01100008CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
22995 STANDING OAK CT
WATER HEATERS ONLY
01100008
OWNER'S NAME:
APPLICATION SUB DATE
hit GOHRING KURT K AND ERIKA A
970 E. MAIN ST, SUITE 20)10/01/2001
PHONE:
(415)566-2209
SANITARY NO. CONTROL NO.
Z ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
0
BLDG ELECT PLUMB MECH
i LICENSED CON'TRACYOR'SDECLARATION
Job Description
als
C Ihon700(am,thmirinn3ofbeBorder provraonaof Charter Code.ndmyenense
Division3of the duAncas mW Professions Code. anJm license
with Sectiorceand
REPLACE 40 GALLON WATER HEATER
of
is in full force and effect.
a Lltenm Clop Lie ro
D Dae COmCLA
v ARCHITECrS DECLARATION
4 1 undersmnd my pleas shall he uxd a, public records
Licensed Podc"ioml
i OWNER -BUILDER DECLARATION
I hereby alarm that 1 am exempt from the Contractor's License Law for the
following mown. (Sectio, 7031.5. Business and Professions Code. Any city or county
$700
^ which requites a permit m construct. alms, improve, demolish. or repair any structure
.pnet u0.s Issuance. also requites the apPlicumfor such permit 10 file a signed statement
- - - -
,
r1:'_�R3 �d'�U2Y7,rr/�r�a �-Ti
Valuation
- Nm he fi liecound puffs eon to the pmvraaays of the Contractors License law (Chapter 4
Seaton7")of Division 3 me Bmipe� Professmns Code)
(commencing with of and
or thai he d cxempt themfrom and the basis for the olleied exemption. Any vinlaion
k:�Ti:'`;
- of Stttion0031s by any applicom fora pmrvuubjtt¢ die appliratno 0 civil penWy-
'of nmmnmthan Bvehundred donars(5500).
5024PN�2ft'a PLUMBIN
ENERGYOccupancyType
° I, as owner of the property, or my employees with wages as their sole compensation.
-will do the work; and the structure is not imendcd or otsme, for som (Sec: 7faa,
eutdncns and Professions Code: The Contractors License Law does not apply to an
507 - FINAL P]]d 1y&iE&Uspections' " •' `
owner of property Who builds or improves moment. and who does such work Warner
or through his own employer. provided that such improvements are no intended or.
Yearo
oRaed for sale. If, however, the buildingt is sold within one (
ob imen
of pro
the owner lder will M1uve the harden of proving that he did not build or
improve ro-
improve fm puryass of sale.).
c
I
_it
° 1 d 'i, y contracting g with I' crud twcmrs to
f tl p(See
- �'' • t .I'.
on. t nth prof t (S 7016 B .rtes ertl Professions ons Code 1 The Contractor's
e 7
Lie. L d t apply to a owner ofp property h hold p thereon,
t r
FI H 9 A■ E
.and who comms for such project. with a commands) I' sed p m 10 the
,_
r E �'Y Q'16a _._.. .. _ _. _ .( ... .. ----
Contractor ,
Contractor's License Law.
° l um exempt under Sec. . B A, P C far his mason
12 2001
_ Dwher;,. Daie:,1
0�1
WORKER'S COMPENSATION DECLARATION
1.
I hereby alarm under penalty of perjury. one ofthe following declarations:
BUILDING
° 1 have and will maintain a Cenlacaic of Consent l,, ssl6irome for Worker's
Compensation, as Provided for by Section 37M of the Lather Code, for the
performance of the work for. which this permit is isxucd..,
_ ° 1 base and. ill titanium Workers Compenwtiun hemarrce, ai rcquiied by Stenon
37W of the Labor Cade, for the IicAormona of the worKfor which this permit is
issued. My Workers Cumpeosadon Insurance caries and Policy numbor arc:
_
Cime'a 4 y' t r.•. ...,.r policy N r ... ;..
r-.. v L^ t a T t (
Li CERTIFICATIONOFE%EMPTIONFROM.WORKERS]-r*-f'�•x'•-s1•-
...r, COMPENSATION INSURANCEt', -.
__...__._. ____--._-__...
(This section cried rot he complctca dine permrr is foram hundred dollars
-
(SI(p)mlcsa) .... ,,,. •n •u.
.
�t
... ._ ___ .... _....... _ .._........ -
°It 1certifylr that in the pert rat mr f4 rk f which t Awed, I
r,
ct
object
shall not e n IU an pe. In any manor su us 16 Mcome subject to the Workerx
P Y
_Y
Compensndun laws of California,nae. '. .. '.
:Applicant .. .,
NOTICE'1'OAPPLICANT :ILa¢cntuking this Ccniacmc u(ExcmPtion. you should
j•`"'t a'' "` '' � •
inion Code, you mus
bccdroe the Workeri Compensation parr sof t,
deemed
fonhwitA'comply with such pmvisium or this permit shall be deemed revoked.
comply
'
0 " 's CONSTRUCf10N LENDING'AGENCY
�
r.m., ''1 hereby am. that there is a construction lending agency for the performance
�o(the
'
toork'(or which this fronit is issued (See. 3097, Civ. C.1
t
Linmicrs Name '.. •`o•,r .... ,....
Lender's Addresi "
1� Il {'• t•, ••., ,
•„
I cenify that 1 have read this application and sum that the above information is
1 agree to comply with all city and county ordinances end nom laws relating
I ) O
wrect.
building commicion:ana hereby nedwm repmanimkis Of this City to enter upon
T/ ,CnJ IN
the abovomentioned progeny far inspection parp,se;..
�I/fj
4 (N'dj agate io rove, indemnify and keep harmless the City of Cupertino agairrst
O IiaMlitien, judgments, casts and expenses which may in any was accrue against said
! City inb..quence of the granting of this pcmah'
APPLICANT gqNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
';
Issued by: Date
y'
soIIRCE REOIJLATIONS.' _�
Signamk.of/rnacam/Commtor ..:"•" ,. :'". - Date',
Re -roofs
` - HAZARDOUS MATERIALS DISCLOSURE.
will thauppaaant f m' budding pi st re or handle inai:rduus moment.
Type of Roof -. v -r --'- -- - - ------ - -
i s d f d by the Cupsn n Mu a pal CodeCharter 9.12, and theHealth and Safety
Code. section 1553201. :.: 'rt .•.
t
' • p•: • f. . J,'4S '.' i .t., :x.n t., fii•r
v _.
s
❑Yet'..' + °" GI ' :
_All .roofs.shall.be mspected.prior to, any roofing,material being installed......
,•. wifine�rpl�c��t'o;ruwrewiiainl:«aPamys�eq�i�me��oraevi�pAwmrn'
If a roof is installed4ith'out first obtaining an"inspection; Pagreeao remove
conal hoe - d s a ort t a. def cd by the Bay A ea A Quality M agement
Dari t - -
all new materials for inspection; Applicant understands and will comply with
dY - ❑N - 5 _
all non -point source regulations. - -
y ;
I have read the h.dous. materials re9mrements undc Cbaprer 6.95 of the
Culiforniu Health & Safay Code; Sections 25505.25533 and 25534.1 understand that
- If the building docs not currently have a tenant. that it is my m,,onsibility to notify the
"
oucupSm of the iequimment, which most M met prim to issuance of a Certificate of
`y''� ' " �•
Signature of Applicant Date
-
All roof coverings to be Class "B" or. better
o.mec or natnod:<a ageb�,n gate
r
.. .. , - OFFIGE