03060119CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRicT®R INFORMATION
.
DING ADDRESS: -
PERMITNOO 3 0 6 011 9
IGWNER'S NAME:
PERMITESUBDA%$8/.2003
// 11
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SANITARY NO. CONTROL NO.
ARCHITEC (ENGINEER:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby Marina that I Am Iseread under provisions of Chapter 9 (commencing
with Section 7=)of Division 3 of the Bust and Pmfeuiom Coda,W my tic.. is
In (all fa1CC
t
��L
lad effML ,
LicenseC7111M - e -� 17s � � �
REPLACE 6" SEWER LINE
cu Com' R��Can�aclor >y-•r-�'.?sat sN�
ARCHITECTS RATION
,g
JUN
_L IgeN nagyplensehall�-- heuu� Jupubli`nrds
JUN 2 4 2003
L e Pmlaxamal
'
OW NEm BUILDER DECLARATION
1 herebyeco +(nem Law for the
1 em exempt from Ute Coshes Any
-BUILDING
Co : c
following esan. on 703 1.5, Business and Code: Any city m county
permit . .emus
Which requires M permit to eon sig any stmumm
c 1 alma improve. mmish. m
! ver the s e a mancent
PHOT miacensed Num re I. the the applicant Of the for suehpennn te files LAW(ed ome,9
I. the pmvisimuo CMde)or
NnMincing
Sq. Ft. Floor Area
$l gtq�ion
with Section oftheBuaux]llamessio
(commencing withthhendion 70n r the Business
and Profeson. vi latade) of
basis
d theaof
ext Any
! Net he la exempt thuefrom and the basis for da tltago0 cacmpaon. Any violation a(
that In is f the
3 APR Mffi&r 0 0
Oe
Occupancy Y �'P
Sedrn 7011.5 by any Applicant far • permit subjects the applicant to a civil penalty of
Ant ream man law hundred dollars ($500).
❑ I, as Owner of the property, or my employes with wages As their sole Compensation,
—
will do the work and the.W.lare is not intended or offered for We(Sec. 7044, Buaineaa
ana Prefesuoro Code: The eonlrw.wrs Limmae Law does ant apply in an Owner of
202 — UNDER 8 IG
property who builds or improve thereon, and who doessuch work himselfor Waugh his
own employees, provided that such improwmrnuare not Intended oroffesed fu Made. If.
301 — ROUGH PLUMBING
however. the building or Improvement is said within am year of completion, the weer,
builder will hoe the burden of proving ths, he did not build ter improve for purpose of
507 - FINAL PLUMBING
sale.).
❑ I, as owner of the progeny. am "elusively contracting with licensed Convectors in
convect the project (Sec. 7064, Business and Professions Code:) The Conuscturs U.
cam law docs not apply to an Owner of property who builds or improves themon, ad,
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License law.
O lamaemplunder Sea .B&PCfuthisres,nn
Owner Dau
,10WORKERS COMPENSATION DECLARATION
I hereby alarm under penalty of perjury aro of The following declarations:
have And Will ..!main A Cenlf .m.1'Consul to self-la um for Worker,Compen-
sation, u provided fu by Sedan 370C.17 the Labor Col., fu the performance of me
wmk far which this Permit is Issued.
❑ I have and will maintain Workers Compensation Insuanu, sa required by Secdon
3700 of the labor Code, fur em performanceof the work for which this permit is issued.
My Workers Compensation insun.9lca genu and Policy num r
Came F"^ C' Polity No.: O
'
CERTIFICATEOFEKEMPIION FROM OR ERS'
COMPENSATION INSURANCE
Trisection need not I,ecomplued if the permit IsforonchuntlmddollarsTi
ver leas.)
I unify Net in the performance of the work for which this permit is issued. I mail not
employ any person In my manner as As 0 became subject to the Workers' Compensation
Laws of L'allfamie Data
Applicant
NOTICE TO APPLICANT: If, after making this CeniBcam of Exemption, you should
become subject . the Worker's Compensation previsions of the Labor Code, you mute
foMwilh comply with such provisions or this permit shell he deemed revoked,
CONSTRUCTION LENDING AGENCY
1 hereby Mahan Out Nem 1. A consumed.. lending agenry In, the rufmmanu of
the which thio permit la Wood.)
d (Sec. 3091, Clv, C
Lenders Namc
Lanese.
deh Add dress
I certify mat i haw rtad this Application and sue that the about information is
'
correct. I agate to comply with all city and county oMnaueund save laws relating to
'
building construction, and hereby authorice representatives of this city ro Inner er upon the
I.
above-mentioned property for hapeclion purposes
(We) agree M saw, indemnify and keep parades, the City of Cupertino against
v
liabilities, judSmenu, costs and expcmes which may in My way Manu against said City
W�q
Or
in amegmenu of the grating of this permit.
LICANT UNDERSTANDS AND WILL COMPLY WITH AL ON-POINT
Issued by:3 Date
0 RE
Re-roofs
cure afAppli_ _tm Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle huardous material
As earned by the Cupertino Municipal Code. Chapter 9. 12. and the Health and Safely
zsslz(a)1 -
nae,y.
All roofs shall be inspected to any roofing material being installed.
0Ya [341.Ja
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will are appricma or future building occupant use equipment or devims which
bavanima air cams riouts ss defined by the Bay Area Air Quality Management
all new materials for inspection.
Wrier? /
❑Yrs oxc
1 have mad the hneanhms materials requirements under Chapter 6.95 of the Califo>
nix Health & SafuyCodC Sections 25505, 25533 and 25534.1 understood the if the building
-
does not currently have A tenm4 Nn it u my responsibility u nos ly tlm opent of the
qui me hicbmuRbemnpdortoissuance oraCenificeteafc mpan
Signature of Applicant Date
i JData
All roof coverings to be Class "B" or better
Owncr
or Murmured agent
PROPERTY LINE
%PPR . OVE
IN ;CCORDANCE WIT O
CUP. RTINO Cr00 .
DFTEz
SIONEtt' _�
This srFof plan and spe,ri ti s MUST }
keF�m the job et all t e^ a itis
Io ulr X I S TI N G HOUSE
U S E
lawful i make any Cheng ^ IteratioiEs
on Don r s 'on frorre
0
ih@ h@I nR.Dopt., City of p ' o, d
ft@ 0101 Ing of this plan a s c fi' 460RESS: -7-3-7s- IZo\I'.r�� de4l
3111ALL I OT p@ held to per ' to be an c
�f afqV9tdnason 01 e y revisions
or
d
d
CO
DRIVEWAY ^ 3
PROPERTY LINE
FGt1�n,a� CO UTYU613
SIDEWALK
GUTTER ^_
FACE OF CURB
o LATERAL 50
;SEWER LINE
STREET NAME: 1`
SIDEWALK
�CITY OF
CUPEkTINO
u
RTY OF CUPERTINO •
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
o 3 4()
APN #
Bld . Permit Fees
BUILDING
Date:
PPERNflTFEE&
Plumbing Permit Issuance
PLUMBING
18
Building Address:
PLUMBING
BPFLYTURE
Pbl . Fixture
7375
BPWSVCS
Main Water Service
PLUMBING
Owner's Name:
Sewers
PLUMBING
BPSEWAGE
Phone #:
G " s
BENERGY
Ener
BUILDING
yqg- otq(,- 100 (0
Contractor:
Phone:,,License
#:
Contact:
Phone:
Cupertino Business License #:
lel k
Clnso�
Building Permit Info:
Bldg ❑
Elect ❑
Plumb EK
Job Description:
Cwt` \',n2 . 0.
v
Residen ial
Commercial
CostofProje
\(Q, •� F1g4 rcJa
�t ric
A!mQty.
) cFee ID
Fee Descrintion
Fee Crroun
BPE E
Bld . Permit Fees
BUILDING
PPERNflTFEE&
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Re i e of Fixtures
PLUMBING
BPFLYTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BENERGY
Ener
BUILDING
BUSLIC
Business License
BUILDING
79-2� oQ- 7