08060139 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ':
BUIL 1 GADDRESS: PERMIT NO.
�
4 ROSE BLOSSOM DR AQUA FLOW PLUMBING 08060139
:R'S NAME: FE[LMR ISSUE DATE
GI_EBEL PHILLIP P 565 N 6TH ST 06/19/2008
PHONE:
SANITARY NO. CONTROL NO.
(408) 265-9504
ARCHIIER(FNGINEER:
BUILDING PERMRINFO
-BLDG ELECT PLUMB MECN
0 0 0 0
woo LICENSED CONTRACTOR'S DECLARATION lob Description
V 1 berthy affirm that 1 am licensed under Provinces of Chapter 9(commencing
with Section 70M)of Division 3 of We Business and Professimu code.Soul MY Re—is ADD ELCTRCL SVC TO 200AMP 240V&RMDL BTHRMS
n.H in full Incensed efpML
iq? Ucnoso class Ue.g 5X6&5X5, REFIT SHWR/TUB VLVS, ,RPLC
p Dam ARCHITECTS DECLARATION TUB,VNTY,TILEFLRS&LITE FXTR &NO RE-RFOR
�W V I understood my plans shall be used as public mrnA
rSTRUCTURAL
g LiCnemd Professional
3 OWNER-BUILDER DECLARATION .. -
.�i f I hereby aRrm Nat I am exempt from the Contractors License Law for the
p O following nx-"c.(Section]W t.5.Business SM Rofessiom Code:Any city or coumy
B which requiresa permit m cnnswct,alter.improve,demolish,or minor any mumune
–iy prior ut its issuance.also cominestW applicant for such Permit m file a signed comment
< that he is licensed pursuant to We provisions of the CunmuctohLicense Uw(Charter 9 Sq.Ft. Floor Area Valuation
x~9 (commencing with Section 7000)x(Division 3 of the Business and Proreuiaes Code)or $12000
Q Nat he IS exempt therefrom and the bub for the alleged exemption.Any violation of
Seedon 7031.5 by any applicant for•permit sobjecu the appl'¢ant to a civil penalty ofNumber Occupancy Type
nut¢ort Was love hundred dollars( OT. 3 5 9 0 4 012 .
0 1,as owner of the property,or my employes with cages as their sole cr mpew0on,
will do the wort.and themucmm b not intended or offered for som(Sec.7W.Busmen Required Inspections
and pmfessixm onmtu
Code:The Ccres es License Law dnet apply tu an owner of q p
property who bui Ids m i m pressen Demon,and who does such work himvl f ser through his
own employees,provided thatsuch improvemmu am not intended or offered farsak.If.
however,We building or improvement is Sold within are year of orapleuon,the owner.
bonder wi0 have f burden of proving that he did net Mold or improw for pu yose of
ala.).
O 1,as matter of the property,am exclusively comma ing with licensed contractors to
comWet the project(Sec 70th,Business and Profettimm Code:)The Cmcmumrs Li-
cense Law does not apply m an owner of property who builds or improv thereon,and
who conaacts for such Projects with a cxntranar(s)licensed pursuant se the Contractors
Lice.Law.
ern exunn un9er See B A P C for thb¢Sion
B �•��yn��'/7/"� Dam r
WORKER'S COMPENSATION DECORATION /
1 hereby affirm under penalty of pcdo,one of Js fallowing ISotimu:
T haw and adll for by
Section
37M of ft Labor Code.
for Wmtrrs ce of -
smixn,r whit i this
for by Scetion 3]00 of to labor Code.for the performance of IW
wort for which Nis permit is iaueQ
❑1 have and will resinous Workers Compensation Insurance,as rexpired by Section
3700 of the Lxbm Code.for We perromonm of to were for which Nis pemhit is issued.
My Workers Compensates Imseramx carrier and Policy number am:
Carrico Policy No.: ,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissemixn need net uncompleted lithe Permit is fxrome hundred dollars($IOU)
or less)
I certify that in the Performance of the work for which this permit b issued.1 shall not
cmm i
ployany pern any mance,an as to become subjectortc C pen
Laws of Calif..Ar�ns 91_ 2
Apple., N n��a� _
NOTICE TO A1)PLlCANrvIf.after cruising Nb Cenifhnm of Exemption,you should
become subject an the Worters Compensation provuiwu of the Labor Code,you most
.J O forthwith comply with such provision or Nu Permit shall be deemed rented.
Z 7 CONSTRUCTION LENDING AGENCY
(-oma I hereby ansm Wl them u a comuuction lending agency for the performance,of
Cithe work for which Nis Permit is tuned(Sec.309],Civ,C.)
G.1 0 Usurer.Name
n z I<nders Add.
U 0 1 oemify that 1 haw mad this appikauon and sou Nat the above informeton is
U. F correct.I agree to Comply with all city and county entireness;and atom lam reating to
0U Wilding construction,acc hereby tuborim rtpmunutiwx of Nis city to enter upon the
abevcmcmianedpropent for expenesspecuon purposes
F 4 (We)agree m Save,indemnify and keep horanlen tbe City of CnMxWrW a pool,
rat incoisequenc of ea.We ore and expenses which may to any ways xTue Sgaiutsaid City
t.)z m consequence of We granting of A Permit. / / G�
APPLICANT UNDERSTANQS ANO WILL COMPLY WITH ALL NON-POINT Issued by: Date G
SOU
gU1.ArOr{S.
h`�t"c Re-roofs
ShRCE�gnemm ofApplicturoffoamelor pram
,v.
nARDOURnoebMAnERIAlsolsaosuRE Type QfRoof
Will the applicantn,future building cecupantatom erfthaoud
Seri
Ratthe ed by Cupertino Municipal Cao.Chapter
Je yard
r 9.12.and Health and Safety
.Scetion 255320n
(:1y. tic., All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Dnmct Jmxm uu air conminanu Jcfne by Ne Bay AMAir Quality Mamgcmcnt all new materials for inspection.
❑Yes BIG/
I have maul We hanmoes materials requirements underchaper6.95mfthe Califor.
Shia Heal"SafmyCxdc Sections 25500.25533 and 25534.IuMcmund thulfte building '
does no unemly haw a ant.tut h is my mvpomibility o notify the occupant of dm
reyui tsa nut tire¢,¢issttanca a ncenir�ej,m�aryatatpganey Signature of Applicant Date
owner m anthxriaea sent ,`rJ' D�oaB All roof coverings to be Class'W'or better