01020044 CITYBUIO�n�PVISION o PERMIT' CONTRACTOR INFORMATION:
uml.DlNcnnna11 E3.1 LA MAR CT - •ATLAS''HEATIN6 PERMIT"°.-...01020044
OWNER'S NAME:
GRIFFIN WIBIRT A AND JCAN A 155 SAN LAZARO AV pp1.ICATI0NSUINMTGG09/2001
.� PIIONIS: - SANITARY NO. 1G : CONTROL No.
(,408)739-0516
WWO O O ARCHITECUENGINEER: - "? P - - BUILDING PERMIT INFO
ty p BLDGCLECji PLUMB MECH _
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Z S N Z LICIiN51iU CONTI2ACIOI2's DIiCLARAI'ION .lob Description ?'
O Z I hereby nation that I um lwrosed under mo,mnm or Chxpler 9(aanmencing
withsecti... amn)inima Janne Ba,mex,an rte adr.andmrlicen,c REPLACE & INSTALL NEW WATER HEATER & 71
a Y�' i,in fall Interned
m a License��jlapf Lies,p ` '
a Date_y(!If7Y` ' Conlmnur x
a-In
ARC l I ACT'S DECLARATION
SyC usa, I undcminml mpplans sludl be nscd ux puMlc records - -
ar p O Licensed Pndensional
eu�' OWNER-BUILDER DECIARATION '
=' I peachy ufiinn that 1 an,exempt from the Cmdamemr's License Law for the ,
f-ZQ following rca(ot.Seelinn70315,Busine,sand Pwdfi,1imwCWe:Any citymcond, _ -
$,t p which requires a pelmil to construct,alter,improve,demolish,or repair any swclum ' -
1`rj 9 Prot t also l 11 ppl I t to penemin.file :i,ncd moncrasent "
' >•3—
not he I coosed paAment1 ilic provisionsthe L- 1 t I' L 1 (Chapter 9 Sq' 0
Ftl Floor Area Valuation 0
' (arm g with Section 71p0)(if D' 3 I to B d i f. Calc) of
Or th 1 he is exempt therefrom d the bm,ix to,1h fl ged f.cannium.Any violation -
ofSection 70315 by any applicant fapermt subjects the applicant h acvil penalty - {�
of act arem,nfivehmdreddrnarsT5la). APN N�fpib95043. 00 Occupancy Type .
469
❑I.as owner nnhe to peny,mlay, employee,ah wage,as their sale ro;npensmimr, ,.
will do thu wad.Ind the stmcmre is not intended or offered for sale(Sec.7194.
Business and Pssions Crile:"rhLaw e Contractar's License does Int apply to nn' - g re -
owner of pnpeny who build.m impowe%thercan.and whimibt ares such work himself 502 F I I P�� G ENERGY .
Or through his Own employees,provided that such improvements are ren intended or o
offered for sole,If,however,the building or inrprovemem is.sold within one year ter 506 — GASt TEST' -
completion,Inc awner-bu ider will have the burden otproving that he did nm build ter -
mpro.<mrpmpa,rnraldu). f. 507 r FINAL PLUMBING
01,xs awnrr..r the propmty,ann exclusively eantmetmg with heen,edmra
cadior,m
construct the p oicet(Sce.7194,Bashes,xnd Pndessions Calc:)The Commcmr's -
License",v it,.,,not apply to an owner of property who builds or improves thereon.
and who esntmcts fm such projects with h amwnnr(s7 licensed pursmm m,1he
Commcolrx License Law. -
n .
❑Iarxlen
cn,a der Sur, B&PClirthe,ma... -, ,
s. Owner hale +
WORKE'R'S COMPENSATION DECLARATION - 4r _
I hchchy onfifirran muter fcnalty of pej ry One ofIh full ng duelumi s'
L
't rpt i e I , t tel:n u Cenrficut 13 0 1 1 s U f Worker','
he ` 1'
r
'who t h'work far
f r by Seel 3test f the h err Calc for he
pert � ,I he wolf I hlhis IT t'. I '
❑1 hue and will maimam Wnden Comlenw0on Insurance,an regn red by Section
37M of the IaMv Cale.for the performance of the work for which this permit is _
is eaS/tfy,Wppk i,s Compensal nn lnsurahcc runi1uWl'ol¢y tm1 te'th`er a�mJ V2 �J
four .IN �Pol sy Nu �S.L ` 1 V / O r / D
COD FICAI'ION UP '
XEMPTION FROM WOII K17RS'
COMPENSATION INSURANCE
phis section need not he completed if the permit is for one hundred dollar, + -
($100)or lass) -
I<cnlfy teal In the pert loaner nfthe work lar which his permb Is issued,I - -
,hall not cnIPIoy may Nosnn in idly manner sb as on becmne suh,leel w the Wm1,,,'
Cnm"I'annon Law,of CSlihamr,Das - -
Applicant -
NOTICE TO APPLICANT:If,Other making this Certificate of E.e npdon,you hadd
0 tinremne sehjen to the Workers Compensation previsions of the Labra Cale.you mmst
molovilh comply with.mb pnwimann Or this permit shall be deemed m,Uw1.
F � r CON%'l lot IC'1'ION LENDINC,AGENCY
a, • . 1 brachy add.that there is a cophownam lending agency for the perhrmmnce
w
W of the ork for which Ihi,lomat Is Issued(Sea.3097,CIv,C.)
IY Q '.I,ender.,Name ,
= z Lender's Addrexs
U0 �" I fmjY(l't i have IIM: iplt fnnand"mone pact d h f 't hots y
W air 1 I y (,replyit), r ,,, ,,,it ly adinomrr. d slien low,x1.116 „
0 t..) ronu llnbe rrxmci on rdhsrchy nmhur 'pt's.u.nives trim se ly to o.mm upon '
ys i the Whish nenumed propeny for Inspechun pts p ses
re,c ly IWc)agree tnsue.indemnify mrd keep harmless the City of Cupertino against
y .liabililiee,judgments,costs and expenses which may in any way accme against said
sU .Z.I City in consequence of the griming of this permit. . fI,
APPLICA UNOGRS'r 'US AND WILTWool .COMPLY WITHAL )NPOINT 7
: . souacE anal, no r�/ �•, Issued by: t• Date.C;
sigma, b ^• tor L Da - Re-roofs
UAYA )US SIATERIAI S DISCLOSUR
-
Will the applicant m fu 'wilding arrapam,fare m handle ha mmnv matit Type of ROOf
u defined by the Cupertino Municipal Cafe,Chmpscr 9,12.and the llenlm and Safety -
Cute,Seninn 25532(x)?
0r o"" All roofs shall be inspected prior to any roofing material being installed.
Will the arplicantorto emil"ling occupant Use oapoln@atarobvious oldch" If a roof is installed without first obtaining an inspection, I agree to remove
emit hvd rcont t: defined by the myA aATQuality M gement
District? all new materials for inspection. Applicant understands and will comply with
❑Vee 0Nall non-point source regulations.
T I hou ad the h leu,analliUllSli rare 1,made CI purr 6.95 0.1hr,
Califrmin i leallh&Safay Code.Sections 29505.25533 rend 25594.1 Unit ursmnd lime
if the building does not currently have a tenant,that it ix toy respareadelily to entity the
cupant of the requirements which must he met prior to issuance of a Certificate of,"Ccup,smy' Signature of Applicant Date
Owner oranllnrludengrm - Date All roof coverings to be Class "B" or better -
OFFICE '