01040060 CID SNO
BUILDING V (NPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRHSS: PERMIINO.
22998 STANDING OAK CT HOT WATER INC 01040060
OWNER'S NAME. APPLICAUON SUIT DATE
LUNDY Dni jr, PT pi 2531 7/20101
ONE: SANITARY NO. CONTROL NO.
�-6 AkCIII'I'ECI'IIiNGINHER; BUILDING PHRMITINf0
C O BLDG ELECT' PLUMB IdEcH
w
Niw CI
an
LICIthat[am Oeireduder p visiov RATION Job Description
1 hereby aBims thin 1 am liccnneIl under Pmvi,ionn of Chapter 9(commmoclny
t-w withfal famean11dDivlsinnJul the Burinash real l'rolesniunn Code,anA mylicense
xmvCI.ce:mnenzel. REPLACE WATER HEATER.
S e�i License cross Lie.p
' 6 V One SIJIICnr
3 a ori, ARCHrl be we DECLARATION
H I I unda,slwW my pl;ms.hull h sled:u public l'caorJn
i p p C Licensed Poi owl
o z that I ak-IfUILIn ll the Contractor's
=`�, L heresy arnrtn n,at 1;,m caemm trots me enmmnn,.Lmenx Law for the
following reavm.(Section 70315.Basin„and Pral'ccxiolss Coda Any city nr a my
D whirl,requires a permit o amatfuct,atm,.immons,dcm,JGh.or mPuir:my summit,
prior to han
s issuce.Rho requires the applicant for such permit to file a signed statement
n3" that lie is licensed pursuant mthe provisions(it the Clualac e"Lieea.ew.Whispar9 Sq. Ft. Floor Area Valuation
,...numbing w,,It Senior TXXI)of Div mon 3 it lie Rosins,:mil Prof..far,Code)
or Thal he ismpt therefrom and the basis I'or the alleged exemption.Any violation
of Section 7031.5 by any applicant for a pernlit object,Jin applicant to o .,it penalty
man redmnlive hurdled dokas(S5g). APN Number Occupancy ype
❑I.0 nrrlra nropea,n mycmployees with wagae ax mei,xldu cini,emation. 34250007
will Lin'hc wink,and the swcume is not intended or onered fer mala(Sec.7194,
Business and pr fession'Crn
sle:The Contractor's License law Joon not apply'to an Required Inspections
,rsr of pro,cf,wen huiid, ,nn,ocs thereon,;md won noes sues work himself,
fhrnmgh his own elnployces.provided Inas such impmvesmms art not intended or 502 — FINAL PLUMBING ENERGY
onerW for sale.If,however,the building or improvement i,sold within one year of
ilnpleion.the ow'ner-buildal'will have the bnnlen of pro ing that he did not build or 505 — GAS TEST
mps,'.rte pdgnse of,ale.).
❑1.lis owner tithe prnleny.din e,cm,ivnly cmnmctlng war licensed contractors to 507 — FINAJ_ PLUMBING
cunswa the rally (Sec.h pro Business and pronava lions CaleU The Cnnt to the
Liven,law dins sol apply in;,it owner of pruprny who builds or in,prvve,there.
Co who Contractors
I.Ne01s Ibr such projects with n commewgs)liccnmd Pumoam m the
El I It.exempt
pt and,lax.
❑I am cncmpl under Sac. .It,@.I'C Wnhis ruoo , I
0.rill Dam
WORKI!It'S CUMPENSA'fION IJIiCLARATION
I Mroby star,muter p Rd,,of pe,,a,otic nl'the ollow in,dm1walin 1, Z
J 1have nod xincmc'ill maintain a Ccnof Consent in sell-insure for Worker's
Compensation, as provided kr by Seetion 311ID of the Labor Code, for the
perinl mine--the work Por which this pern,it is issued,
❑1 have and will nminmin Worker',Cn.R,wr,lion I-mmace.a,rn,oured by Seenio i
371Al of the Umo,Cade,for the performance of the work for whlah this permit is
sued.My Worker's Compensation Insumnc mnier and Policy numb ac
Currier: Policy Na.:
CIiR1'IFICA710N OP EXEMI9ION FROM WORKERS'
COMI'ENSAI'$ON INSURANCE
(This section need on be cnmplcfol if the permit is Ibr ane hualmd dollars
(511Mp nr lunsJ
I cenify that in the pedrnmunec of the work for which thin peonit i,1—red,1
ball not employ any Imrxan in any matmer so:u n)becoom subject w the Workers
Compensation Laws of Calibration.Dae
Applicant
NOTICE TO APPLICANT:U.after making this Cenilicme of Exemption,you should
become subjecto the Workers Compenmtion provisions of the IaMrt Calc,you must
Q 0 forthwith comply with send,prvvision,or I ii,lanai,shall be dccnlsal revoked
7
F u
CONSTRUCT 4..a IONLEN DING AGIiNCY
> nereby arm,mat thcic 4..,s nand(Seen Icnd,ng e.C.) for tie performanm
I the wod,for which this permit is iswnl(Sec.lW7.Civ.C.)
G C Lender's Name -
z Lcndcr's AJdmm
V 0 1«Nfy that l have rend this application and slaw that the above infmn li ian in
rrem I tithes,m cnn,ply with,It city:rod county nnlinnnees and scam laws relining
Q [,
an huilding contraction.mW nereby authorize representatives or this city it)enter mmn,
the aline-mentioned property fur iminxdnn purposes,
rF. y (We):gw,dsyave,inncmnd,sendkeep hunnll,the City of CuPenino ageirs,
N liabilities,judgments,civil and expenses which may in any way acame agahw said
U L Cil,In omwgncnce of the sn,mia,of in,Ixrini,.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-1,01W Issued by: Date
SOURCE REGULATIONS. Y'
signa,me t,rnppkcanummnm
cnDae Re-roofs
HA9AR000S MA9'IiR1ALS DISCLOSURIi
Will nae apph,l or fill wcbuil,htignccupum stoen hwidil na,ardeu material Type of Roof
as defined by the Cupertino Municip:d Cole,Chapter 9.12,and the Ilealm and Safety
Code.Section 25532(W"
L)Ye, 0N All roofs shall be inspected prior to any roofing material being installed.
Will Ill applicant orflow building ommiantuse cvnipinan,mdevicr.which If a roof is installed without first obtaining an inspection, I agree to remove
mit hmrmluns air cone rimmis a,defined by the Buy Area Air Quality Management
final, all new materials for inspection. Applicant understands and will comply with
°vex 0N all non-point source regulations.
1 have wad the haimmous materiak requiremmits under Chapter 6.95 of the
Culifomia Hea11h&Sawl,Ci de.Smion,25505,25,5)3 and 25534.1 anderxtmA that
if the building does not currently have a mount,that it is nsy responsibility to nosily the
cup on of the requiemmhu which must le met prior to issuance of a Ceni licam of
Occupancy. - Signature of Applicant Date
Ownermlmmori,cdagmn Dae All roof coverings to be Class "B"or better
OFFICE