax: 877-846-5888
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To: Cupertino
Building
City Hall 10300 Torre Ave
Cupertino
CA 95014
4087773333
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Permit Handling Instructions
Mail
The city will mail the approved permit to contractor.
Contractor Reformation
Company: Budget Plumbing Worker's Com Carrier
P HIH America Compensation
Address: 28695 Roanoake St. Worker's Comp: WC701-000D433 Exp. 01112/2001
City: Hayward State Contractor's License:769745
Exp. 10/31/2001
State/21P: CA
94544 ,
Phone: 5102641119 Exp.
Exp.
Fax: 6102649291 Business License #:
Exp,
Small: hudgetplumhing@home.com
Credit Card Information
Credit Card Number. 4802099260046275
Visa:
Expiration Date;
3/2003
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Mastercard:
Card Holder Name: Brandon E. Clark
Other: n
Pre -rag: YES
Payment VISA
Agent Authorization: YES
ORG[] NOTE] FV.i]
Project Address: 10149 Judy Avenue
Comments:
Notes
Attachments:
WCQ✓ SCL[✓ SABER] AA Q
Parmit Type;
Permit ID: 65602
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NOV.28.200
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148sV,Ju
rYDIL'B >,chard A
11:54RM NETCLERK INC.
I hemb •Olen °ho I w Ikam.d •1mdv YVLwlnauN
rqh 8wdao 4000 d Dhieim 1 of me i eA b harm
Of cMm a (,mmmndn[
i. m all mrm I with w mY IlamW
utem.01,„ Lk,BZB97 5 Water heater replacement
Dero: 17/12/2000 tet.,
ANCIDTStC p8 DECI.�IIATIO N
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n,pum mi 04. poo. 1M., Q,am a and Pmhulem Ccm:1 TU Gnengce.
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end "moace Ila, wh pnjma wa! .pmepmguryrmwllpWall, W mmwtoren,
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Iha by siI ynd.rpp...•p41y ofpWJun me ofaw /pllowmp dnlrragom;
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a Cinigmla of Comm 1. nlmn.oro no, WI
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or A,. Labor Codi, @r Ibe pahrmmm or b. weal roe wb,& it,. Paah I,
I„uW. My VI Companomlm rommo• Vint".nd policy nnlnbm pn:
NmPDNBATION WSUDAI'la•�•••••, •� .•.• n;
(714. smAm naN m, ba mmplon A If Ila Pencil i. mr ons hpodn0 dela (Slbd) er bn.
I teellry that to m. pmrm,nwoi a the wmk for xhiall tlJ, pwp,D ie i.me
mNaVMl YIMA en' Pwon m in any mane m m 10 bmam augjw Do Ow wmb.4
Gaba
x.11/12/2000 ,,VawA4
NOTICE 70 -- . 14 .Ile -00 dJ. G,AllavB of Narom4a
4epam mblem on AV wi"e, CoMim tio. pmvfam- of Am LbW 'abode
Idnhxilh eo•WIY with lop, P jgam W IA4 Pwml, Oull k do.m.d rewtad. 4 wY mal
CON=UUCnfAA 4gNDINC AGBNOR OY
Or nRoAk for Whioh,h4 pari, 4 law (am 3097, civ. a)dlnp ,papY Ihr IM Perre,wnro
]Andm'd AJdart
) teed(' 101 I haw mad VIA, A,plimdan WORD Alae aK Obpw Imanm{Ian Y
vgm. at mngg' xiJ, NI oath w0 an IV adimnrm end .4n )A” mbea,'
OF.
N. b -I M m VaRVICA04 mW haub mpW= rommnmAml
,m of , dT n .w, app
pBa) pmpmy mr impeedpn 'Team.
Il.bilry4a 4WB, OF. mi yn eln0ammfy rod kne, k,m1w N. Chy of Caped. again,
ChylnmQII& moo""whlcb nsY to any DAYeomu against aid
mmuwm Dile [:mJp[ aC,h4 Pemeb,
APPISCANT mm"-- ••y WILL Cf1MPLV Wl1R AW NON•PO
APaI IinmS. /rAw...-. Dff POURM
HA ARbOUSMATmRLATA DUiCI. t= W
_Will M .Ppllero, m awn hpllaro[ maupnw amn a imp. Memdom namdp
0a se 1d'm2SIS1(� p0°o yea'❑°I O 5 A•'7, and 04 111-161 and Si(NI
WIII W A"lkmt of Cduro ill I I �frl
mop oewpw uw iqulplpmr m dwkm 1014!
and MLrdom n4 ar"ra"y fin No Ow Arm Air Flour, Mmoeeman
Dlglep
041'.6 NN'll d, we(y w m,meiy to waned, "A" Mw d'PI of Ile
If IM bullel- i+ w-..,..,� -mems 1SSm, 1-. W u K t undamal Om
low a mall qµ1 D N TY aspmlIDaiy Inn.* Aro
.Mint a
Ouup.npy� h mat to mn Fria In kWAnu of A CWdApm of
4114 7Mnnn
NO.243 P.2 — — —
Job Dmdr'ryddq
600.00
Required Anspeetipnn
rto- ah
TYROnfRobf,
All roup aball ho lnrpaerod prior OR "U' rooOng mn,orial being Insmilimt
Ifo roof l lnaml(ad Wjtlawl lint ohmining ae Invited". I rpm to renew
all now
M4 -W' fie ARP"llan, ApPlimnt o11DIMMAN and will Dom
aU -lalgt epwea mguladdna. DIY with
11/12/2000
signutma of APPU=t
AllrOofdoYminp tAhoClar "li"arbcDm Da¢