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03100196 CITY OF CUPERTINQ BUILDING DIVISION PERMIT ',CONTRACTOR INFORMATION.�" .,kms@ .°sw 0th—€ BUILDINGADDRESS: S P GORMAN INC PERMIT"`03100196 OWNER'S NAME: 2880 AIELLO PERMITL95UE DATE HUDNUT F V AND SOPHIE K TRUSTE 10/28/2003 "Eo (408) 362-9200 SANITARY NO. CONTROL NO. ARCHOECTIENGINC•ER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 !Op LICENSED CONTRACTOR'S DECLARATION a 1 hereby affirm tnat 1 am for sed under pmviaions of Chapter 9 wi mmcncin, Job Description £_ with Scaio/t]gBD)uf DiviaionJof NCB '(rte, dProfcssimu Cedc andmyliccarcis mf un fon m 3�L (,, iso 19 REPLACE WATER HEATER `® 7M— License Cl FINALE® yr Duc Contrac A BTS S OECLARATI N f U I understa d my pla all he sed mods .o Licensed Prof id NOV 2�U3 OW NER-BUILDER DECLARATION <F I hem affirm that I am exempt from the Co mrecmr's License Law fur the ��'�®� n o following 1= n,(Sccdon 7 W L5,Business and Pru(asions Code:Any city or county 5 m which requimst a introit to mnsvua.alter,improve,demolish,or repair any structure woo pdonu its issancc,also trquimsahc applicam for such permitmfleasignpdalammcm ma< that he is licensed pursuant in the pmviaions of the Contractor's Licansc Law(Chapter 9 Sq.Ft.Floor Area Valuation YF$ (commencing with Section 7WB)ofDivision 3ofthe Busincsaand Professions Code)or 36923024 . 00 c .. that he is exempt thcrefmm and the beau for the alleged exemption.Any violation of, Section 703 1.5 by any applicant for a Permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred della,,($508). ❑I,a owner of the pripeny,or my employees with wages as their sole conaNnutlon, will do the work.and ",somehow is not intended or offered im mle(See.7014,Business and Preload nes Code:The ComnnnYs Liana Law docs not apply to an owner of Required Inspections property who builds or impraves theman,end who does wch work himself orNmugh his own employcea,provided that such improvements ere nol intended or oRered formic.If. however.the building or improvement is sold within one yea of completion,the owner. builder will ban His burden of proving that he did net build at improve for purpose of .to.). ❑I,as owner of the prnpcny,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Cade:)The Contractor's Li. anae law does not appy to an owner of property who builds or improves thereon,and, who comment for such pmjecu with a contiaclor(s)licensed pursuant to the Contractor's License Law. ❑ I son exempt under See. B Ar P C for this recon lCay ner Due WORKERS COMPENSATION DECLARATION ' T hereby affirm under penalty of perjury am of the fallowing declarations: 1 haw and will maintain a Cenifcam of Consent a self-insum for Work es Compen- on,a provided(ar by Section 3700 of Ne lobar Code.far Ne performance of Ne rk for which this permit is issued, 1 have and will maintain Worker's Compensation insurance,u acquired by Section 0 of the Labor Code,for the performance of the work for which this Permit is issued. Worker's Cnmpensetio�Nsunn ;a ier end Policy numher are: /g CERTIFI P C FROMWORKERS V/ COMPENSATION INSURANCE (nod ractlon nand not rte completed if the t romini for oac huddrad collars($100) or less.) 1 certify that in the perfommnce of the work for which this permit is issued.I shall not employ any pc.a in any manner an as to taw omc sobjecl m the Wmkeri Compensation - Laws of California.Dow Applicant NOTICE TO APPLICANT:IL after making this Ccnifcam of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Cale,you must �z forthwith comply with such provisions,arthis permit shall Wdeemed minified. OCONSTRUCTION LENDING AGENCY 1 hereby affirm that there its constriction lending gency I'or the perfurmana of Y4 7 the work(or which this permit Is issued(Sec.3097.Civ.C.) SJ A Isndcr'a Name z Lender's Address Q I ceni(y that 1 have read this application and aau that the chow information is y correct.I agree to comply with all city and county oNinances and slate laws relating in 'Immngconswctiom riyhor by inspection np r-mors. utivu of this city to ewer upon the 4 about-mc einn re.to save for omni fyoad keep (We)ogres to cove,indemnify end keep harmless the City of Cupertino against j Z inconstre+.judgmenLL granting of awhich may in any way ecerue against aid City ;J z A APPLICANT of UNDERSTANDS of this permit " APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POI NT Issued by: Date SOURCE ULA S. Re-roofs Si torp App we nonan, am HAZARDOUS MATERIALS DISCLOSURE Type of Roof /ill the applicant or future building Occupant store or handle havudous material a f ed by the Cupcnimo Municipal Code,Chapter 9.12,and Ne Health and Safety Section 25532(a)7 , rl n ❑Yea A. All roofs shall be inspected prior to any roofing material being installed. Will the applicant orfuture building ozapantamequipment mdevices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants iss defined by the Bay Arca Air Quality Management Wrict? all new materials for inspection. ❑Yes ,, I have read we hazarduusmaterials mquimmens under Chapur6.95 oftheCalifor- nia Health&Safety Code,Sado d 255115.33537 and 2573.I undersand Net if the building does not currently hat a tenant Nu mo at it my resporsihilit of the axupact of N uirec taqmcnk hichm MmetptiortoWilmccof a cupancy. Signature of Applicant Date own agent IU Date All roof coverings to be Class "B"or better CITY OF CUPERTINO mg WATER HEATER D a a 6 CUPEkTINO PERMIT APPLICATION FORM APN # © Date: u 0 � Building Address: Iql I In Owner's Name: Phone#: F•*,kf rxi., kL& v Q$ 5 0 Contractor: License#: Q. ID 3d Contact: / Cupertino Business License #: .Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: nn t^ 2� Residential JR Commercial ❑ Cost of Project: c�, Strapped LJ On I atform U Bonded New Location ❑ Replacement Qty. i A cable Fee ID Fee Description Fee Group BPWHEATER Water Heater/ Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BEN ERGY Energy BUILDING BUSLIC Business License BUILDING