06060001 !CITY OF CUPERTINO T��,g�g+ c �*�
,BUILDING DIVISION PEFIN 1 :"X' ' NF'
5• cArA`�,mws.*.
' BUILDING ADDRESS: THOMAS PLUMBING INC Pa MITNO'06060001
10185 STELLING RD
OWNER'S NAME: PERhOT ISSUE DATE
CITY OF CUPERTINO 8862 MURAOKA DR 06/01/2006
E:
SANITARY NO. CONTROL NO.
(408) 736-3050
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ceLICENSED CONTRACTOR'S DECLARATION lob Description
wF 1 hereby affirm that I am Themed under provision of Chapter 9(commencing
za, wiOSecdon7000)afDiviuon3of Businwaml rofessiuu Cod ands!my licence is
in hall farts and effort- C3 WATER HEATER-QUINLAN CENTER
'12Z Liccmc t.:.�� L'c.g
F,p Dau _ Conuacrar
I 'JaI A CHI7ECTS DECLAR N
i p i I UMermand my plans shall be used u public records
tyU qp
Licensed harchPrafey affirm
�rSTV p f� {T rl D
'tu D3 OWNER-BUILDER DECLARATION IIfW't]t[®7OF,tVWWt G([,r Q�tll[gllpa{1p�il�s
1 berthy aRrm Nal I am exempt from Ne Cantrazmrs License law for the
D C following soon.(Section 7031.5,Business and Professions Code:Any city or......
%$ which requires a Permit lo construct.alcor.Improve,demalLah,or repair any sternum 0
priorm itsiuuame.alsosyuirnlhcapplicaniforsuchpermiuofilcasigwdsuumem ❑
Dat he irlicunscd purwanmo the pmvisiouaf NC Conummr's Lkcnc faw(Chap.9 Sq.Ft. Floor Area 2U Valuation
dFn (commcncingwLh Scction7000)of Divuion3n(lhc Businmwd Professions Code)m
that he at exempt therefrom and the basis for the a bred exemption.Any violation of -
Section 7031.5 by my applicant for.permit subjects dm applicant to a civil penalty of r Oect{pancy Type
not mart than five hundred dollars(SSW).
❑l,uowrcr of the prepmY•mmY wploytta with wagauth'v ante cmnpenauon, _ v��/
will do to work.and thestrwawe is On'm McdmaRcrtd Tarsale lSec.70a4,Busirmv
and Propulsions Cade:The Counselors Li¢n¢ ss Law docot appy m m..of Required nspections
prepeny who basildsmimproves thmuon,and who tirossuchworkhimv3f ar through his
own employer,provided Nat such improvements art mol ineuOW m o@cod fe sale IL
however,the building or unpromenum usold within ane year of completion,the owner-
builder will have the WNen of proving Nat he did not build or imProw for propose of
old.).
0 1,as owner of the propcny.am exclusively contracting with Restated conoacmrs in
construct Ne project(Sec.71W4.Business and Professions Code:)The Conuacmrs U.
cc=Law doss not apply to an owner of property who builds or impmws demon,and,
who contracts for such projects with a comncmr(s)licensed pursuant m the Cantrmtors
License Law.
I am exempt under See .B a P C I"u;mswa
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirmunder penally of perjury oro of the following declareuo ,
l
hum ad Will mainaio a Caruf roof Cement W self-InumfmWarkehCamper-
salon,u provided for by Section 37W of the labor Cade,fm the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Campenauan Insurance,as Implied by Suction
37Wof the labor Cade,fm In. do...ofthe wart far which this permit is sound.
My Worleces Compensation Insurance artnierI and Policy number tic:
Canner.Q�t CA FIC 1JEMINIDOIi,y No, �0 -OI
1AICA OF EX PTION FROM WO KERS'
COMPENSATION INSURANCE
(Thu section need cot be compleed ifthe Permit Is fmhundred dollars(SIW)
or las)
I ani fy that in the perfofmsme of Ou wank for which this Permit u issued.I shall am
employ any pc.n in my mmncrm as to become subjcn to the Worker'Campeuatian
Laws of California.Dau
APpliaat
NOTICE TO APPLICANT:If,after anakiag Nu Ccnifialc of Eampdon.you should
beccom mubjm as the Workers Compmuation ptovimmu of the labor Code.You muse
.J z forthwith comply with such provision of this permit shall be dmmed revoked.
zO CONSTRUCTION LENDING AGENCY
1-u Ithereby&Rrm that then is a construction lending agency for Ne peffurmave of
D:
the work for which this Permit is issued(Sec.3097,Civ.C.)
!7]A Lenders Name
jz Landers Add.
U0 1 candy that 1 have road this application and sum this Ne mew information is
fly correct 1 agree to comply with all city and county mulances and stale laws slating to
0 building consuunion.and hemby 2Ud1mis MPremmaives of this city to crake upon the
F ymove-memiancd pmycny for impccuou purposes,
(We)agree to save•indemnify and keep harmless the City of Cupertino against
N liabilidexjudgments,coma and upcnses which may in my way accrue against sm ey
U Z in eonayuence of the granting of this permit G
APPLICANT UNDERSTAN AND WILL COMPLY WITH ALL NON-POINT Issued by: Date S G
SOURCE REGULATI° /� / 06-05-0
/T}f^f�i VJ Re-roofs G7 ------
Signature of Applicant? err °am Type of Roof
HAZARDOUS building
MATERIALS LOSURE T
Willy tapplicantor future buildingeecupantrt 9.1orand the
Health and
as de,Suc by de Cupertino Municipal Code.Chapter 9.12,end tM Health and Safety
Code,seNar 25532(a)7
❑Yn All roofs shall be inspected prior to any roofing material being installed.
40 Will dm applicmt or uwrtobuilding Occupant use equipment or devices which
If a roof is installed without first obtaining an ins agree to remove
inspection,I g
emit b.1merms air contaminations as defined by tha Bay Area Air Quality Management all new materials for inspection.
Dimict7
❑Yrs No
Lha mW SaINYC numriaurt33 ands 55 underdOser6.95 ofdm Caliper;
ria Hnithdr odyCode.Sunt.Out it
m 33am12u534.1 W nouly d ocsucbuilding
does cot curtcntlY haw enant that it u my responihility b mtify Ibe aaupant Of Or
reyuirtmena wltK et prlorm of a CcnlfKanarDTN��O�
�/a✓{//i g(/� Signature of Applicant Date
Owmrmaathmiaad,Sem D,m All roof coverings to be Class"B"or better
CITY OF CUPERTINO
D WATER NEATER
• CUPEkTINO PERMIT APPLICATION FORM
Date:
Building Address: I o ( gS I l 1
Owner's Name: Phone#: 6
Ct`r CvPerriVid ?77 - 32 `I
Contractor: Phone: 54y5 cense Li #:
gyb- 3 b y
Contact: Phone: 779 — 4 J l? d Cupertino Business License#:
Building Permit Info: —/
Bldg ❑ Elect Plumb Lel Mech
Job Description:
v cf WsTer eJe,r
Residential ❑ Commercial
Cost of Project:
Strapped On PlatformEl ] Bonded
• New Location ❑ Replacement/ z
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMTTFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING