00100191CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDINGADDRESS:
PERMIT NO,
OWNEII'ST0090 PASADENA AV # B3
ALMADEN ELECTRIC PLB`AP&ICl;ytpf-ji0CX)jll;t0191
I1INI7ADLER DARIN B
1278 ALMA CT
SANITARYJID130/2OMNo.
ARCHI'PECDENGINEEW
O
1 408 1 995—L (I I 1
BUILDING PERMIT' INFO
ELECT PLUH - MECH
ItLDG M1I
F1=7
Cl O I-1
LICENSED CONTRACR II'S DECLARATION
Job Description
I hereby affirm that 1 .,It lieenwd under prolwom of Chnpmr 9 Paman awing
with Section olfDivsinn J n,hc Ifuvinns cast Pr_ofcsonv Code unA my license.
'Lin full force gild effect
iecus; Clan. ZUC 341 Lie. n Sp`L(LJJ
Date_ Cnmmanr e4 -
lta-43o�o�cun'1:crs
DIscl.nl n'rloN
GAS TO OVEN
ulc t nd my plans shall be, used as public rd
-
Lit,taved1 f.: 'I
OWNER BUILDER R DLCI AR PITON
I M1 by Ir door l II f theContractor's 1 1 f the
following No 7031.5. 8: d I I"' C d! Ane ly r n,y
/
wii eh up o, ; permit,, mmswu, vlle, rmpmve, dnnol h, nr comic any ImClure
Prior m its issuanmc.:Jon requires the applicnmia wMno Ien nniIlic a signed dalecrenl
Sq. FL Floor Area
Valuation
that he is licenced purvamt to the prooloinin, or the contractors Licence Law lch:tnmr9
(commencing with Sectio 7(XXp it Division 3 onhe itusinmm and Proresslonv Code)
or Ihnt he in exempt there I mon and the basis Be, the alleged exemption. Any violation
of Section 7031.5 by any applicant lire a heard, mhjmm the applicant hr a civil penally
APN Number
OccuptagybType
rfnotmoreth-five hu de.1lehot,P15001.
with wcs no 0eirarie c ofertxntion.
❑I,n rot the hnenyo my randoym ng
p
3571 7089. required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7644,
1111111, ell :aid Pnde,ions Codc: The Conlrucmrs License Law does nm apply to an
of property Who builds or improvesdoes thereon. and who ds such work himxlf
unhnr
mgh his own empinyeu.. movided but such impmvemenu arc not Intended or
offered for sale. IL however, the building of improvcmmnt is wild within one year of
the owner-lotdm will hnvc he burden A ovia, that he Aid sol hand it
?_02 — UNDERFLOOR PLUMBING
imuplelii,
mprove for l umnse' of sale).
301 — ROUGH F'I_LIMBING
of the tenet. 7(am c3 cots, annractingwith licensed Concmner
❑Laoo the (see.
,,ne:coandPnorehionun.,impeorc,dicnrr'c
50.'_ — FINAL PLIJMBING ENERGY
,,a,
ivicow Law does man awv
aidd wh Lawtrre, pmpcnywho Moldsorimm,a th1.
reapply
will, he
and who eomtucm rat such nmjmm wire a so:hlraeltmq nm,h.al parsnant ,n mm
SDE — GAS TEST
oi.`a sompimich;SSee. BAPCfor hi, ,awon
507 — FINAL PLUMBING
Citta D:rc
WORKER'S COMPENSATION DECLARATION
I hereby oflimh under pamILY mf perjury one of the following declamtionc
I have and will maintain a Certificate of Content it sel6insum Ilrr Worker's
ompensa,ion, as provided Ibr by Section 371m of the Labor Cod, Ilrr ,he
pedonmmee of the work for which this peril is iswed.
cale ;red will maintain Warker'v ComMnvnion Insurance, as m9umal by Sectio
'3 of the Labor Code, fit the pcmn of (he wool, for which this per nit is
'
- voed. My WTtak�e[� CContliensatinn Insurance c:Imuieerr aannndd� Pelicv nuummber r
Caretag ��cEwlflCA NO Palo,EMINOON FROMWORKERS u o
.
COMPENSATION INSURANCE
(This .anion nerd not he completed if me permit is for one hundred dollars
IS I0f) or lea.)
1 certify that in the peformarocc of the work for which ,his peri, is issued. 1
shill nn, ,in,lo, any .,,on in uny numncr so a, ,o hcmmc sobjml in the Wo ke',
—
Compenvalum Law, of California. Date
Arphcaol
Nal '[CIE 'm APPLICANT: Ho ane, making anis Cetilieme of Ev,andson, ,in should
o nhor Code. you oust
become,objectxpre Wo der'n C ... npensntiun par or the lr
forthwith comply with such previsions or this permit shall be damned revoked.
CONSTRUCTION LIiNDI NG AGENCY
I hcrchy.11ir but mere is a mnmmunion lending ugorcy, lire be lsrfmmmra,
of the work fpr which this peril is issued (Sec. 3097. Civ. C.)
6cndcf's No c
Isnder , Address
I certify that I have read this application and a om that the aKwe information to
nicer I agree in comply with nil city and county omioancex and smc laws "Laing
nr limiding consnmtion, and hcrchy nutbnnic repro entativen of Ihi, city In enter upon
the toove-mentioned pnrnedy for inspection purprote,
1 We) age,e to save, indent fy unit keep harmless the City of Cultemom against
liabilities. judgments, cost and exNnwv which may in any way occrac against said
City in etmw luence of the get of this permit.
WILL COMPLY WI'T'H ALL NON.POINT'
APPLICAN T UNDERSTANDS AND
Issued by: Date
y'
SOURCE, REGULATIONS.
Sigranac A APplicanvconlmcmr [)are
Re -roofs .
HAlARWUS MA'I'HRIAL,S DISCLOSURE
Will ,he apploara nr tuu.re Wilding «n:iXam more of handle Sammons material
Type of Roof .
m deGnN by ,he Cupetinn Municipal Code. Chapter 9.12, and the Health and Safety
rale, Smtna 25532(a)7
0 Ye, 0 N
All roofs shall be inspected prior to any roofing material being installed.
Will me applicant or fame, building occuptn use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
coda htooths, sir cm.theemmns a, &F..ed by the Bny Area Air Qaanry Manage on
)ilmct7
all new materials for inspection. Applicant understands and will comply with
El Ye, 0 N
all non -point source regulations.
1 have rend the huaxnlous nrxtetials mqui.onen,. under Chapter 695 of the
California U.Ith & Safety Cale, Sections 25505. 25533 am125534. 1 undesmed that
iIthe butdares no, coorenty have n haat. that i, is no, o,,, hail, to notify the
cunnm a[ the reyuiry eta which st be mm prior m issuance of a Cetiflca,e of
on`y'
Sign re of Applicant Date
1014 M ' 3 O n G i
i
All roof coverings to be Class "B" or better ..
„tar, r ,,gent Date
OFFICE