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05080119
CITY OF CUPERTINO / > BUILDING DIVISION PERMIT . WCONTRACTOR INFORMATION ,, BUILDING ADDRESS: AAAA—DRAIN PATROL PERMITNO.0 S 080119 OWNER'S NAME: PERMIT ISSUE DATE DORIS ADAMO 24QO TNDBFRrT4 RT 08/15/2005 IF ONE: SANITARY NO, CONTROL NO. (408) 989-6005 ARCHITECfIENGINEER: BUILDING PERMIT INFO BLDG ELER PLUMB MECH 0 0 0 0 igLICENSED CONTRACnOR'SDECons ofC Chapter W 1 hereby arum mat I am Baexa ander provlalfess or Code, 9(commencing Job Description Z with Sermon9O fof Division3of NC BusinuunO PrOlessiuns Code.and my license is n22Z Lice me aneerte Z 61 REPLACE 2" SEWER LINE (KIT LAUNDRY) j�= Lice Cln Lk.R / =F0 Dalc cut= br ARCHITECTS DECLARApheff m 1 undersand my plsanshall M used az s public record gpG Licensed professional Oy3 OWNER-BUILDER DECLARATION <f 1 hereby affirm Nal 1 am exempt from the Contractor's License Law for she COO following M...(Section 103I.S.Business and Pmrassiun Calc:Any city or cmmy which requires a permit to construct,alter,improve,demolish,m repair any suuclnmtcP,�/� /Or1 O 0 0 prior to its issuance..).require Wapplicant for such permit m fir A signed statement EiG Nat he is licensed u JPursuonoNeprovisionsnftheContmcmriLicenselaw(ChePmr9 Sq.FL Floor Area ✓n Valuation .1- (commencing with Section 9000)o(Division 3 of the Busiress And profusions Code)or Q Nat he is exempt IMreform and the basis for he alleges exemption.Any vimlafion of Section 7031.5 by any applicant for a permit subjects be applicant In A civil Penalty of OCCU T not more Nan five hundred dollar(SSW). r P anC Y YPe ❑1,As owner of the Property,Or.,.,].,C.wit wages as deb role compensation. will do Ne work and theswctum is not in¢naed oroffered forsale(Sec.7044,Business and Profession Code:The Contractors Liatue Law does not apply in an maner of Required Inspections property who builds or improves thereon.and who does such work himself or through his Own employ=.provided Nat such improvements Are,notinended or offered for We.It. however,be building or improvement is sold within ore)car of completion.Ne ownep builder will have the burden of proving Nat he did not build or improve for purpose of sale.). ❑1.as Owner of the property,am exclusively conuacting with licensed contractors m construct the project(Sec.7044,Business and Professions Codi The Contractors Li. wrote Law docs not apply to an owner of property who builds or improve tamer,and who contracts for such pmjecu wide a contraemr(s)licensed Pursuant to the Contractors License Law. ❑I Am exempt under Sec. ,B k P C for this reason Owner Data _ WORKER'S COMPENSATION DECLARATION __ - .- I hereby affirm under penalty of perjury one of tie following declaration: 01 I have and will maintain a Ceo ficam of Consent to self-insure for Workers Compcn- . . _. .. . __ cation,As provided I.by Section TTM of the Lahor Code.for On.pertormantt of the work for which his permit is issued. ❑1 have and will maintain Worker's Compensation mamma,ss required by Scelimt 37W of he Labor Code,for Oc pcRormance of the work for which This permit is issued. My Worker's Con mpeatm Insurance carie and Policy number Art: Carie1:-Z�jje_1 NIivy No.17o 6.7ZT—e CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This xctim,need not becompumd if the Permit is for one hundred dollars(sl W) or less.) 1 cenify,Nat in the performance of thc work for which Nia Permit is issued,I shall nut employ any person in my manner an as;In beamcsubjectto the Workers Compensadon Laws of California.Dale Applicant NOTICE TO APPLICANT:IL after making this Cenifcate of Exemption,you should become mnCel.On the Workers Compensation provisions Of the labor Code,you muse .J Z, foMwith comply with such provision or Nis permit shall he deemed revoked. z O CONSTRUCTION LENDING AGENCY [-+ I hereby affirm shat Nem is a cons uctino lending agency for tbe performame or fY> Ire wurk for which this permit is issued(Sue.3W9,Civ,C.) W Lender's Name z Lender's Add. f,Q 1 cenifY that 1 have read Nia application arrd sum that the above informniun is W P COMCL 1 agree to comply with all city and county ordinances and sou laws misting to p U building construction,and hereby Authorize reposenmives ofthis city to enter upon the vcanoue ahomtid property fa inspection Pry uosea �/"w�/W V F 0. (We)agree M ave,indemnify and keep Wordeas the City of Cupertino a avegain, h liabilitiu,judgorms.cnts and expencs which may in my way same against mid City UZ in conxguenec of the granting of this Permit. APPLICANT RSTANDS ND WILL COMPLY WI ALL ON-POIssued by: Date SOURCE ATIONS. / signaureo ApplicanuConuaeor Dale Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof ' Will the applicant or future building occupantatorc m handle haoardma manurial As defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety Code.Section 25532(a)1 ❑vcs .Tam All roofs shall be inspected prior to any roofing material being installed. Will the aPPlicmt or fumm building occupant use eya;pmom at devices which If a roof is installed without first obtaining an inspection,I agree to remove h harsrdous air canuminnu As defined by the Bay Area Air Quality Management all new materials for inspection. sure" ❑Yes 1 have read the Mxardous materials ayuimmcnu under Chaper6.95 of the CAlifo,. iaslnothd Safmy Codc.Scctiun75505,25533 building Jots n t c rc re a¢rant,NatJ1 u my msponihility m nmtily de pmt n On myuire ich must be of m issuamc of a CcniBcae of Oce 1 '�a yM� Signature of Applicant Date Owmerarauthorn<dngent g l m/�"—�'� All roof coverings to be Class "B"or better r Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 161UPEkTINO Building De artment JOB ADDRESS: PERMIT # 10,;-70(b Cb ['S-69 oil o/ OWNER'S NAME: p, ; U PHONE # Y 91 GENERAL CONTRACTOR: ,, FAX # I am not using any subcontractors: $ Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO ' = u`' REPIPE/SEVERS/MAIN SERVICE CUPERTINO PERMIT APPLICATION FORM APN# Dat -3 :r 3S /'d` © � 2 � �S'oc_ Building Address: t,02-06 4-V6- K A 9 / Owner's Name: i IPhone#: V-15 o ilo 5r glil ontractor: Phone: License#: tell P oil •-i (o Contact: Phone: Cupertino Business License#: Building Permit Info: La1 ��cg q � H, rGw BldgEl Elect El Plumb ' J Job Description: R ,, �✓� t ✓ice Residential Corq1nercial ❑ Cost of Project: a c • f1l,00 Qty.. if A licable Fee ID Fee Description Fee Group / BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING