00100187 CITI'OF CUPERTINO
FlUfLDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: VERMIT NO,
IKIV 001 10187
OWNER1�5 ORANGE BLOSSOM DR - APPLICATION SUB DATE
/2000
11 IIONE: SANITARY NO. CONTROL NO.
MEIER DONALD J AND KRTHRY� M
M W Z ARCH]'I'EC'PHNGINEER: G am— BUILDING PI!RMI r NFO
00
� BLDG ELIiCf 1'LUM11U MECH
LIC
ay
Sy: firm that
colarMd under o,lnv,d TIONCh.t lob Description
_ hereby affirm tens I um licensed under provisions of Chuptcr 9 fmninmmncing
rtwith Sort i 7lNNp of Division 9 nl the lhoinexv'and l4ufevsinm Code,mW my license is RJI fra"i 11111,w U hiccnsc Claus Li,p .
Date Contractm
e1 3 a_G ARCBn'ECI"S DECLARATION
1.108 1undimyplansshalltic mcdaspublic«cords REPLACE 40 'GALLON GAS WATER. HEAT
ER
S O O Licrnwsl I'rnlcsxinnnl
A OWNER1BGB,DERDLCLARA'rION
W=I f bcatby utwr that m e,in Ilam da,CrmnutCo Lime Law for tM
$ which
meson,[Sadnn loo iS�i.alue,and pmAr,v,denioa,Ctdrl Any city or cmm�y
S O which its%u aIxnnil re uix,thn,utter,improve,h lamin.th.ore a airsig ed enemlrc
i 3 pat fie i u etar,e e.purr a aquian lh vvi piu cant for rhe Cor penult Liven signed elatenum
mol lxencing cal Sectio to the rmDivi%i of flu ae Business
LieenseLaw
,,ions(Chapter Sq. FL Floor Area Valuation
or that he is i with Section ain n of Division a of alleged
x and ionrAny vs Cdcl
mf Seel he is mxempl thafmm�:md the hvsis for the alleged exemption.Any violation
of Section 711x1.5iv any hundred
den fur a permit stbjcdx the npplicam m u civil penalty
nr not meat man ttam nmdatn<lehnn lS50X1>. APN Number OccupaliIorTSpe
D I,as owner oi'the Pm,",,art my employee,with wage,a,Ihcir xnteet..npumutinn. s.
will do the work,and the mecum is not intended or uttered for sale(Sec.71W. Ulred Inspections
liminess and 1'mRm ssioCode The Cnmractor's L iceme Law docs tint vppIv or an 9 P
owner of pmla•ny Who weds or improves theater,and who dors such work himself 3661, 1050A
or through his man nnploytts,provided that such improvements are not intended or
offered fur_sale.If,hnwcver,the building or improvement is sold within enc year of
ntmpledaa,die owne,brndee will have da,burden of proving that he did not mild o, FINAL PLUMBING ENERGY
prove fa pmmoaeofaale.h 502 —
D L as owner til the pmauny.ran exclusively cramming with licensed colurYnas to 506 — GAS TEST
rowel thedoes
project ISec, to a Business and Promy who
b ildor The thereon.
construlathd«xnaappy'manewnneofpropertywenelm,erimpmvosmmum. 507 — FINAL PLUMBING
and who contracts for such projects with it commit N)licensed punwnl to the
Commear's Llcensc Law.
D l an,eannpi under Sue .B&PC far this memo
f,wner Illam ! ���
WORKER'S CUMI'ENSA'PION DI!CLARA'1'ION
1 hereby of irm under penalty of pe jury one of the following deelamtions: 0
C 1 have and will provided
n f Cvnil So,, nr Crnsem m xdginsum roe Warder's
Compensation, he work
for lin by Scninn 3JIN1 of the hvwr Code lie the
pmHmtname of m1 work err wldadr ria perarJl i,i,,w1d.
❑I have and wgl n ninlain Worker,Cmnreeaden In,u nuc,a,readied by Scnion
3700 ,1 Ire Labor Code,fur the arbtmemod of the work for which this permit i,
issued.My Wrvkers Compensation Insurance carrier and Policy number arc:
Cartier policy No:
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSAI'IONINSURANCI! .
(Pili,smfun need not he con.plmd if the peratil Is ter enc marked dollars _
(SI(NI)or le".) '
1 certify that in the 1wrfonnmme of the work for which this permit is issued.1
shall not employ any penin in any manner m as to warm,subject to the Workers'
Cnmlumatiun Law,of Culifomia.Date
Arpncam
NOrriCE I O APPLICANT:11,eller making this Certificate of Exemption,you should
became nuhjcm m rbc Wodse,Cn.mica,alion provi rte of thve
e lar Code,you mstu
Q Q forthwith rnm,ly with such provision,nr this permit,hull he dimmed revoked.
FCONSTRUCTION LENDING AGENCY
C ' I hereby afttms that them ix a constmenon lending agency formal performance
W of the work far which this lermit is issued(See.IINJ.Civ.C.1
Q Lender's Name
Z Lender's Address
U O I teddy mat I have road ode application and slate mat the above mfertuatlnn is
k, Ea cr erl.I agree in comply with.Il city and county on inmmes and slam laws muting
O t.7 Ir building construction.and hereby vmhorim repmsematives of this city to enter upon
Ike aw.comntimed property for iaspcnion tamps.e,
[r. 6s (Wil agree to nave.indemnify and keep hamdess the City of Cupertino against
N liabilities,jdgnmmx,ensu and expeows which may U it mry way revue vgeimr said Z
Cly of the gratningof this permit r
APPLICANT UNDGRS'1'ANDS AND WILL COMPLY WII'11 ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. y'
Signature of Apph,rnt(Cnnlmclm Dam Re-roofs
HAZARDOUS IMATERIAIS DISCLOSURE
Will the applicant or future holding occupant,mre ur handle hamachas material Type of Roof
as defined by the Cupenlna Municipal Cove,Chapter 9.12,and the Health and Safety
Code.S,,Iion 215321a1°
DYe, 0N All roofs shall be inspected prior to any roofing material being installed.
Will the applicenl nr l umre building mcupanl me cauipnerd in device,which If a roof is installed without first obtaining an inspection, 1 agree to remove
m I wmnlnu'u,
a air cnnmminams us delind by the Ray Arca Air Quality Munagemcm
n:m1a all new materials for inspection. Applicant understands and will comply with
DYe, 0N all non-point source regulations.
I have read me ha. rdmn materials requi mmnaa under Chapter 695 of the
Caldonoiu I Ismlm&Sul'1y Code,Suliun,25515,25539 and 15534.1 u idemland fine
if ere building does air,rornmly bnve a muam.that it is my rest auihdily it,moil,me
occupant of the reauardmnas which nest be met prim in is mince of a Cendleme of
OCcnti rte, Signature of Applicant Date
Owner mmthaimd agea, Dam All roof coverings to be Class"B" or better
OFFICE