01080127 CITY OF CUPERTINO'-",
suer DIIVGbtvtsiola, �, r " " CONTRACTOR INFORMATION:
rI ; PERMIT ( — . —-_ .
BUILDING ADDRESS: ."... - - I �I_.,i 40'4 .. ,Yj`�t'IC.!H( PERMITNO.'
i197I0;.-MERRISTT.fDR( ;k: j WATER HEATERS'-'ONLYI!"^- t" `i ' '0108012.7.c1 '
7 OWNERS NAME' _ APPLICATION SUB DATE
'`ALICEA LOUIE JR AND MARCIA G ' 9707` E =MAIN ST, SUITE 20008/27/2001
PHONE: SANITARY NO. CONTROL NO,
(415) 566-2209
a a Z ARCHITECT/ENGINEER:, .BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Li 1 I_J IJ
LICENSED CONTRACTOR'S DECLARATION _
s • 1 herchy affirm that(am licensed under provisions hf Chap¢r9(commencing ]Ob DCSCCIPt1Gn -
u,f-w withSmlihn7000IhfDitlsion3oftlieBuslneamWPmfessionsCalc,rndmyliceme REPLACE 40G GAS WATER HEATER
is in full foreeand effect. _
:z u< License Clea• Lic.p - -
:O0.
u Dart Cramer.,
i 3 Cor ARCHITECT'S DECLARATION-
` S 1 understand my plans shall be used as public records _
i o 2 Licensed Professional ' i s i n .•.
OWNER-BUILDER DECLARATION
r%++
to I hertby vlRrm that I am exempt from the Contractor's License law for the . . •11 - s ,
r z< following mason.(Section 7031.5,Business and Professions Code:Any city or county ,•, ,',•:r Vs •. .e et: .. $700
I=G which q s pr n.cons , h p d moE,n tepv any orudu •` t
to its mounme, so rtq stn ppl ,f such nlsfl g dOsteme t __- __- ... .... ..__ __._......
...
W 3 prior ie Ic had per! :inrtolit6 pro of thee. tractor Lc rue la (Chaps 9 i_i ( pp r', J Valuation
(tomaheneum smean,70(0of Divsonl f iB mess and'Prnfe.on'Cod) � , �1� e3��,FI 7, V,V b..��.} , 1:-t
Or g basis far the vll8 ed teem t o An violation M 8 Pto Any - _ _._ ... .. ._. .. . I. ......
of Section]031:3 by anY applicant lot a permii subjects me applicant m a civil Penalty r_:L.'J�:•-'
:hr not mnreman Bye nn�arta ahnam asofB' - 5O'Y'PN lis` § 'L PLUMBI JENERGPdCupancy Type
❑1:3s�w cr of the properiY•^r my as.ithw' es as sncir sole compcmmion, _ L'
...5. 0 n
�wilTdo'Ihe work,and'the strucmm is'nnr intended or offered for sale(Sec 70/4,-
Bueineis vrld'Profmsions Code:The Contractor i License Eaw does not apply to an -5 OJ FINAL -PRt44R &pectiorlsowns, -
of progeny Who Wilds or impmvcs thereon,and who dao such work himself
or through his ownpl Ye Provided that sh improvements am not , J d Or 1
offered for aideIf however.the Wit ng in improvement is sold within caneyear of
completion,the buldr isill have h burden f provingthth did notWld or
improve for purpose fsal )
Q I'as ow ne,of,he prvpent a to excl usive IY cononuing w ith licensed convacmrs to
d
oiroluel c project
) ,IS ItBusiness and ProRsh ons Code:)The Contractor's
�1 Remit La docs not to e f property who Wilds improves ereon
ns such projects wlothchnvanodA LttnveJ
-
puauam to the
Conten L<nu
(ala eempt deeScc _� B&PC for thnrtawn - •• " 17. 1 ,
Owner •"
e - WORKER'S COMPENSATION DECLARATION •
I hcrtby eHiim under penalty of perjury one of the following declarations:
'� ❑ 1 have d will mai tan a C111ifilcal,of C4111ent to air nwrc•hm Worker's ,1 - s '1'
Cmapimainim, ars provided far by Section 3700 of the Labor Code, for the
pedontwnee of the work for which this permit is issued,,
11 P
O 1 hove and will inaimain WdrAer s Gimpepsatiim Insurance,oa«yuireJ by Section
37W of the Labor Code.far the pedormoicr of the voc i which thisPermitis •- ` ' I' t 1":]:`['
issued,My Wurker'nCTmpmsdti,in Insurance c5nicrpnd Polic rmor fort:
Ca
+ ro its if ,'oh %P.l 1'olicYN a .'Y i t1�i 1 1 �. is t r } `.
A CERTIFICATIONOFEXEMPTION FROMWORKERSg ,f; -_. .
M1..' _ - COMPBNSATION INSURANCE _.. ___\_.._
'•-'' (Th (on need not be c mpim6d itche Permit is for one hundred dollars 'Ofvl 1 ) ' ,,. - .•I .ill' 1-,t;„ -
(f1W)Or Ica) a ., f
n fy
that
in the ped n cc of the k for, h ch
this
hr gem l -hued.I
s stiall'not empl Y anY,pe Y hoer, ns to I+icome x b)n to tnc Workers
Chmpcn. ,un L ws of C I f Dtie;
Applicvnt 7. .. .,,. . - -..... _ ._
'iYOTICE TOAYVLICANT:II.alter narking this Cenilic le of Eacmptioo.You
nhrdO
bedtime subject m me Wdrker's Compensation provisions of the IShor Code.yod most
0 O f^nhwim comply with such provisions or this Penni,shall he Jeemcd revoked. I
^ • .:'CONSTRUCTION LENDING AGENCY -
CI hereby Orion Oat th a nsrmct IeoB gig ncy for the perform ace
the work far hlcym perms '.sue"Sce 319]Ci C.) -
L arae
LcndersN
Z Lender's Address - .. _ .`';i+ bid
U'C `
1 nfY that lh read his ppfat dstte that thaboveinformation is
I. [.: Canso l agae to comply with all city and county,ordinances and state laws mlating A (�
O.f) thea longconstruction:'vdh hinauthorize mprescricativerofth City to enter upon
>, 0. the ab^ a ncd pmpcny for fy and e purposes.
y Is.j ague so save, and expenses
and keep ,harmless me City of cru Cupertino agarld
W liabilities,judgments,cams and expenses him,may any way accrue against said
City in CANT UNDERSTANDS
D R the NDSgratingD this permit. . '
SOURCE REGULATIONS. Be
WILL COM1/PLYWITH'ALL NON-POINT Issued by: -'Date
• SOURCE REGULATIONS. � � k'tl' � Y'
Signawrgof ApplicaMCommeror .."'.s. .' , Dae-.' Re-roofs,'- I' -
HAZARDOUS MATERIALS DISCLOSURE l .' `
..W'llthe.Pplidant or future building occupsuals baadl hauA maunal e Of Roof- -- - --- ----- --
as def d by the Cupertino Mun opal Code,Chapter 9,12P ad theHealth d Safe, ;P_„_ +:r l) \•, ,
Code S era 2551 W)^. #e - r A t. r d s :• 1 �s,'• .
❑Yaa r ❑n Ir i{ + , - All roofs shall.be.Inspected_prior.to.any:"roofing.material,being installed.
_. ..__.
Wll thevppl cam It rc lite ldinguc Amuse cymp em raeygea wmeh If a roof isoinstalled without first obtaining an,ihspection; Pagiee'to remove
emit hazardous air chnmai n tits ah defined by the Bay Area Air Quality Management
nh,nn all new materials for_inspection Applicant understands'and will comply with
❑Ys olJo ;., all non-point source regulations
t: 1 have cad me•haz:udous maiedals r q r mems under Chapler 695 of,he ,
t �• Criifomia Health Ac Safety Code.Scion 25505;25533 and 25534:1 understand thats
,if the building does not currently,have a tenant,mai it is my responsibility to nmify Oc _
oceupam of the requiumen¢which must be ma prior to iseuance of a ce.ificne'hf
aeapapay.;,,,. _ „ . Signature of Applicant Date
o- - Data All roof coverings to be Class."B"or better
Owns toad degc,
7— 7r� -, n�.- r.:', F i OFFICE