00110118CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:P
6295 SHADYGROVE CT
ANDERSON HOT WATER H=�tIG00110118
hl'1' fIfA.
OW'NER'S NAME
MINSHALI_ CONRAD AND WAHILA
P 2866 JULIO AVE
APPLICATIO].1N SUIT 2Tdf,
/c�/I_000
NIONC:
SANITARY NO. CONTROL NO.
4083783868
ARCIII'1*11C"V iNGINHEII:
111_11 DING PERMIT INIY)
BLDG IiLECIPLUMB 1.111i
I=I 1=1 1=1 7
I.ICIiNSIi1)CONTRACTUR'SDECI.AR ON
Job Description
I hereby ¢Rion that 1 am Ilaanxed under pot Chu r 9 (nn mein,
with Section ]IMk1) n Fi'"c" m oe Bminess and P he sNc, and my license
�Infulnice eph d3
R/R BOILER
I.iccm 'ic. «
_
.p cntms�tm
Chall
ease for
1 Ban ntY Plane hall Ise used as pu
Licensed Professional
OWNER -BUILDER L/. 1(lN
/
I herrn, affirm Ihut ion exempt f nt - nlmcto,', License Law for dm
Gdlowing reason. (Secliun 91H L5. Nusinc s and Profe..inm Calc: Any city or county
7
which "noes a permit hl construct, ahm, implore, demolish or ¢pair any structure
pdnr m'ns issn;mee.;dso r«Itdres ore apprrl,n na smn per.Ii:lo oda a siglavl.w:nentem
Sq. Ft. Floor Area
/ u'tio
$ tt` [t.0
tWtne is lmelrx'd put,mmnn me pm.sinn. nr me Cnmmciora.ieen,e law tenapuro
(commencing with Section Tlk) of Di%ohm 3 of the Busineca and Proles mmo, Code)
or :hal he is nsnmpl Iherulirnn and the I.... ka the alleged nxumption. Any violation
'
of Scetion 7031.5 by any applicant fur a pcouir subjects the applicant to a civil pemahy
APN Number
Occupancy Type
of sol mite than eve hundred dollars ($5k)),
37541028.00
01.asowneroddheproronr. arm, employees wimwagesasmehsolecompenmdoa
Required Inspections -
will Ao the work, and the stmertaa is not intended or offered for sale sec. ]Md,
Law does
Irosluess and I'mfcseiuns Codc 9'he Contractors License not apply In an
solveof,onmertyWhoWildsorimprovesthereon.andwhodoessuchworkhimself
301 — ROUGH PLUMBING
or ough los own employees. provided that such improvements um no, unrolled or
offered Iia sale. If, however. the building oe improvement is sold watln one year m
303 — ROUGH MECHANICAL
�
completion, the owner -Wilder will have the burden of pro ing that he did not build or
'upr..
ELECTRICAL
d,ort�rPt"u�trs;Im.l,
304 — ROUGH
01. as owner orate property. am .elusively contracting with fcensed contmemnm
305 — FRAME
Lm,frod the Pmjov'I N,c. ]6M. luoine.. Imd ponos...., Code:) TM1e Co onemr e
icenseLawdowsnotapplyloantmmernfpr,pertywhnbnddsorimprove there..,
308 — SHEETROCK
and who contracts for.such prucets wilt a contact..¢ licensed pursuant to the
— FINAL ELECTRICAL
Contractor'-. Lorene¢ Law.
505
D l am exempt under See, , B & P C for this reuse
507 — FINAL PLUMBING
Ilxnu
:SOB — FINAL MECHANICAL
WOR KER'SCONI PENSATIONUECLARAI'ION
514 — FINAL PUBLIC WORKS
I henmy a@rn umer, ands, IperjtI. our of the Endow in, dcclam:ims:
11 0 I have and will n 'rain a eenidena of Conecnt to sell-irsom for Wnrker'a
Compensation. as provided for by Section 1700 of the LnWr Cofe, for the
performance of the work for which this permit is issued.
01 have and will maintain Worker: Compenv n Iasomn , al mquited by Section
371X1 of the Labor Coln, Ior the rtornu, of the work Torr which this permit i.
%med. MV Worl Compensation losto cc canter and P licy numhcr aro:
Policy No.: _
CEMIIICAI'ION EXI?MPTIONP MWORKERS'
'
C(L lNSAT1ON INSU NCB
(This section lad, I teeomplered if n, mn. rel dollen
(SIINIIor ]used
w.
1 certify tM1.al ce nl the work which this pemth is i N. I
+rem
'hall not mnploy o per. any nuunm o . N`'orlep•
Cnm; ...too 1. sof a. I C/
.
April= _
NOI'cL T(1 "1:11 her looking thi s Ccrti scam 1Eacn lion, you ebould
bucom nunj othe W'orke Compensation p io., of the labor Ctsdc,nu.0
'
forthwith c ply with sac pmvisiuns or lois permit shall W JcnneJ mvokrd.a
'ONSTR MON LENDING AGENCY
'
hereby afrum:hm Ihnre is a consuly In lending ogeney for the perfonm oat
-
of the oak Iia which Ihis larmil is issu IYfSe llm], Civ. C.)
Len ,Nam
lmnirytholhaventhisapP'¢dun and store maltnnaWve inhmmminn is
"
ttn. I ngrec,, unmply lth ell el aI I county ordlmmec and i:ute laws relating
mbuildingetmunnion ndheoch mbdrize represcntmlves of lbix city aa+Tnm–
Ihe elvocountioned gmrty b o"etinn purposes.
(ve)a"vet toldyand kre on -.1 the Cnyof Cupcdino ogainst
lido otic,. ludg:tte a, rn. and expert. Inch may in any way accme against said'
Cu in conw.ry re - negmntio This permit.
At'[ NDWILLCOMPLY I' I ALLNON�I'IJIN'r
_ _
�Z 00
.ICANT DI'ANI
Issued by: Date t
Da,
Re -roofs
Signam of pprc 'untronm
ALARDOUS h1ATERIAIS pis C.OSUR-
Will r lull... unue bulkho,nccmpanl one or handle ham:dous nnerial
Type of f
IineJh "Muni '.ale. Cbapmr 9.13. nnJ the llealth:uW Sarmy
C e,See' 11255321.1
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"'
All roofs shall be inspected prior to any roofing material being installed.
'ill the up an, rrtunm milling occupant Ilse equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
end nm,Iran,, s Acf Neel M1y din nay Arnl sir pn:Jity Mnnugcn¢nl
DLtricrr
— all new materials for inspection. Applicant understands and will comply with
°nn
0)'e^all
mumnmms
non -point source regulations.
1 r d th Iarardous alto under Chapme 6.95 of the
Cnllfom Ilct s .ntcty Codc ctiuns255g5. 25573nnA2553J.1 r dcmm�d that
if theW Jin tcome have a loon,Ihal it is my mspurrob, In, ,, nor ly the
ccupno 1 1. to »hitt Inst W met pdnr m issuance of a Cenircatc of
0... "`'
Signature of Applicant Date
All roof coverings to be Class s'B" or better
)woe o aedn• ll
/ neclee
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