00090066 CITY OF CUPERTINO '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDR IiSS: PERMIT NO.
UN'NIiR'S NA UL N'I'LICAI'ItjN SUIT LAI E
PHONE' KOPA, JUDY SAN)ARY NO. CO ROL NO.
❑s0Z ARCHITECENGINEER: G BUILDING PERMIT INFO
ad❑❑
FEW RLDC ELIiCr PLUMB MFCH
L _ I -1 I=1 I:J
Z0v=suii LICENSEDCONTRAC,OR'S DECLARATION Job Description
O v,es_ 1 hereby affirm the 1 am Iicen.N under prnvtsmns of Chapter 9(ro ancia ng
t. with SCatian 900(dofDiv'ninn3of,he Ihrsocs,;nl Prnfanaon.Code,und, y hccnw
dmf-'aI is in full force rntl cfft.
aswQ ueenkers_�3_lp_ Lica CDZ`I ��l:tirt REPIPE, WATERHEATER
0 DECItm_ .ar
ARCIII'IbCT'SUECLARATIO
1 undcnanJ my plans shall W usCd az public rcahNs
}
IL O O Licensed professional
OWNEun es int .the RATION
1 Wets.uscet that I ton es—in from the Cn,i I,Cod :Ann c Law for the
jullowh Z 2 %hick ing rerson. erten to 7031Sconstr, t.afros,and I'c.do ioii Cale Any city s county
c'i ca which requires a e.alsorc mrchthe alms imfor such
dcmrmin t or repair any fmnure
6jw pnnransItuen:mee.alsnittlu;restnaaprrcnntfnrweh aaba mflen
a,Lonlfatcn,en,
teethe i.ucen,ith Sectionome of Divisin 3 of the BusinesandPrfew[ChtCter9 Sy. FL Floor Area Valuation
lamwencis exempt with there ium aj of Division 3 0l the 1clind ss and ma.An ons Cade)
ur that he is31.5taly 4pl n and the haste for the els the exemption.Any vipenalty
of..I a than by any dled d est!n ICrmil xuhj 7e the opplicum Io n civil penalty
of nal mole than five nanarca sonar,lsstioj. ANN Number Occupur( MOL
01,as owner of the property.or'try e,npwyees with wagce as mcir sole cmnpcnsutime. '
will do the work,and the structure is mm intended or offered far sale(Sec.76W,
Business and Pn c,,ion,Codc:The Cnmmcmr's License Law does not apply to as Z-' fired Inspections
ret Prupeny Who hagebor fmCs fifer n I who due+ u.,Ifwork bin,sdf
or through his tun cmpl,Y s.punidNuch that simpmvcmcmsare or IntendCd or
olfeed for sale.If,nowcser,the wilding or;mprovemem;s soldwithin one year of 106 — SEWER R- WATER
,mplei tri.ton owner.hmider will nave the brolcn of proving ],at ha did 11,11 build nr
improve for purpose ofoale.). _ 202 — UNDERFLOOR PLUMBING
01.asowrer of fire praperty.,,or,adu,i.ely aunuoulm,sate,Iicemed eommeore to 301 — ROUGH PLUMBING
construct the project(Sac.9044.Business and Professions Calc:)The Contractor's
Licen.e Law du,s not apply to an owner of pnq¢ny who builds or impales thereon. 302 — TUB & OR SHOWER
and who commas for such projects whb a uunmmot(s)I;cmacd pmwtmt t"the
Comencmrs license law. 502 — FINAL PLUMBING ENERGY
❑I a,1,esenpt mhder Sc,. :R&P C far this reason 506 — GAS TEST
Owner WOR_Date KER'S COMPENSATION DECLARATION S07 — FINAL PLUMBING
1 he,ehy afnnn under ryrally of perjury one of the following declarations:
❑ I have and will mai.,mo a Certificate nl Convent In xrlGlnwrre for W..ker'n /C7' j
Compensation, as providcl for by Section 3I00 of the Lahr Cade, for the
Ipelbormunce of the work lot which this permit is issued,
01 have add will maintain Worker's Cmnitc.-u on],I...snort,os required by Section O O
39tg1 It the Labor Cale,for the performance of the work fur which this Penni,is
i...ed,My Wnrkcrs Con.prmmion In....an,c cu i,r Bud Pohey am he,am
Carrier:_knsk C� VolieyNa.: -W>—o7038'9y_
CERTI FICA]ION OF EK I:M PITON FROM WORKERS'
COMPENSATION INSURANCE
1'ILis s,,roo,cud nnI he r, r,leled il'the penult 1.for one hundred dollen,
IS 11101 or less.) _
I uenifv tlrW to,he palonmmm of the work Ila which this panni,la issued,I
shall not employ any person in any,Banner sit as to become sabjcct,o the Workers'
Compensation Laws of California.Dmc
Applcant
NOTICE FO APPLICANT:IL neer making this Certificate of Exemption.you should
become subject to the Workers Compensation provisi ms of the tabor Code,you must
Q O lunhwith uv....1,with sod,It r,iva or Ih;v ,rent bit[be deemed rcvalad.
z
^F = CONSTRUCTION LENDING AGENCY
a yI hCerhy of irnh that there is a a,nawction l=nding agency for life erli n mnec
'he walk[nr whieh,hi,perms,is issued(Sec.307.Co,.C
Q Lender's Name
5 z I.cnder'x Address
U QQ 1 certify that I have lead this application and fare that the aMve information is
fY f✓ corns,.I ugrce m comply ,it,all city and aunty ordinee-,and sure Iawx relating
t.> to Wilding ronslmninn,and hereby authorize represenmtivesnf this city n,enter man
the aMwo-mentioned property for inspection purpose,.
T y (We)ugrm to stn e.l ndcmni 1,1 1kelp harmlc,,,he City of Capeninn ugainat
F'r W gaulities.judgn¢ms,costs and expenses which may in any wiry accrue against said '
U z City in crmeeyucnce of granting of this pemut.
APPLICANT UNDERSTANDS AND W'ILI,COMPLY WITH ALL NON-POINT Issued by:- Date
SOURCE REGULATIONS.
Sigomme aMppl;canVCornactor Uwc Re—roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding occupant store or handle hmmdnus material Type of Roof
as darned by the Cui,<mtino Mnn;c;p;d CIA,Chapter 9.12,IOW the Heart and Safety
Calc,Section 25532801 '
All roofs shall be inspected prior to any roofing material being installed.
Will theapphean,orfinure bo;ldingoccupant tocerfupmhcm or deweeewh'iclh If a roof is installed without first obtaining an inspection, I agree to remove
mi,haiadamairctmtamiranu s defined by the Huy Arca Air Quality Management
,;.Idol" ,f all new materials for inspection. Applicant understands and will comply with
❑Yes ?"" all non-point source regulations. .
I have read the haeallous Inamnals rc9uirentems trader Chapter 6.95 of life
Califnm;o Health&Safety Code.Sections 25505,25533 and 25534.1 and o,land Rhin
if the Wilding does not curmnlly have a tenant,that i,is my responsibility w ratify the
,ccuryuu alet eBurt fish must be met prior to issuance of it CCni icule of ,
D"ap � —p a Signature of Applicant Date
Owner or hoti:ea age - Lane roof coverings to be Class "B" or better
OFFICE
CITY OF CUPERTINO '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDR IiSS: PERMIT NO.
UN'NIiR'S NA UL N'I'LICAI'ItjN SUIT LAI E
PHONE' KOPA, JUDY SAN)ARY NO. CO ROL NO.
❑s0Z ARCHITECENGINEER: G BUILDING PERMIT INFO
ad❑❑
FEW RLDC ELIiCr PLUMB MFCH
L _ I -1 I=1 I:J
Z0v=suii LICENSEDCONTRAC,OR'S DECLARATION Job Description
O v,es_ 1 hereby affirm the 1 am Iicen.N under prnvtsmns of Chapter 9(ro ancia ng
t. with SCatian 900(dofDiv'ninn3of,he Ihrsocs,;nl Prnfanaon.Code,und, y hccnw
dmf-'aI is in full force rntl cfft.
aswQ ueenkers_�3_lp_ Lica CDZ`I ��l:tirt REPIPE, WATERHEATER
0 DECItm_ .ar
ARCIII'IbCT'SUECLARATIO
1 undcnanJ my plans shall W usCd az public rcahNs
}
IL O O Licensed professional
OWNEun es int .the RATION
1 Wets.uscet that I ton es—in from the Cn,i I,Cod :Ann c Law for the
jullowh Z 2 %hick ing rerson. erten to 7031Sconstr, t.afros,and I'c.do ioii Cale Any city s county
c'i ca which requires a e.alsorc mrchthe alms imfor such
dcmrmin t or repair any fmnure
6jw pnnransItuen:mee.alsnittlu;restnaaprrcnntfnrweh aaba mflen
a,Lonlfatcn,en,
teethe i.ucen,ith Sectionome of Divisin 3 of the BusinesandPrfew[ChtCter9 Sy. FL Floor Area Valuation
lamwencis exempt with there ium aj of Division 3 0l the 1clind ss and ma.An ons Cade)
ur that he is31.5taly 4pl n and the haste for the els the exemption.Any vipenalty
of..I a than by any dled d est!n ICrmil xuhj 7e the opplicum Io n civil penalty
of nal mole than five nanarca sonar,lsstioj. ANN Number Occupur( MOL
01,as owner of the property.or'try e,npwyees with wagce as mcir sole cmnpcnsutime. '
will do the work,and the structure is mm intended or offered far sale(Sec.76W,
Business and Pn c,,ion,Codc:The Cnmmcmr's License Law does not apply to as Z-' fired Inspections
ret Prupeny Who hagebor fmCs fifer n I who due+ u.,Ifwork bin,sdf
or through his tun cmpl,Y s.punidNuch that simpmvcmcmsare or IntendCd or
olfeed for sale.If,nowcser,the wilding or;mprovemem;s soldwithin one year of 106 — SEWER R- WATER
,mplei tri.ton owner.hmider will nave the brolcn of proving ],at ha did 11,11 build nr
improve for purpose ofoale.). _ 202 — UNDERFLOOR PLUMBING
01.asowrer of fire praperty.,,or,adu,i.ely aunuoulm,sate,Iicemed eommeore to 301 — ROUGH PLUMBING
construct the project(Sac.9044.Business and Professions Calc:)The Contractor's
Licen.e Law du,s not apply to an owner of pnq¢ny who builds or impales thereon. 302 — TUB & OR SHOWER
and who commas for such projects whb a uunmmot(s)I;cmacd pmwtmt t"the
Comencmrs license law. 502 — FINAL PLUMBING ENERGY
❑I a,1,esenpt mhder Sc,. :R&P C far this reason 506 — GAS TEST
Owner WOR_Date KER'S COMPENSATION DECLARATION S07 — FINAL PLUMBING
1 he,ehy afnnn under ryrally of perjury one of the following declarations:
❑ I have and will mai.,mo a Certificate nl Convent In xrlGlnwrre for W..ker'n /C7' j
Compensation, as providcl for by Section 3I00 of the Lahr Cade, for the
Ipelbormunce of the work lot which this permit is issued,
01 have add will maintain Worker's Cmnitc.-u on],I...snort,os required by Section O O
39tg1 It the Labor Cale,for the performance of the work fur which this Penni,is
i...ed,My Wnrkcrs Con.prmmion In....an,c cu i,r Bud Pohey am he,am
Carrier:_knsk C� VolieyNa.: -W>—o7038'9y_
CERTI FICA]ION OF EK I:M PITON FROM WORKERS'
COMPENSATION INSURANCE
1'ILis s,,roo,cud nnI he r, r,leled il'the penult 1.for one hundred dollen,
IS 11101 or less.) _
I uenifv tlrW to,he palonmmm of the work Ila which this panni,la issued,I
shall not employ any person in any,Banner sit as to become sabjcct,o the Workers'
Compensation Laws of California.Dmc
Applcant
NOTICE FO APPLICANT:IL neer making this Certificate of Exemption.you should
become subject to the Workers Compensation provisi ms of the tabor Code,you must
Q O lunhwith uv....1,with sod,It r,iva or Ih;v ,rent bit[be deemed rcvalad.
z
^F = CONSTRUCTION LENDING AGENCY
a yI hCerhy of irnh that there is a a,nawction l=nding agency for life erli n mnec
'he walk[nr whieh,hi,perms,is issued(Sec.307.Co,.C
Q Lender's Name
5 z I.cnder'x Address
U QQ 1 certify that I have lead this application and fare that the aMve information is
fY f✓ corns,.I ugrce m comply ,it,all city and aunty ordinee-,and sure Iawx relating
t.> to Wilding ronslmninn,and hereby authorize represenmtivesnf this city n,enter man
the aMwo-mentioned property for inspection purpose,.
T y (We)ugrm to stn e.l ndcmni 1,1 1kelp harmlc,,,he City of Capeninn ugainat
F'r W gaulities.judgn¢ms,costs and expenses which may in any wiry accrue against said '
U z City in crmeeyucnce of granting of this pemut.
APPLICANT UNDERSTANDS AND W'ILI,COMPLY WITH ALL NON-POINT Issued by:- Date
SOURCE REGULATIONS.
Sigomme aMppl;canVCornactor Uwc Re—roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding occupant store or handle hmmdnus material Type of Roof
as darned by the Cui,<mtino Mnn;c;p;d CIA,Chapter 9.12,IOW the Heart and Safety
Calc,Section 25532801 '
All roofs shall be inspected prior to any roofing material being installed.
Will theapphean,orfinure bo;ldingoccupant tocerfupmhcm or deweeewh'iclh If a roof is installed without first obtaining an inspection, I agree to remove
mi,haiadamairctmtamiranu s defined by the Huy Arca Air Quality Management
,;.Idol" ,f all new materials for inspection. Applicant understands and will comply with
❑Yes ?"" all non-point source regulations. .
I have read the haeallous Inamnals rc9uirentems trader Chapter 6.95 of life
Califnm;o Health&Safety Code.Sections 25505,25533 and 25534.1 and o,land Rhin
if the Wilding does not curmnlly have a tenant,that i,is my responsibility w ratify the
,ccuryuu alet eBurt fish must be met prior to issuance of it CCni icule of ,
D"ap � —p a Signature of Applicant Date
Owner or hoti:ea age - Lane roof coverings to be Class "B" or better
OFFICE