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04080156 CITY OF CUPERTINO - suaomc mvlslon PERMIT CORA 'OR INFUt211�IA.'TQL , • Bu1LDINGADDRESS: NATIONAL ROOTER PERMIT No.04080156 • OWNER'S NAME: PERMIT ISSUE DATE VIVEK A ONE: SANITARY ONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u00 LICENSED CONTRACTOR'S DECLARATION lobDescri tion Ui 1 hereby affirm Nat 1 am Iimnscd under provisions of Chapter 9(commencing P ^i wOh ScrotaB7pg7)af Division 3of the Business ofusinns Code,udmyliconx is I- ■ - � ® mrml rbtgpim mrc_ Lig 76Q.3�v REPLACE WATER LI �ml�alyq''ja,G,p` H USE) N Z Licenu Clan¢ q Dae Contractor n W ARCHITECTS DECLARAWN <3 I understand my plans she]be used as public mcorda AUG / D6u 2004 3O Licensed Professional OWNER-BUILDER DECLARATION 1 hereby alnnn that I am exempt from the Contractor's License Law for the aO following manna.(Section 7(13 1.5,Business and Professions Code:Any city or county K a� which requires a permit to convect,alter.improve,demolish.Or repair any atrumum e—to prior m its issuance.also requires the applicant forsuch permit to film a aigneJ statement tx�x< thatMislicensedpursuanlmtheprovisionsoftheContractor'sLimenxlaw(Chapter9 Sq.F[.Floor Area Valuation c�SF$ (commencing with Section 7000)of Division 3 of the Business and Professions Caic)or that he is exempt Netefrom and the basis for de alleged exemption.Any victual on of Section 7031.5 by say applicant for a permit subjects the applicant m a civil penalty of 3 ] Isle eir0 O Occupancy Type net mom Nan Eve hundred dollars($500). ❑I.uownuof Nepmp ay,armyemployceawiNwaguma irmlecompensadon, will do the work,and Nestrueture is notintended aroQered loosen(Sec.7044,Bananas and Profetalons Code:The Canuecmr's License Law deo not apply on an owner of Required Inspections propertywho bulldsorimproves Nement.and whodoassuch workhimself orthmugh his Own employee,provided thmsuch Improvements am not intended oraRered forum.If. however,the building or improvement is sold within one year of completion.Ne owner. builder will have tho burden of proving that he did not build or improve for purpme of nam.). ❑1,as Owner of the property,am=elusively contracting with licensed convectors to convect the pmject(Sec.7044,Business and Pmfusiom Code)Tim Contractors U. cove law does not apply to an owner Of property who builds or improves demon,and who convects for such pmjeem with a contractor($)licensed pursuant an the Contractor's License law. ❑1 am exempt under Sec. .B&P C for Nis moan Owner - Date WORKER'S COMPENSATION DECLARATION 1 hereby of ore under penalty of pedury one oftie following declustiom: 1 be-and will mounted aCenifi=m of Comenl m self-insum for Worker's Camped 103ZO und,u pmvided for by Section 3700 of the Labor Conde,for Ne performance of the k for which this Permit is issued. CD I have and will maintain Worker's Compensation Insurance,u required by Section of NC labor Code,for the performance of the work for which Nis permit is lamed. y WorkoYs Compensation Insmanm certiu and Policy number am: me' e OWEN1 T d.: WO K iS'I D(�.Q ,3 `/ CE�RTIFI ATE OF E%E FROM WORKERS' COMPENSATI INSURANCE (Otis section need not he completed if the permit is for one hundred dollars(S 100) or loss.) I certify Not in the performance Of the work for which this permit is issued.l shall not employ any person in any mannerx as to become subject to the Workers'Compenutian Laws of California Date Applicant NOTICE TO APPLICANT:If,after making this CeniEnm of Eacmpfion.you should become subject in the Workers Compensation provision,of the labor Code,you must .,0 foMwith comply with such provisions or this permit shall be deemed revoked. .Zi CONSTRUCTION LENDING AGENCY (~14 I hereby air,.Nat Vert is a comtrudion lending agency for Ne performance of fYr ti the work for which this permit is issued(Sec.3097,Civ.C.) 0 Lender's Name .7 z Lender's Address V Q 1 cmAfy that 1 have road thin application and area that Ne shove information la IT, F cannot-l agree to comply with all city and county ordinances and sate laws ranting m Q[) building convection,and hereby autharim mprexnmu tivof this city to enter upon the W above-mentioned property for Inspection Pegmxa 6, (We)agree to five,indemnify and keep harmless the City of Cupertino against rn liabilities,judgments,mets and expenaes which may in any way acme against mid City O2: in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE RE IONS. \ 0--" A? Re-roofs Sigrusuple T Applm— andC.rfs cmr Dow HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant Or future building occupant earn or handle huaNaus material as defined by the Cupertino Municipal Code,Chapter 9.12,end the Health fid Safety COJe.Section 25532(e)? All roofs shall be inspected prior to any roofing material being installed. ❑YesO Will the applicant or fumm building occupant use equipmen or dcvim$which If a roof is installed without first obtaining an inspection,I agree to remove 7Dirtflcr? t harmdnus air contaminants u derided by the Bay Area Air Quality Management all new materials for inspection. ❑Yce eI have mad Nc hmaNuus maeriala myuiremcnts under Chepmr6.95 of the CalifnrHcalth&Safct� ode,Sections 25505,75 and 25334.1 understand Nat if the building a not current ave a mnam Net it k my m pomibility w dory the occupant of the ui c 'c uu th me 'orwism ce or a cc,dficam Of occupancy. Signature of Applicant Date All roof coverings to be Class"B"or better ner o uthorixa0 ag al Dam Community Development -- 10300 Tose Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building Department JOB ADD / J PfIT Y OWNER'SN T a PHO _2tF GENERAL CONTRACTOR: F 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 �L Roofing Septic Tank Sheet Metal Sheet Rock Tile er Co tractor Signature Date CITY OF CUPERTINO o c, REPIPE/SEWERS/MAIN SERVICE • CUPEkTINO PERMIT APPLICATION FORM APN# / Date: Building Address: // 7 6/-Ta Owner's Name: Phone #: e /aUa / -7y7.2 Contractor: // Phone: �y��Sg7 License#: 76 ���0 et77 tJ o Contact:. Phone: Cupertino Business License#: erg ` OZ5'/-D887 Building Permit Info: Bldg ❑ Elect ❑ Plumb Job Description: Pwlacea2�=rxve c7-i Lcovfe Residential Commercial ❑ Cost of Project: A?'j3yjricab Fee ID Fee Description Fee Group PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING