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04070177 r CITY OF CUPERTINO BUILDING DIVISION PERMIT I;CONTRACTOR TNFRMATT�ON a BUILDING ADDRESS: CUPERTINO PLUMBING PERMIT N004070177 OWNER'S NAME: PERMN ISSUE DATE MAY KOSKI IFNE: SANITARY NO. CONTROL NO. (408) 253-0618 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH I� L 0 jdF LICENSED CONTRACTORS DECons or CON .A y. 5s p 1 hereby affirm that I am lithe Bu under and Professions of Chapter 9(commencing AUGJB IJe ion [M with Section 701N))hfDividon 3of0m Business and Profeufum Code,and lieenu is sss000 infuUfume andeffe. , G2 a-/ U5 COPPER REPIPE z = Llrenx L Lic g BUILDING z p Oem Cunlrlcbr f� 7W SDEC TIDN yt� Iundera dm a u" a GS Licensed OWNER-BUILDER C N ji S I It by aTrm Nn 1 am exempt from the Contracmr's License Law for the 0 0 followin mason.(Section 7031.5,Business and Profeuions Code:Any city or county $ which tarpons a permit to innWuct,alter,improve,demolish,or repair any swcted snno. s.Zepoor to its issuance,also requires the applicant for such Permit to rile a signed statement 0 that he is licensed punuBnuothe prvislorunfthe Conuactor'sLiccnmlaw(Chapter 9 Sq. Ft. Floor Area Valuation a (commencing with Section 7")of Division 3 of the Business and Professions Code)or that he Is exempt thertfmm and the basis fm flue alleged exemption.Any viDladon of Section 7031.5 by any applicant far a permit subjects the applicant in a civil Penalty of 3 W N3Quhl7er0 0 Occupancy not mom than five hundred dollars($500). p y 'Tri 7 pC ❑I,es owner of be pmpeny,m my employees with wages u theb sole eompenudon, will do thework and umstsuctum is nmintended oraRered formic(Sec.7044,Business Required Inspections and Professions Cade:The Contracmr's License Law does not apply b an owner of q p property who builds or improves Nucon,and whodo auchwmkhimulfor Waugh his own employes,provided that such improvements art not intended oroffered for uln IL however,the building or improvement is sold within one year of cempleuon.0te mammy builder will have the burden of proving that he did not build or improve for purpose of tib.) ❑1.a owmr of the property,am exclusively contracting with licemed.ntio ebes to construct the project(Sec.7044,Business and Professions Code:)The Conlnebr's Li. cents law does not apply to an mount of property who builds or imp haves thereon.and, who contracts for such projects with a conuacter(s)liansed pursuant he the ConuacmYa License Law. ❑I am exempt under Seo ,B k P C for this moon Owner Data WORKER'S COMPENSATION DECLARATION I hereby+Dion under penalty of perjury one of the following declanuons: 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compon- sstian.uprovided far by Smile.3700 of the labor Code,for the performance of the work for which this permit is issttM. 1 have and will maintain Worker's Compensation Insurance,a required by Section 700 of the labor Code,for the performance of the work forwhich this permit is issued, My Whittles chmpenaadan Imuran.carton and Policy n��umvvb.er....art: Cartier..Flr1+C—GUNGI Policybkx:(!:�T 7G6(0 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (ITIS a.tbn need not he completed ifthe Permit is Indian hundred dnllan(5100) or less.) I.airy that in the performance of the work far which this permit is issued,1 shall nos employ any parson in my mmncrm as to become subject m the Workms'Co npcnsathm Laws of California.Dam Applicmt NOTICE TO APPLICANT:IL nfler making this Ocr ificam of Exemption,you should become subject to the Worker's Compensation provisions of dm labor Code,you must ,JO forthwith comply wilt such Provisions or this permit shall be d.med booked. Zti CONSTRUCTION LENDING AGENCY F+� I hereby afrim that then is a compactor lending agency for the performance of C' the wants fur which this permit Is issued(Sec.3097,Civ.C.) Qcorrects Name =z Lender's Address O 0 1 certify Nat 1 have read this application and sure that the abhor inforadun is 0 U building 1 agree b comply with all city mu county ordinances mu sum Irvnt r Upon to 0 building construction,only hereby imps aha n representatives of this City to coot upon be LVLT ahove-menudgm pmpcny for imps n purposat. fY (We)agues to ears,hour y and p harmless the City of Cupertino against h Ilabilitlea,judgments,ca an pens hich III an ay III eccagainst aid City V z mcootsegancc ofth of th' rmi✓ ^ APPLICANT U R N ND WI ITN ALL NON-POINT Issued by: Date SOURCE RE A S cw� P, 7 zg'QL� Re-roofs Signal of Appl UChntnnor Data HAZARDOUS MATER CLOSURE Type of Roof Will applkamrfuwrc building Occupant store or handle hvardous mamael a defined the Cupanian More Code.Chapter 9.13,and Be Health and Safety odc.Se on 35533(.)7 �j All roofs shall be inspected prior to any roofing material being installed. Yea (4-a Wi0 the applicant or future building a.upam ata equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove mit hazardous air contaminants as Jcrined by the Bay Area Air Quality Management all new materials for inspection. DisuicR ❑Yes COV. IhacmaJthehoes, yv/amamr9m'q entsunderchaporfi.95ofthc Califor. nit Hmlth&Sof YC iso 25' ,25533 d25534.1unticomndthalifthe building e.a note he ¢n thi I ism ihility b hoary the occupmt of the bquimmen wic p et" sfacenifica� �acy.-_ Signature of Applicant Date Owns ram nxeJagent pais All roof coverings to be Class "B" or better aClOF Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 �UPERTINO Building Department JOB ADDRESS: e / P vT#7v 7 OWNER'S NAME: / PHONE # Nds 2S3.6t, i o GENERAL CONTRACTOW Ift11771n FAX # (t/02)2!r3 0Co7 3 L I am not using any subcontractors: 6 T SignaDat Please check applicable subcontrtors and com let o in_ 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 Roofing Septic Tank Sheet NjeAl She dock /Col actor Signature- Date CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE 2 CUPEkTINO PERMIT APPLICATION FORM APN # d3 .0 Date: Building Address: .^�� Owner's Name: ,fin p� S�l -f— Phone �56� Contractor: �rU��to �0 S License #:r Zy�Qr Cont;c�0", / Phone. Cupert'no Business License #: � Building Permit Info: Bldg ❑ Elect ❑ Plumb Job Description: Ii Residential Commercial ❑ Cost of Project: • Qty. A_ is le Fee ID Fee Description Fee Group PPERMITFEE Plumbing Perrnit Issuance PLUMBING " BPREPIPE Re i e of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING BPFIXTURE Pbla. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING a C) � 3 ,