00070024 CITY OF CUPERTINO
BUILDING.DIVISION PERMIT CONTRACTOR INFORMATION: 457�L'_;'-Cb
BUILDING ADDRCSS. � PERMIT NO.
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OWNERWSNA .. - ) N'I'LICATIO ) G
8 C Mf J4 k^� S'
1'HONr: + SANITARY I. ( O.
739
O Op ZAROU ITiCT/pNGIN6HR: BUILDING PERNIIP INTO
e.+l'f � I 2 - BLDG EI.ECr PL(1M11 MECII
�¢y
�y- Llceh t I a RACIOR miler s DI ions of CION- Job Description -
O7�, 1 M1erehy affm,that 1 am licensed under prvvi,ion,of CM1apmr,4(comn¢txing
2-4 'ifh Scctian]pxp of Divi,ionJnf the Rosiness cosi Ymfe„inm C,Ne.and my liceme
6 w in full Intel,anti effect. 0/9 2.
C z w< Licen,e Cla,v�/�� Lie,.h l S n
i O Dam .'7 Comm o GAS LINE
ARCHITECT'S DECLAI IION
I,
an I I andemmnd Illy Plan Ira a ns�pnggl� (nI / -
p O hittnvcJ Prnle,sional /T—T
It.
X o e.ap OWE iR-Itsviep,iR DECeCono UN -
m—w I hereby affnn that 1 am exempt Inn..ma Cnnvannr'x License Law Ibr the
C Z< following mown.(Section 7031.5.II., wse and Pmfcsirms Code:Any city or county -
Y—O which requires it permit u,conslrvcl,alter,improve,demolish or repair any,wcmre
6 sQ prion....x hnunncG nlxn requiem tle applicum far,uah lwnnil to flennigncal ewfcnfcnt
I
at Leis hcen-d punnam in the prma,inn,of me canracmr.Licenw,Lima(Chapter 9 Sq. Ft. Floor Area Valu i�
(commencing wxifh Section 70(1 of Divi,ion J of the Rushee,,and Prlcssionn Code) Gy-�
or shot he is exempt therefrom and the basis for the ul leSet eaemptiun,Any vinlat inn ✓V
of Section 7031.5 by unyapplicnnt lout Penni .necw meappli,me ,,a Gini l penally -
.of nor more than five hundred dollar,(asro). APN Number Occupancy Type
❑I,: weerof the er co,o my employee wi n,"age,as reit sole eompensadnn.
But ne be work,and he,(morn i,na emended er e I,u fan a:Je(see. toaa, 36933030 �gy��r�I
Rusin,and property
Who build,cafe:The,Car the,,o and, ed does h appy'm en rCC(IUlred InSPCCI1D115
owmrafpropeny wonlo,rnrnveded I.e..h andwho la1amees cI winkuded(it
or erect fo his own cmployeas.provlde,l mal mpr rp,avement I%%ol wi ran ire ye r or
olreple for vide.ILhn-build % )wildingorimpn of prim.what he did ane yew of 106 — SEWER R WATER
cunmpleinn.the awncrhuilJer will have the M,Ncn of proving that he Aid not hU11J nr
I.:mpmne forpmpmg or acle). 202 — UNDERFLOOR PLUMBING
❑1.asowner ofthe pmpenv.tor exew,icelycemmcdngwith licensed contractors,to 301 — ROUGH PLUMBING
n
names he the p,,,jet,(Sen 70,14,liu, ,and Pro ion,Cca cContractors
Lke aLawdoe all applyti,nV,dp,n6,rcD ITB lyIn"haJ,l,nrin"loc, here..... 302 — TUB & OR SHOWER
and who entrees for such pmjecnwith a contmemr(s)Iicemed punuent to the
cmnractor,Llagme Law. 502 '— FINAL PLUMBING ENERGY
❑lam exemp nedar See. .B&PC for tkriscn 506 — GAS TEST
Rpa se, +PCNSATIONDrCLARATION �� 507 — FINAL PLUMBING
1 herby affrn.ander pnahy el perjary rare of the ILlmwing dellaradmu:
❑ I
have and will m:urain it Cenilieme of Covent a, self-inmm for w'orker's
Cnn.panmfion, a, proviild lin by Scnion 3700 or the Lt.or Cwla, for the
perfanmance of he work for which this pcm,it I,issued.
❑1 hmr and will mainwin W'urkcr's Cmigwnsafion Imumn<e.as regoireA by Section .
3701 of the Lalwr C,A,.for the pnforamoce Ill'the week for which this pennil is .
issued.Fly W'n ker',Cum us Zinn Immune carrier and Policy number
Carrie: 'elegy Na:
C:R 1 IC I N( E%IIMPTION FROM WORKIiRS' /
COM :NSATION INSURANCE
(Thi,wetion need not he mmplotcd if the wrout I,fit,one hundred dollar O/
($110)or less.) y�•�
I certify lent in the pater ncc ol'the weak fat wvidr.is punnet is isxncd,I V
,hall not employ any person in any manner w,as In bccgope,cljea to the worker,'
Coau,sa on I-aws of Cahforie.Date
Applirmt
NOTICE TO APPLICANT:11:aIle,olein,min Certifeate of E.enonamn,you should
became suhjecl m me w'orker's Compen.salion pnwisions it(the LM)r Code,you must
Q O forthwith vomply with such provi,icm or this Ill.hall be deemed revoked.
F ^ CON S'FRUCT10N LENDI NO AG UNCY '
I herby aRnn thin then,is a commit lending agency for the performance
fry ufthe work for which his pennil is ismed(Sce.3097.Civ.C.)
Q Lendrh Nanus -
LcnAcr's Address
U I cerdly that I have read mi,application and orale shat the above infer tin r is
4. E.. a....1.1 agree m comply with v11 it,and county rdinunce,and ,are Invs'x relating '
Q V
to building construction.and hereby outhadxe representative,of this city to crop upon
ry the above-met imeed pu,peny for fmpeelan mrsl .
fy( OV agrm ill xuvc,Indeaonily and keep lw,mlexs the City of Cuperti nougulnst
N liabilities.judgmetv.a,costs and expemes which may in any way accrue aguina said
U ,Z City in cnnsequcna,of the griming of this permit.
"'• APPLICANNffiiUNDERSTANDS AND W LLCOMPLYWITHALLNON-/pppnnnINNry/''Tff'' Issued by: Date
SOURO6REGUL 1 NF. 7 1G o ff
Signet .•gym A,p ieaer/Cm m r D,a Re-roofs
I IAZA OUS MAA HRIA1S DISCLOSURP.
w'iu me apphNin to future Wildin,..'an, fact a handle taceardat:material Type of Roof.:
as defined by the Cupertino Municipal C, .Chapter 9.12,and the Health and Safety
Code,Section 25532(ulp GY'�/
El yea All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future buadingoccupant use equipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
emit hauuduux an Cnnrm,inuntn Iclinpl by the Hny Area At,Quell,Mi anent
• Dearne (r/ all new materials for inspection.- Applicant Understands and will comply with
Up, all non-point source regulations.
hung mad nw h✓/:ntly �ma tcha nghit if is m under Clutpxr bAg nr the
Culifomin Hcalth&Sofro Gate.Seetion,25505,25533m,1255ii,l understand that /
i(mc building dos ern cumcntly havca¢nam,mm if is my rtspansibiliD In notify the
sect pan,nrtunclear,
yran prior to „umme of a Canilcam of
Occupancy,
- I
Signal re of Applicant Date
Owner nr mhal ngn,a Data All roof coverings to be Class "B" or better
OFFICE