NOT CUPERTINO 01040154 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING AIIIIR[SS: PERMIT NO,
15042 MONTEBELLO RD. BUDGET PLUMBING 010401.54
APPLICATION SUB DAI
/r t4'NIiR'S NAh1E: S
JERRY KROTH 26695 ROANOKE ST 04/27/2001
SANITARY NO. CON MOE,NO.
HONK:
(510) 303,-7847 ;
BUILDING PERMIT INFO
O z z ARCIII'IpCI/he GINIT21t:
p^aOO BLUE EI.ECT PLUMB 1,1E01
�m I,ICFNSIIU CONIBACI'OR'S DI:C1.AIlAI'ION - lob Description
0 5 a,� 1 letnbr:,lBmt heat 1 am Hcen%ed ander pmd'ahm,of Chili 9(commencing
will Savlinn71X)(11al Division?oT the Biome and l'od'e„ion Cude,and mylicense
ext mulbraanlerce WATER HEATER REPLACEMENT.
K z K 6 Liccnx Clens Lic.M
O E' Date Contractor.
ce LL y0 gARCHITFCf'S DECLARAIION
1 undemmnd ny plans.hall be used as public ousad,
c ¢<
p
Licensed liofcssinnal '
L_a OWNER-BUILDER m he CoATION
1 hereby vfamt that 1 1. Benne from the fevskaemr'.%License Law for the
F_z C followingreason.(Section]onstr Businessandmpr Profusion,Code:Any cin of mumy
ure
t, ❑ who t% pe nn newt he ml demolish, p anystructure
a. el pr, I I. 'rsurequiresthe
applicant bps PermittoIIsignedaatnncm
mean lcmdp,. int' In p nn Contractors 1 1 (Chapter Sy. FL Floor Area Valuation
a, . g with nup,tht nxxu rhe vi nn Bg „ era r An, ration $550
nr het he i,ucanpt Ihad'mm and the Baa. or me alleged exanmtlon.Any violmh,n '
of satbn 7031,5 by any apdiennl turn Pennit,aobject, he npprc:alnn ci.il peanity APN Number Occupancy Type
to nut mom Into live hntdmd dollars(&51111).
❑1'a,own” odh,Employ - v ,ploy dl uu,v, ol,,....... r,n 3514006. fit
;ll to 1 A d all 1%n , l d or"flied I '...'I (S 7a4Required Inspections
Hu a'nal lrtfw.i t Code The Cot , I .el 1 r-pplyl no q P
t`„fpmpery who b,ild,0,in,pto.es hereon,:art wan does a,[,wok ltd%df 502 — FINAL PLUMBING ENERGY
of thrmgh his own employeee provided tom such impmrentenn are not intended or
offered it,,sole.IT owe,el, he handing ,, amnovenwo,is son wood,one rear of 506 — GAS TEST
eampletion•tiro ownc,mimer will nave he bmJen n1'proving drat he did ran build or
moove for ramose til,ale.). 507 — . FINAL PLUMBING
01,as Owner of the pmpemy,am w clushe[y contracting with Effect sc l contractors m
construct the pmjmi(Sec.](W.Business and Pmfnsiov,code:)The Contractors
Lien,%law does not apply to an o,arc(of Orpeny who Ends%or intpm%c%tbcrrnm.
and won contracts Ill such project..,with a commeto"%)licensed pursuant to the
Conus,mm,a make
law. I'
O m PI N
I acr"Licer Scc. .B A C for this rem
a ,
D
/\Q Bora oc kj'AwA
1 W) lV(1RKIiR'S COMI' ole 'ION UEChARAI'ION
J Inede
rcbyuttim,anr punal,yul'perjury aneaf,he following Jeehlrndoa,: AN 03 2 q00 .
r5 I het and will anai,Iain a C,rilkalc til Cmncnl m sclkir,im Ior Worker,
Cen.pc kion. as oo—i'l Int by Secbo, 3700 of 'he 1,11,nr C11111. 1111 the
'i-ft io,s of the wort:for which dda pernit'I,issued. D1/V
13ura
1 have l will lnainlnin W,rkvr'.,Compan.mion Insumn'v,a, c".ind by Section G
3700 of he Labor Code.for the pafo ounce of bre work for which this p,unit is
issued hay Winkles Compensation Insurance carrier and Policy moot er are:
Carrier: Policy Nn:
CIiNl'II[CATION OFSAI(ON INS PROM WURKIiRS'
COblp[NSAI'ION INSURANCE:
(This xenon nest nut be completed if the permit is for one hundred dollars
IS 100)or lased
1 ccrify than in the setfom,ancil of the work I'or,hich this permit is o,ned.I
%hall not employ uny person in any manner so as to become%object in the Workers'
Compcmmion I.uws of California.Date
Applicant
NOTICE:10 APN'CANT 11.able%making this Ccnihate of Hwnaprion,you should
Benson xa,ljcct m ahs Work,•%Cnmpea,utiou pmvixior,01 doe Labor Code.you
Q Ibt id comply wish such pnwilt p,m-this pcmlil shall bell...led revnkal.
Fy C(INSTRUC'T10N LIT.NDING AGIiNCY -
w , hen:ny alarm thou dirt'e ix a sons,vcllon Imtd l ng agency Tut Bre prli,rmance
of the work lot wI i,l,do,permit is l,,t,cd(Set.3097.Civ.CJ
0.. LZ Lender's Naue
7 7 Leder',AJJres,
U 1 anily hal I hall read Ili,arm icadan and Blanc tom the aMrcc inli,rmmion i,
fa (•" Innen.1 agree n,comPly wish all city and county""'no
nees anA assn Ixw,adoring
Q U mM1nilJing<onmmdinn,and hemny amhndm cpmaem:nives of lois city v,enmr upon
the antis'owntloned pmpc,Y fur in,pcninn purry,xs.
F y fv Ence to mc.indemnifyan'kap handle%,the city of Cuperino agaimn
V] liuhc juJEn tis,costs and a%penau,Bich may in any say Icons ugnins,sail
U G C'ny in coI 'a cc of the greeting of this permit.
^ API'LICAN,"llod STANDSANUWILLCDhIP1.YWlTHA1.LN(lNl'OINT [slued by: Date
SOURCI7 REGULATIONS,
Signature of nppLcanveommaor Date Re-roofs
HAZARDOUS MATI?RIAI.S DISCLOSURE:
Wiu h,appillant Or hour,Mmmng o,,emd%,ores hndlc la..amom,amedal Type of Roof
n- ed by he Cnpedina NJ....OI Code.Chapter 9.13•and he Ilcahh:aul Safety
CHoOdc,ScaJry 255?2001
ID Ye, 0 N All root's shall be inspected prior to any roofing material being installed.
w'Jlhe:applies,a,Iorlot atebuoant;acnl,:tnall c,m,aeetorde,ncc,wm,h If a roof is installed without first obtaining an inspection, I agree to remove
�irianth hwam ou.,air mmmninanw a,defined by the Bay Area Air Quality Mnnagemem
ls for inspection. Applicant understands and will comply with
oloi<r all new mate .
❑Yea 0 N all non-point Source regulations.
I have read the basNnu,mi,erit,e4mcncet,mule,Chane,6.95 of the
Culifmni.Health k Safety Code.Scctiona 255115,2553)and 25534.1 uedm%mnd het
it the building hoes nal currently have a count,real it i,my msrym,ibility n)notify the
celebrant of the"Wremenn which non',be'net prior to i%rnence of u C'macac of
Occupancy Signature of Applicant Date
Dwnm or amind%<a agcm Date All roof coverings to be Class "B" or better
OFFICE