01100073CITY OF CUPERTINO
[BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMR NO,
912 NEW HAVEN CT
CUPERTINO PLUMBING
01100073
OWNER'S NAME:
APPLICATION SUB DATE
.TOM WILLYOUNG
10297 S DE ANZA BLV
10/10/2001
BONE:
SANIARY NO. CONTROL NO.
(408)253-0618
z ARCHITECT/ENGINEER:
O
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
u9 with Section 700)) fDivision 3.fthe Bmimv,mdprofession, Cache, utlmylicense
REPIPE/ MAIN WATER SERVICE.
been force ands cr. (a�4 SOS
` ._:?�CP
Uis
License Class Lic.p
Date —i C) - LCI - [O 1 Contractor
ARC1ITECT-5 DECLARATION
1 understand my plans shall he used as public rtcoNs
F' � 9 /� L C
tI A+'+1. C
oLicensed Professional
OWNER -BUILDER DECLARATION
fromheoras License Law far the
0 C T 2 2 2001
< fallowing obson. (Secuma7031.5. East.... nd Professions Any city so weary
improve. h,
demol
O O
$6000
6 O...
o permit t m repair any structure
rtqui R construct, �auo
O toed issuance assort requires a applicant 'no fileesigeed sutereent.
primh issuance
... _ - __ ..._ .. _.. .. _ .. .... _ ._. ..._._ _ -_....._..._ __ _ _ _
_.. _ . .
•r.'•,:':"}"" Q I �pj1C'�,51kC ac ,11
�:i�'�
{��/'� Valuation
•'IY<A
d nueni a Ne rbvinons of Nc Commruittodil
- .,
But he i m t t ntra"onx Licenu Inw (Chapicr 9
Pu'' P
Bs Se<tioP7000 orof Sc Code)
(commceein Irk ofhe basis be aBgedessaMPati.An vi
ar thai tic is exempt rhertGom and the basis for the alleged eaempuoe. Any violation
( la1S.Y i3 jS'(j l.�`j tJ - V�'lh.\'l
j
of Section 7031.5 by any applicant for a permit subjects the applicanrto a civil penalty
of not more than me hundreddollars(s5w).
p NAm�� Occupancy Type
202 - UNDERFLOOR PL BING
❑ 1, as moue, of the property, or my employee wish wag. as train In compansatim,
will du the work, and the sm cture is not intended or offered for sale (Sec. 7044,'
Bu mesa end Profession, Code The Contractor's License Law does not apply to an
,R.,,,`,,,< 1 ,1,
502 - F I NAL PYarorilr� q9sPE14ERGY
owner or property Wbo Wilds w improves thereon. and who does such work himulf
,
or through his own employee.. provided thin such improvememis am, now intended or
_ 50.7 - FINAL PLUMBING_'_ —
offered for sale. 1f, huweven the building or Impmvenrcnt is sold within one year or
completion, rhe own,rviWilder will have rhe buden of proving shat he did not build m
I
improve for purpose of sole.).
I
. ... ...
of the pmpcmy am exclusively convening with Ii mntrtcmrs m
❑ C tact
.__ .. ... .... .. . ... _. -' '-1 _ _
ocenud
the Project (Sic.
c the and Profession, Code:) Tile Cmthereon,
1.an
to owner o
License Law does not apply m an owner M property who Wilds se improves thereon,
License
r
the
7 and who contractsforL aacM1 projects with a contmctm(x) licensed pursuant to the.
.. .. _ .. .. .. _ _I _. _ _.. ....._. ... ._ _ ..
01.. ols ixstnde taw.
❑lam exempt undcr,Sm. B&PCfor Nis.rtason
Owner' I Dam ' .
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pcmlry of perjury one of the following decimations:
7 I have and will mommim a Confute of Cohocia to self -insure rm Warkv's
:ompensiumn, as provided for by Section 3700 of the labor Code, fm rhe
performance of the murk for which this perms is issued.
0I have and will maintain Worker's Compem alu m I...... as unpaved by Sccrim
37(111 of the Labor Code, for the performarcc of the work for which this permit, is
issued:h7 Wmkefs ComMnsation Insurance carrier and Policy m ram:
.
Corrier.•I. .,(,X)OMW RKER.S'I,�,
iii �4s Art i(t`�.�.tC i(i�.: ... '.ls'.1'
CERTIFlCATIONOF, E%EMFTON
`•�: v 1'.^i�Ik .I
COMPENSATIONINSURANCE �,:",.
- (Thin xciion need eve be compined if due permit is far one hundred ddlan
($HKB or In..)
I cfnify Thal in the performance of the work far which dos pemdt in cou-I l
�, , l s . L .• a 1., �..: .,
shall not employ any person in any manner, so as to become subject Ir the Workers'
Compensation laws of Cdifomia. Date
Applicant
NOTICETOAPPLICANT:If, after making this Cenificate of Exemption. you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
I
forthwith comply with such provisions or This permit shall h deemed revoked.
1
CONSTRUCTION LENDING AGENCY -' "' ' - s.
-'
1 hereby affirm Thal thele is n construction lending agency for the pedimosncm
-
.filmwork for which this permit is issued (Sec. 3097, Civ. C.)
_
Lender's Name - -
- - - -- --
Lenders Ad dress -
Ir'-, 1 ..
I certify that I have read this application and sure that the above infomestion is
'
sect. I agree to comply with all city and county ordinances and nate laws minting
J to building mnsuuction. and hereby euthorire representatives afshis city to enter upon
gI the above-mentioned property for inspection purposes.
k. (We) agree to save: indemnify and kap harmless IM City of Cupenibd against
O liabilities, judgmerns, costs and expenses which theyy way moue egainsr said
City in consequence of the granting of Nit pSpmR.
APPLICAW UNDER D - D '' C s Y LLNON-POINT '
.
Issued b Date
y.
URS�O CE R�',GU N5. • �,. w,,, 0
Signature oIfApplDate
DUS MATERIALS DISCLOSURE
Re-roofs
pplicr future building occupant store or handle la",mammal.
Type of Roof --'—�--'-•-- _: — --' -'----- -
asdefinedbytheCKmiroMunicipal Code, Chapter 9.12, and the Health and Safety
•'
•4"f;l; "' / r'F ry•, 4111'1"')1
1. 1'.Qfe_
.':.r :1 -:o".n
Cock. Section Z532(a)7-:: t!, - O No"
t'::.,tt J. ..f r,
All.roofs shall be.inspected.priocto.any.roofing material being installed.
Will the epplicem or Pomrt building acupant use equipment or devices which
If a roof is insialledl without first obtaining an inspectidri, Ilagfee to'remove
emit harerdous air contaminants. defined by the Bay Avec Air Quality Menagcnrnn
Distrin7all
new materials for inspection. Applicant understands_ and will comply with
ores, �; ❑Na ,', _.r - .,
all non -point source regulations;,.
I have read die haurdous materials nequirtmrnrs under Chapter 6.95 of the
California Health & Safety Cade, Sections 25505, 25533 and 25536. 1 understand that
if the building docs not correctly have a tempt that it is my me,m ibil ity to ratify the
occupant of the requirements which must be met prim to ieavanie of a CeniOcarc of
Oceup... y'
-.
Signature of Applicant _ Date
All to coverings to be Class "B" or better
Gweerara�tnoriredage , " " Date
...1 ...
I OFFICE _ ..