04020034U'
CITY OF CUPERTINO
�
BUILDING DIVISION PERT
MI
C
UN R , 0 1M,0RMA.'�J
BUILDING ADDRESS:
JIM�MARKMAN PLUMBING
PERMITNO04020034
7375 ROLI-INGDET-T, OR
OWNER'S NAME:
pswiT ISSUE DAM
GS LAS HADAS LP
P O BOX 44Q4
09
ONE:
'/04,2004
SANITARY NO. CONTROL NO.
(650)341-9669
ARCHITECTrENGINEER:
BUILDING PERMIT INFO
BLOO ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hemby affirm that I am licensed under provisions or Chapter 9 (commencing
with Summ7 Bar Division Sof tiro Bnainesa d Paramours Cnde.and my license is
idmumme ercec� _-sV g 12i\l.
REPLACE 1" GAS LINE .FROM
Licew CI LIL
Date o cadliacmr
TION
ARCHITECTS psi ARATION
crsanJ my all E a used moks
1 uddN
METER TO SPA HEATER. .tt
INALED
plana public
FEBOWNER-BUILDER
F 0 5 200.1
Licensed Pmrcuiodal
DECLARATION
I hereby affirm Net I am "sand, from Ne Cnnuacmr's License Law far the
Y
rollnwing reaon. (Section 703 L5, Business and Profcuions Cede: Any city or county
which moraines a permit to onnarim, alum. Improve, demolish Or repair my etrunum
prim in its issuance. also requires the applicant for such permit to rile a signed suumem
that be is licensed Forward m the moviaimu of me Conmmor's Uttnse law(Chapur 9
Sq. Ft. Floor Area 0
(commencing with Scolded 7") of Division 3 of the Business and Protrusions Code)or
Out he Is sump, motorman and me bah for tits alleged emmption. My violation of
APN Number
Occupancy
ane
P Y �'Pe
Section 703 1.5 by any applicant for a pemsit subjects the applicant to a civil penalty of
nm team man rive hundred dollars (M).
35933012.00
❑I, as owner orthe property. or my employ= with wages as theirsole compensation,
Required Inspections
will do the worLml meswctme 6 not intended or offered (ceramic (Sao. 70a, Business
and Profemions Code: The Conmmols License Law does, nal apply m an owner of
e q P
props ny who builds or improwu thereon, and who dnea ouch work himsel f or through his
own employees, provided tat uch improvements ate not intended oro@red for rule. If,
however. me building or improvement is mid within one year of completion. the owner.
Wilder will have me harden of proving that Im did Out Mid or improve for purpose of
sale.).
❑ 1, a owner of dm property, am uelusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Prefusi Code:) The Disclosures Li-
cense law doss not apply m an owner of prepeaty who builds or improves thereon, and
who contnea fm such pmjecu with a contractor(s) licensed pursuant in due Conammes
License Law,
❑lam arm toncer Sec. ,B&PCfar tela mason
Owu(a/l .i Data Ai �c U
WORKER'S COMPENSATION D�L.ARATION
"
I hereby affirm under penalty of perjury arc of the following decimations:
1 have and will mein W n aCertiGcau of Cement m selFiaum far Wartds Comped.
muon, a provided (m by Section 3]00 of Ju labor Code, for the performance of dm
work for which this permit la issued.
❑ I have and will maintain Warkr's Compensation Insurance, a required by Section
37M of me labor Coca. for the performance of dm wort forwhich this permit I. Wood.
My Worker's Compensation boodam a carrier and Policy number are;
uric'.. S*� Jla.ans -golj rya.: t7�'Fe1S(e 20 o'j
CERTIFICATE OF EKEM MON FROM WORKERS'
COMPENSATION INSURANCE
(TMs medm need not IN completed i(me parmi, Is foram hundreddnllara (SIM)
car las.)
1 ceni(y the, in the perlorman a of the work for which this permit is Wood, I dull not
employ any Noon many mandarin a in become subject to the WorkeA ComFamtian
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Ceniriam of Exemption, you should
become subject in me Workees Compensation provisions of the labor Coale, you muss
forthwith comply with such pravisinu or this Permit Nall be deemed mvoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm ma, mere is a construction lending agency for the perfmm use of
the wish (sir which mis permit is mood (Sec. 3(197, Civ. Q
Undoes Name
Lenders Addmu
I certify and 1 have mad this application and sum that the above information is
minect. I egret to comply with all city and county ordinances and sum laws relating to
building construction, and hereby authorise representatives of this city in color upon the
above-mentioned property for ialmmin purFoms
(We) agree m.K, indemnify and keep hYmlea the City of Cuparlino against
liabilities, judgments. Costs and expenses which may in my eddy mcae against said City
in consequence of the granting of this pmmit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURC R GULATIONS.
Re -roofs
Type of Roof
n071040'r
Siliturdireof of Dam
HAZARDOUS MATERIALS DISCLOSURE
Wi
Will the applicant or future Wilding occupant nom aar
or handle hdous material
u defncd by the CuNmm Municipal Code. Chapter 9.11. and the Hulce and Safety
ods. Section 25532(m)?
All roofs shall be inspected to any roofing material being installed.
❑Yu Nu
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will Ne applicant or future building Occupant use equipment or devices which
it harardnus air conuminanu u nod by the Bay Area Air Quality Management
all new materials for inspection.
OiilrlCl?
❑Yca No
I have mad the haardan materials mchuircments under Chmter 6.95 ofthe Califon
nia Health&Salety Cade,Sccdoa25S05,25533md25534.iundersmndthatifine Wilding
Zinct curte�ndy hi unanL ma, h is my uspoamility m nudl'y du axupant of me
requite mat W me, prior m Numw ora CcniB ,upaney.
<a
Signature of Applicant Date
i
All roof coverings to be Class "B" or better
O
rorauthorincdagtnt
Omvo
CUPERTINO
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
APN #
Z, �r
�% l/
PLUMBING
Date:
Re i e of Fixtures
✓
BPERMFEE
5c1n. 4 7-C)o Ll
Building Address:
BPFIXTURE
Pbl . Fixture
-7S-7S
BPWS VCS
Main Water Service
Owner's Name:
/ S
Sewers
Phone #:
Contractor:
Phone:
PLUMBING
License #:
S YY) ar \c rY,
h' CoSU - 34 %
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Contact:
Phone:
Cupertino Business License #:
tA e:
to \"I 0 3
Bui rmit Info:
1�ldg Elect
❑ Pl mb
b cription:
"Ra 1 "
s V 42-4
Residential ❑
Commercial ®�
Cost of Project:
S
O O U
•
AQty
An icable Fee ID
Fee Descrintinn
Fee (Irrnm
PPERMPI'FEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Re i e of Fixtures
PLUMBING
BPERMFEE
Bld . Permit Fees
BUILDING
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWS VCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
B
RE rz
I