01110081 ciBUILDING OF ;PERTM1NO
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7918 OCTOBER WY AQUATEK PLUMBING INC 01110081
OWNER'S NAME: APPLICATION SUB DATE
TSUNEKAWA TATSUHIKO AND ROSE A 1716 STONE AVE #E 11/19/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 295-7767
G OO ARCHITECTIENGINEER: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MECH
n L__I I--I
'Sus z I thereby aRrch he,LICENSEDmo CONTRACTOR'S
und.,pmDE unsof DECLARATION
9lcommcmin Job Description
yN_C qde
FrosviinfllforceundofDivision 3ofthe BusinasandPmlessioroCwe.andmylianse COPPER REPIPE.
;x� m pen force ana`
Liv.p 6>7—6
S 3 s, Dme/ Commct°r
ARCHITECT'S UECLARATI N
:.0< 1 underspend my plans shall be used as pontic records
t•�i >
so o Licensed rwrea,mnm
OWNER-BUILDER DECLARATION
I hereby afmn that 1 a.1. exempt from be Contra,, s I_iccmc Law for the
z a asrch re rcawn annstot 701 1.5.Bunlac,s ane Pro&„inn,ewe:Any any nr c«me $4860
F F o Yncn requires p[m,h I construct. Iter p a Iliirepairy igned someone
3msi� _'barh I alw, q _ thef hosimiufl Law
c� ____. _ _.___._ _ .____.__ __.._.
than 1 cd pu3uannothep i' n otdRC todLce se Ls (Chapter 1;3 OZ.11 ,61'm:ffvll<'111 ;,.,_I Valuation
(commencing with sect o mn'ra r e as J rat l penes a a itan As ons Cwe) 1� Tj s'D 1
or that he,s 335 b IncreGom ana the aper rnr the alleged aempuoo Any riP natty
-af Section tOJf.S by any applicmr for a permit subjects the applicant m e civic penalty
of not more than live hundred dollars($500), 20LAPN_ N-Wett'RFLOOR P UMBINGI Occupancy Type
Q 1,as owner of the property.or my employcex with wages as their win compensation,
will do the work.and Profession,
structure is not intended or offered Law for sale(Sec: to an 502 - FINAL P�%44]h4GPiFAE4FGY
o nem of antl'arty Who
Cwe:The Conetaoeo License Law does trot apply to elf
awn f p perry employees,
m l builds raided t thereon,and wood h work himself
nr through H. own mnpl y .p mea mm wen improvements t' mwga or 50..7._..-.._ FINAL.....PLUMBING
-compllefor sale water-buildcrhebuildingonmpen of mann>tha'whhm not year or - irl. .__. .. __ ._ .. ....... _._ .. .._. _..
completion,the owner-Wilder will have the burden of proving that he did not build or
improve for purpose of sale.).
them of the prtspeny,am aci se comraaing with licensed convenors m _ :... R','r r't'
l
License
construct the prosect(Sec.appl it)a Business aro Priary who
Croat)The Contiertom's
License Law does nm artily won owner of Promur who builan ie improves thereon,
- _ sae who es License
for such.Prolecu with a comrano:ls)licensed pursumt m.the.
01 am ors in unde Law. _. . 2
❑lame pt urea see.' '- .BSPer«this to DEC�EC � 200. ..'!l :
Owner' Date
ORKI:R'S COMPENSATION DECLARATION BUILDING
yy 1 heart, afiim,under penalty of Perjury one of the following declarations:
V ❑ 1 have rod will maintain a Cmifc n,of Cement in self-Insare for Worker's
Compensation, as provided for by Section 37W of the Labor Code, for the
performonee'of me work for which this permit is issued.
OI have and will commit.Workers Compensation Insurance,as requited by Section
37W of the labor Code,for tae performance of the work for which this permit is
ismed.My Worke7s Compensation Insurance carrier and Policy number are: _w
” • ,. a"•,rr lig::: .. _. __. _ .____ _ __ .—
. . cam�t:I1/:n•C6tvoohs,No.: 11/9/?—r/9'"t/� _ .. • r r ,. _� _._ . . . .'d,,,;,l.
I ;1 ;CERT1FICATI 111hXLMFI ION FROM,WORKER51,, - fei` , •,I " L.s
COMPENSATION , .
% . _................._.....__.__.___...—
I
'rud'section need nm be completed if the permit is for core hundred dollars "'�''t''I' ,. ,n (I. c(-...,r.
IS100)or less.)
1 e employ
that in the n in any ma n the work for which this permit art orkers'
shall not employ any person in any manner so as to become subject to the Workers' r'"
be n.nmion Lawn of Cdlifnmia.Dart
Com
-Applicant.
NOTICETOAPo the Workera If.after Compensation
this Certificate of Exemption.lbouC ,younould .r -I I.
baconithi campy the such p's Compensation Provisioha ofthe lace!Crook,you must
� fonhwitti comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY _ performance
` "Ifhereay amrm 11ca,m re is o rnnsrucli°n lending agency for the erf irmance
Rl r or the work for which this permius issued(Sec.3097:Civ,C.) ...
QLenMr'n Name_. .... v ... . _ . ... _ ,.
Lender.Addmsx
V Q 1 certify that 1 have read this application and state that the above information is '
Ixr [.., emptied.1 agree to comply with all city and county ordinances and state laws relining
. C V to buildingcomudction,and hereby entente'representatives of this city to enter upon
the eWvcmemioned property for inspired..puryoses.,_
F.,G.1 like)iijune nit save,indemnify and keep harmless Ne City of Cupertino 4turna
fAliabilities,judgg encs,<rnI,ana expenses which may in any way accrue against said
V.Z City in consghence of he granting of this permit.
APPI ANTU MST NDS AN a ILLCO YWITH ALL NON&POINT'
. r sG yr Issued by: Date
_ sigwwra of preaMm
Ceracmt .. ' .. One Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE
P'll Ne applicant future buds ng« pant core or handle hicusn .martmal T pe Of Roof _.
defined by,the Carpenter,Municipal Code.Chapter 9.12.and the Health rad Safety
Code.Section 255721.1 • " .'
QY°` ) i�" j .,I t' r'l yl " All roofs shall be inspected/prior to.any_roofing materia] being installed. _-
Will she applicant orfuture Wilding occurrent use equipment or devices which If a roof is ifigtalled-Without first obtaining an inspection, I'agree to remove
smithazardous mmnht definedasbythBay Arco A Quality Management
'n7 all new materials for inspection. Applicant understands andwill comply with
Ov "° all non-point source reguhni6iis.1 have re.E the et xCo sSeZdonal eq.25533 a ad r 4+1 un 6.95 of the
Calirdmie HceINffi Sa(ny Cwc,sections 35505:25577 and 25514.I undemaro that
ifthe Wilding does not currently have a tenam.that it is my responsibility m notify thecupari of thq rq irtmemx which muit be i priono iewance of a Cenifida¢ofIX y!Dr,
°c'`° y�r'' / Signature of Applicant Date— All roof coverings to be Class "B" or better
Owner nr euNo'cd agent Dote
...... ,.,. .._ .._. . .. .. . - OFFICE _