03090073CFPY OF CUPEMNO
,E> •!
BUILDING DIVISION PERMIT
CONTRACTOR INFORMA'PIfjN .p
BUILDING ADDRESS:
TOM'S PLUMBING
PERMITN003O 90073
OWNER'S NAME:
12246 SARATOGA SUNNYVAL R
RMIT ISSUE DATE
NAKATO RICHARD2003
NE:
(408) 867-6010
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:BUILDING
PERMIT INFO
BLDG ELECT PLUMB MECH
t� t� 0
LICENSED CONTRACTORS DECLARATION
I hereby 1 licensed Chapter 9
Job Description
p
affirm Ilial am underuntie( provisions of (commencing
with Ee..AA poi Division Sof the Business en fe,ainm Gods. and mylicenan i,
in full force and « e
FINALED
License Class LIC.N ((�
REPLACE WATER HEATER
Cosnract
"
2 6 2004
nderatand my pins shall bc�ml As pus mrd
FEB
BUILDING
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm Ilial 1 o crept from the Contractor's License Law lot the
following reason. (Section ](131.5 Business and Pofessiom Code: Any city or county
which requires a permit to construct, alter. improve, demolish. or repair any structure
0 0
prior to its issnmee, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant o the previsions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area Valuation
(commencing with Section 7") of Division 3 of the Business and Professions Code) or
that he is exempt hcmfrom and the basis for the alleged exemption. Any vinladon of
35619027.00
Section 7031,5 by any applicant for a pmmil Subjects the applicant to a civil penalty of
- ' "" -
APN Number
Occupancy. Type
not mom Nan five hundred dollars (S5O0). - -
- - - ...
-
❑ I, az owner of the property. M my cmplomas with wages az their sole compensation.
will do the work. and the structure is not intended or offered for sale (see.]044, Business
—
and Profusions Code: The Contractors License Law does not apply W an owner of
Q
506
property who builds or Improves thre
eon, and who does such work himself or through his
— GAS T
own employees, provided that such improvemenes arc not intended or offered for sale. If,
507 — FINAL PLUMBING
however, the building or improvement is send within one year of completion, the owner
builder will hale the burden of Moving that W did not Wild or im prow for purpose of
aa1e.).
❑ 1, u owner of the property, am exclusively contracting with licensed contractors to
.. .... - -
construct the p djca (Sec. 7044, Bminess and Profassions Code:) The Contractor's Li.
cense Law does not apply to an Owner of property who builds or improv demon, and ,
who contracts for such projects with A contracmr(s) licensed pursuant he the Contractor,
License Law.
❑ 1 Am exempt under Sec. , B A, P C fin this mazon
Owner Data
WORKER'S COMPENSATIONDECLARATION
- --
I hereby affirm under penalty of perjury one of the following declarations:
_ _ _--
1 hew and will maintain a Certificate of Conwntto mlFinsum for Workeri Compen-
sation, As provided for by Section 37M of Lie Tabor Code, far he performance of the
work for which this permit is issued.
❑ 1 haw and will maintain Worker's Compensation Insurance. As required by section
3]00 of de tabor Code, for he Performance of be work for which this permit is issued.
My �Worke�r�' C1ompensation Insurance cartferandpideryypumberam:
9
Carligr'. I PIOIN
RO:�pJ�.`
tss✓✓l%% C TIFlCA FROM WORKE S
COMPENSATION INSURANCE
COOF MPENSATION INN
This umlitm Decd not hecompleted if the permit is for one hundred dollars (SIM)
or less.)
1 ttnify that in the Performance of the work for which his permit is issued, I shall not
employ any person in any manner an As to Wcomc subject to the Workers' Compensation
Laws of Califomia. Data
Applicant
NOTICE TO APPLICANT: If, after making this CariOeste of acninion, you should
become subject to the Worker's Compo random provision of the Tabor Coda, you most
forthwith comply with such provisions or this Permit hall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affifm that dere is A emetor inn Icndi ng agency for the performance of
he work for which this permit is issued (Sec. 3(N), Ci, C.)
Linares Name
Lender's Address
1 ttnify that 1 have read this application and sure that de above information is
correct. 1 agree to comply with all city and county ordinances and sure laws rebound, to
building construction, and hereby auhorim reprmentatiws of this city to enter upon the
aWvomntionadproperty for purposes,
ma.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
expenses
lipconsequenc or ranandexpenseswhich may in any way acemc ageing said City
in consequence of the gaming of This permit
j
APPLICANT UNDERSTANDS AND WILL COMPLY WIT Ff-/kt.L)JON-POINT
SOURCE ULATIONS. b
1/
Issued by: Date
Q
_ 90 qA 0, r.'zaro`.f 9'lr "-3
Re -roofs
Type of Roof
Signialli, o1 plicaHAZARDOUS MATERIALS DISCLOSURE Data
Will he applicant or future building occupant store or handle hararch us material
A'defined by he Cupertino Municipal, Code. Chapter 9.13, and the Health and Safety
cra CY.actioA:ss3zta)?
❑ Ycs [�No
All roofs shall be inspected prior to any roofing material being installed.
Will thea licant or future building «ea ant use a or
oe g p equipment which
If a roof is installed without first obtainingan inspection, I agree to remove
P g
I hvardnus air contaminants az defined by the Bay Area Air Quality Managcmenl
Quality Marta
all new materials for inspection.
,sulci?
❑Yes KNu
1 have mad the havaNmua materials requirements under Chapter 6.95 of the Califin-
anHeald
� Safety Code, SecWm 25505,355]] ad i 534,1 understand hat if he building
hes not currently haw a ¢nam, that it is my respumihirity W Amory the occupant of the
m immormwhichmustWmelpoorWiss cemracetofica¢as y.
Signature of Applicant Date
•
All roof coverings to be Class "B" or better
or auhu rcd agent Dare
A
•
CITY40
CUPERTINO
CITY OF CUPERTINO q o
3
WATER HEATER v
PERMIT APPLICATION FORM
APN #
Date:
5'-
Building Address:
PPERMTI'FEE
I541 -7 GS4,P%D
PLUMBING
Owper's Name:
c%aer7 NAk46+
Phone #:
2r'2 -869y
Contractor: Phone:
License #:
0 s 06-2-601,0
vell7el
Contact: Phone:
Cupertino Business License #:
Q�Nr 2S2—b'BRy
Building Permit Info:
Bldg ❑ Elect ❑ Plumb V
Mech ❑
Job Description:
R L,q « w Ae<14t,e—
Residential Commercial ❑
Cost of Project:
Strapped ®= On Platform El Bonded
ElReplacement JQ
New Location
Qty. if
Annlir�el Fee m
Fee Description
Fee Group
BPWHEATER
Water Heater / Vent
BUILDING
PPERMTI'FEE
Plumbing Permit Issuance
PLUMBING
BENERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING
230 9b
,469.61