00120109vi
CITY OF CUPERTINO
CONTRACTOR INFORMATION:
HJUILDtnG DIVISION PERMIT
BUILDING AiAT7��J"73 FEAR TREE CT
WATERF-IE.R'1"ERS ONLY
PERMIT NO.
00120107
OWNER'S'1 ^
BLV
APPLICATION SUR DATE
1;:/18/2000
fN LINDLEY
500 AIRPORT
PIR NE:
SANITARY NO. CONTROL NO.
(415)349'-3747
ARCHI I EC IT.NGINEIiR:
BUILDING PERMIT INFO
BLUE ELECT PLUMB MECH
=1 IJ =1 1=1
LICENSED CONTRACTOR'S DECLARATION
Job Description
I ncrcby Illi.... Inas I an licensed under prnvi kat, 01 Chapter 9 (,t fencing
with Section 7(A)nlof Division 7ofthe Rusinessomd profession, Ctde. and lay license
WATER HEATER REPLACEMENT
' in lull nice and effect.
License Class Lic, a
Uam
S DI;CItor
AHC111lFCr'S REELAbbe
re'ION
I and nr,tnna my nl:anx Haatu a roes :,, panlio recon.
Licensed 1•mtest ;ana'
OWNER -BUILDER DECLARATION
I.. e
I hechd Idlinu shut I a rupt aunt the CCnumm�rs Liarn,e Law, th
following myon. (Section 1) 1. and I'm@aio,n Code: Any city in county
whet y :''far It t ... ct.ulter, unprove,deroolikic-p' y wroclart,
mor Io I,, kwouncr.I. "mines he rel a l fia,u6 prood, filc it.wined Ilaven,est
Sq. Ft. Floor Area
Valuation
(hit he is 1 d aiNcAnlr the goo isionsoft c t t Licens, L (Chpte,4)
f the Runes, and 1 n fsss on.v Coda
M)) of Division J ogi
(commencing wmh Section 7000)Fu
775
5
or that he Is extrun da rch a and the hu,i, for the alleinsi exendion. Any violation
of Section 71131.5 by any applicant for m pemat wbjmis me applicant R, a civil penalty
APN Number
Occupancy Type
,It mare than five hundred dollars (s500).
31630087.00
❑Laxowner,tfthermtscrty. (it myemployees with wage%astheirml compensation,
Required Inspections
will Jo me work, and the wowture is not intended nr on'ered lit sale Sec. 711-14.
to mess :Ind Profc,.inm Code: The contracmn License Law does not apply to an
of property Who builds or impnacnthereon. and win does such work him.5elr
,502 — FINAL PLUMBING ENERGY
through his own employees. provided that such iramocment, are not intended or
urr
offered tar sale. If, h vocdvr, the building or unprodetornl is w1d within oo year or
506 — GAS TEST
on,pfetion. the owner milder will have the harden of proving that he did not build or
improventpurriweof,ale.).
507 — FINAL PLUMBING
D L m, owner It the Property, uta exdusivdy counclar, with licensed cnnvaour. to
Cade:) Comm an",
mNmq the project (See. 70O. Rmincsa and profes,iomde:) Th
License Law does not apply n, an nwncr of properly who build, Lir impnwa, thereon,
and who mmnicts for .such projects with a contnumgs) licensed pursuant to the
'
Contruemr, Licence law.
01 ten exempt under Sec. . It & 11 C for this reason
Owner Date
WORKER S COMPENSATION DRCLARATION
I hubby allmt under penally of penury oair af oho tol oving declaration,'.
/
Cl I mI 1 w C 5 f t C I t It' c t N kc
Qope . t o s provided l by Section 1 the Link C W f tire
,
pall t0 wink for '1 Ith.p I's i—t J.
O
❑In J will inilarrin WorkC p t ,1stant [is re'lairedbyS tion
379) of the War Cods- for the perfornuntt of thee work for which this per n t i,
,
wed. My Worker', Cou pcmation Insurance earner and Policy nunsar sre:
Cmuvr: Policy No.:
CERT FICADON LIZ 17M 1: ION FROM W OHKI?RS'
COMPENSATION INSURANCE
('This inion nevi not be completed if flue no t ix for one hundred dollars
19100 or less.)
I semi,y mat In the pedormence of the work III, which mfr permit 1, owo-l. I
shall not employ any pawn in any manner so as e, becume subject to the Workers
Compenrminn Lot, of Callli..... a. Out,
Applicant
NOI'IC12 10 APPLICANT: 11: after making thin Cenilieam o1' lixetnption, you should
benne subject to the Worker, Conspemation provisions of the lair Code. you mn.o
torthwl(h comply with xueh pu mmn, u, his ,cr u l 0,11 be detuned tevokral.
CONS] 'RUCI'[ON LENDING AGENCY
I hereby affirm that mem is a construction lending agency for the perfunnance
It the work Int' which mi, permit i, iniad (Sat. 1(N7. On. C.)
Lender's Name
Lender's Addre..
1 candy mutt I have read Iii, application and state Into the above automation i,
correct. 1 agree to indicator -comply with all city and counry inlinor- and ,tate law, elating
, hunli ing cnn.nudinn, and hcaiby muhndeu reprncntmidcs of in In city us enter upon
the made-tncntinned property for I nspection star ,.
(WO) agree Io wvc. Indcnmify tend keep Id mdess the City of Cupeninn against
liabilitie.a, judgmcmo, coat, and expense, which may in any wad accrue against said
City in amnce twice IT the granting or thi, pemut.
APPLICANT UNDERS'IANIIS AND WILL COMPLY WITH ALL NON -POINT
��—
-GULAITONS.
Issued b Date
y'
SOURCE R
SignaturcnMpplirmUCnmrdclnr Date
Re -roofs
HAZARDOUS MATIiRIAS DISCLOSURE
Will the applicant or future building twaupad vice, oa laaadlc hvuNow, numdal
Type of Roof .
as defined by the Cupertino Municipal C'tde. Chapter 9.12, and the Health and Sv1'uty
Code, Scnian 2557207
DYe` D"o
All roofs shall be inspected prior to any roofing material being installed.
W'tu he apd,;i ar,mum buldidgn......n,I uw, a nybuent nr dev we, which
If a roof is installed without first obtaining an inspection, 1 agree to remove
emit harardou, air commninanrs us defined by me Iluy Area Air Quality Management
D"untr
all new materials for inspection. Applicant understands and will comply with
DYe` oNo
- all non -point source regulations.
1 have mad the hazardous rwnerialr aquiremenn under Chapter fi 95 of the
Calif... is Hedth & Satety Clkle, Section, 2550.5, 25513 Lind 25574. 1 wderxumd Ihum
if the building does nor eunently have a tenant, that it is my ropmslnility to notify the
oopunl of me ,esptl taunt, which must be mut prior u, 6uKH111 ofu Cenifenm of
Occupancy.
Signature of Applicant Date
All roof coverings to be Class •B•' or better
Owner (it tatallati,edagrnt Date
OFFICE