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04120155 CITY OF CUPERTINO- __, ✓ o- ,t,� - Buaowc DrvIs1oN PERNUT O1�RAC5TOR-INFOR" T 4th,y BUILDING ADGRESS: GREAT AMERICAN PLUMBING CO �}e N(b4120155 - .0067 SANTA CLARA AVE NER'S NAME: PERMIT ISSUE DATE OW JOHN WILHOIT 166 GRAHAM AVE 4 ONE: - - - - SANITARY NO. CONTROL NO. - (408) 995-6400 'ARCHITECT/ENGINEER: t m: ." BUILDING PERMIT INFO BLDGELECT PLUMB MECN Jgms LICENSED CONTRACTOR'S DECLARATION L y"•i` Gs -' I hereby affirm that 1 am 14mued under provisions of Chapter 9(commencing IOb'De ripnon. with Section 7")of Division 3 of due Bermuda and Professnd ion$CodC.amy 11M.1. I^mnrnmeandmett,%� REPAIR C/O' gZ LI«ve Ctust If 7 DlW - Gmnraeler ✓PRT/e)/N@ ?f//(A( ARCHITECTS DECLARATION PLV.y,6)AJ - 1 undersand my plans shall be used u public meords Licensed Profeautoeal L .. ( OWNUR-BUI exempt from the �tl - I herebyiso aRrm on 1 em excmprrrom the Conuamoc :Any C law for the /j ,1//!� p o following mason.(Swoon Toa 1.3.Business and van.(1C ons Codc:Any city w county C $ which requima a...Lao m .h a,ree aiten Improve,domolbh,AT erepairsig nay atamem C\� 1 a 0 0 F- �^ priar70 it,issuaacaabosequine prevision of for Conamrmi's LkWWLawdsuumenl - _ - _ g�< that nein licensed Section to(he of Division 3 of Comracess Ucewcond.(ChapterCode) .Sq.Ft. Floor Area -Valuation _. oZ FCS motion is ing exempt Scufr 70 00)the bui$lo^3 of NC Business And Pmf ry vi laden or 3$ glut he'it exempt Nemfrmn and Ne beau fm We alleged e$emWo^-AnY vlolalio^a( Section 7031.5 by any applicant for A permt,subject,the applicant w a civil penalty or ¢ . ,. _ _ Occupancy Typo .. .-•_ -_ nwt mom than Eve hundred dolhss($500). -•. . ❑1,as owner or W property or my employees with motet u deb role Compensation. will Ode aorta and to ssuaumisAd,intended or offered for sale(see7044.Endmaa = Required Inspections and Pmfassiem Code:The Comractora License law does not apply w an owner of e, q p - propertywhobuildswimp70vuthereon.and whodaetuch wwkhlmOWwW ujh Wt wnemployus.provided musuch idepmwment,are notinunded oroffaed forale.If. - - - however,the building or improvement is gold within can year ofcompletion,the owner- ., .._ . . builder will haw due burden of pmvinS Out he did not build w Improve for purpose of --- - - .to.). ❑1,43 owner of the property,am e$elutiwly contracting with licensed eomnno,W _ construct the project(Sec.7004,Business and ProfuOans Code:)The Contractees Ll- -• ' cense Law 4cas not apply to an owner of property who WilN or improves thereon.and ,who cwtmcu f0)such prokcuwiN a conuanm(s)licensed punusel m the Co^vacmfs License law. . ❑l Am exempt under See. .B&P C for this recon Owner Date WORKER'S COMPENSATION DECLARATION ha=y affirm under penalty of perjury oro of the following declarWaru .. . Ihamandwlll mainmin&CeNfiemofCnwntwwlf-insumfw Wod¢e,COMNn- aLt..a provided for by Sccden 3700 of the labor Code,f0)ds Performance of the wore for which this permit is laved. - ❑I have and will mutation Workers Compensation Insurance,as requited by Socuon - .. 3700 of the labor Code.for the performance of the work for which Was permit is issued. *- My Workers Compo satim Irmumnce carrier and Policy number are: -- Camler:7QlfrE IN S,r VC/FAr!'L^ liry No.: aIq / CERTIFICATEOP O(EMMON FROM WORKERS' ., COMPENSATION INSURANCE " (Thbsecdm^ead nothe Complewd if tls permit is form=hundred unions,($100) or lets.) - I certify that In the perPowegoc of the work for which this permit is issued,I shall not employ any person in any manner An a w become abject to the Workers'Compensation - -- - Lawa or Califomie.Date Applicant ... NOTICE TO APPLICANT,IL after making this Cenlnau of Exemption.you should become tubjea w the Workers Compensation provisions of the labor Coda you must `j foMwith Comply with such provisions or this Permit shall be doomed mwked. z O CONSTRUCTION LENDING AGENCY (-, - I thereby Arms dug dere it a construction lending agency for the performance of D$> the wish for which this permit Is issued(S0).3(197.Civ.CJ aLander.Name z, landeh Address U0 I CoNfy that 1 haw read this Application and um Na the above Information is ly^. Conntt 1 agree w Comply with all city and county ordinances end tate law missing In ' 0 rV^ building consuunion,and hereby Authorize rcprncnudws of this city w enter upon d0) LT7 shove-m ommed property f.inspecion pug. (We)agree to sew,indemnify and keep harminss than City of CupeNno against rjj IlabilWrs,judgmenu,costs and expone.which may in my way accrue against said City U i) Inco woes of the granting of woe permit. - FG7 APPLI ANT UND NDS AND WILL COMP Y WITH ALL NON-POINT Issued by:9 Date SOUR RE U Re-roofs Sig u o Applicanl/Convactor Daw HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII the applicant w future building occupy stow or handle haardons material As de nod by the Cupertino Municipal Cade.Chapter 9.12.and the Health And Safety otic.Scetien us32(a)7 ip rvo All roofs shall be inspected prior to any roofing material being installed. ❑Yin . Will the apPllCant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mitheardnns air canlomiAM dc'a' by de Bry Awa Air Quality Management - all neW aterials for inspection. District? ❑Yin Nu I hawS&`C the haamwsmaterla.25533 ment,u.1u C&,pteWftifdu Caldi.g —� ls nu Health Smlyh.: 'an 153115, Ty!S 025534.1 unMrawdthuifue Wofdue Jou wt c rrcmly hew Nu it is my resypusMl mufy tine aeeupanl M d0) a reyulmmc uwhi nm be prior$ u rte<c aCerdRawa(.o aey.11 Sign sur ollApplicant Date, Owneh caw risda not Dow All roof coverings to be Class"B"or better Community Development 1 10300 Torre Avenue Cupertino CA 95014 fr Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building DepArtment JOB ADD IT # I©oz� SAA/7A Ccs�� 0y ao 155- OWNER'S s5OWNER'S N — P30, PJE # GENERAL CONTRACTOR: k FKGZ# I am not using any subcontractors: Signature Date Please check applicable subcontractors d complete the followinginformation: 66 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 Metal Sheet Rock Tile � er/Contractor Signature --• Date CITY OF CUPERTINO ORETIRE/SEWERS/MAIN SERVICE b � z` CUPERTINO PERMIT APPLICATION FORM APN# Date: • la a�o Building Address: 0ClAVE Owner's Name: —I p d S Phone#: 9h �.1�i lh0'it Contractor: Phone: License#: 2e4T AvME3ZJ L bi L!0 rr- 9 S'O 0 4S Contact: Phone: Cupertino Business License#: f� Building Permit Info: Bldg--❑ Elect ❑ PlumblNr Job Description: /NSe CL P/loloen blv e-ze" v DuT _ Residential Commercial ❑ / Cost of Project: � oD Qty. if A i b - Fee ID Fee Description Fee Group PPERMITFEE Plumbing Permit Issuance PLUMBING " BPREPII'E Rei of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING " BPFIXTURE Pbl . Fixture PLUMBING '. - BPWSVCS' Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING