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03090207 CITY OP CUPN)RTINO zrr' 3ri m `T' �a B 11 ING olvlsloN PERMIT aCQNTRACTOR3INI'QRMATION t g BUILDING ADDRESS: ALLSTAR PLUMBING PERMIT N003090207 OWNER'S NAME: 656 N KING RD PERMIT ISSUE DATE LORI MCMILLAN 03 NE: (408) 251-6040 SANITARY NO, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 ±oa LICENSED CONTRACTOR'S DECLARATION Job Description fUp 1 b afOrm Nat 1 am 170 Jar provisions of Chapter 9(commencing - - t5 �W withSccti qOf Division SOf Jw By ,s and Profc is a de,mdmylittnse is .or'a inmBrom na ✓ -) nil NEW SEWER q z L mac Lie.a Dam Co s fARCHITECPS DERLARATION 1 f i U understand my plans shall he used as public memos 7 3 e�� Licensed Professional OWNER-BUILDER DECLARATION <z I hereby affirm that I am exempt fruen the Contractor's License Law for the 00 following mason.(Section 1131.5.Business and Profes,imts Code:Any city or county 3 m which requires a permit to construct,alter,Improve,demolish.or repair any strucurc O pilar m its issuance.also require,the applicant for such permit 19 Olca.igned sucocra m< that he is licchsed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation rF� (commencing with Section 70W)of Division 5 or the B usine.and Profeasio.Cwle)ur Nal he is exempt therefrom and the basis far the alleged exemption.Any=of 35611072 . 00 Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of - APN Number Occupancy Type nal more lean rive hundred dollars($!i00). - .. . _. P Y --- D 1,as owner of the prepany,or my employees with wages as their sale compensation, will do the work,and the structure is not intended or offered for sale(Sec.1044,Business — A $� and Professions Code:The Contractors License Law dans not apply to an owner of UN 2 02 DER property who build,or improves thereon,and who does such work himself or through his own employe.,provided that such improvements are not intended m offend for sale.If, 301 — ROUGH PLUMBING ' however,Ne building or improvement is sold within one Year or completion.Ne owner- - builder will have the burden of moving that he Old not build or improve for purpose of 507 - FINAL PLUMBING sale I ❑1,as owner of the property,am exclusively contracting with licensed commetors to construct La the project(sec.7044,Business and Pmfesaia.Code:)Tho.Owner, nd cense Law Do.not apply ........f Peyer(who beside or improve Oemon,and who tae Lacu for such pmjecu with a contractor(s)liumm med punto tie Conudh ao License Lan em exempt under Sm. ,B6PCfor this rtuon _ Owner Data WORKER'S COMPENSATION DECLARATION 40 . 1musty anirre under penallY Of perjury ane of use fallowing declarations: .._ _. . .. . . .. . . 1 hew and will maintain a Certificate of Consent to act f-insum for Workers Compen- much,.provided for by Section 5700 of the Labor Code,for the perfmmonce of the -, work for which this permit is issued. _ ❑I ban and will maintain Worker's Compensation Imunece.as mquind by Section _ 3100 of the Ubof Code,for Ne perfm r,wme of Ne work for which this permit is issued. My Worker nmpeniglion Insuuna¢mer end Polic her are: r. CERTIFICATE EPglia WORKERS'CERTIFIC OMPE SATI ROM WORKERS' COMPENSATION INSURANCE , CnN section reed not be completed If the permit is for one hundred dollanrSIM) or Icss.) 1 certify Not in the performance rar the work for which this permit is issued.I shall not employ any person in any manner so as to became subject o the Workers'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:Ir,after making this Cent Beste of Exemption,you should became subject to the workers Compensation provisions or the LOW,Code,you must = O forthwith comply with such provisions or this Permit shall be deemed revoked. Z N CONSTRUCTION LENDING AGENCY 1 hereby affirm that them is eonswctinn lending sgeney rnr the perfonnam'c or Y. > the work for which Nis permit i,issued(Sec,5(t91,Civ.C.) 11 Q lender's Name Y Lender's Add.. D p 1 ecelfy that I have read this application and state that the show information is y F•' correct.I agree to comply with all city and county oN;nancu and shut laws elating to 7U building convection,and hereby autharin epresenmivee of Ni,city to enter upon the W www-mentioned properly orinpectiam Poole... (We)w; a la sec ndcmnify and keep thrombus the City of Cupertino ageinl r t�'A lisbthlie.,judg nu.eos rad eapcnses which may in any way accmc almost aid City con une ethe gra it gor this permit. a PL A D NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: L/ Re-roofs Dat OU E R [ON 3 � Ly'a� igneture of ApplicaHAZARDOUS MATERIALS DISCLOSURE unctor Dek Type of Roof Will the applicant tar future building occupant nom m hantllc ha.Nous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety . Coda,So don 25533(.). All roofs shall be inspected prior to any roofing material being installed. Ycs sNu win the applicant r sure banding ocaapant trm egmlmenl or devices wMaA If a roof is installed without first obtaining an inspection,I agree to remove u haaadaaa air aanm ta es deEneJ by me Bay Area Air Quality Management all new materials for inspection. Sa ha �` ❑V. ❑Na Ihevcm to rms maa:rials uimmcnu under Chapter6.95 of the Califnry ria Hcalthgr of Od S cdon525505, 5Aand2553d.1umkrstandthnifthe building d¢s not y he resp maininy u nndfy Ibe occupanl of the eui c filch a mmpriort also acc.tcneof ,' ) Signature of Applicant Date Owner or authorizcJ agent Dam d All roof coverings to be Class"B or better CITY OF CUPERTINO o z 7 REPIPE/SEWERS/MAIN SERVICE CUPERTINO PERMIT APPLICATION FORM APN# ?/ Date: Building Address: yos 1 ?Per, t D to bi, Owner's Name:L©.T. i?il l J _Q��3 Phone#: �C 406Y'1' U Contractor: � Phone:qo a) 2S 1-L�Xt D License#:.13X61 1 Contact: {� Phone: /J Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Job Description: Residential Commercial ❑ Cost of Project: Qty. . A is ble 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 2,-3 2b o LLP 7, ��