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03090229 CITY OF CUPERTINO ='�` �' �`� BUILDING DIVISION PERMIT `CONTRACTOR INFORMATION j .n i� 3'S:. .,. •^'.....dilf ^r ✓.r.!."`�', r <l4'tk eU1LDINGADDRESS: DOYLE CUMMINGS PLUMBING PERMIT N0.03090229 OWNER'S NAME: 1431. BUCKNER DR PERMIT ISSUE DATE "E` 4089234221 SANITARY NO. CONTROL NO. 1ARCHITECTIENGINEER: BUILDING'PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATIONIobDescri tion I hereby Affum that 1 am licensed under provisions of Chapter 9(commncing pSection 7QXp mfDivision 3 of the Business and Professions Code.and my license Is icclam; rrtt. ` Lie.Aoya 5 5 gREPLACE MAIN WATER METER Dole Glma �. 3 Coal, FINALED !qq ARCHITECTS DECLARATION i 2 I understood my plans shall he used u public rccnNs D i6n. r Licensed Pmfcuional OWNER-BUILDER DECLARATION OCT 2�n 2003 i q I hereby affirm that I am exempt from the Contractors License Law for the e 0 O following moon.(Section 7031.5,Business and Professions Code:Any city or county 1$ which requires a permit a)construct,alter,improve,demolish,or repair any structure nn ?iy prions its iuuance,alsu uquireslhe applicant forsuch permit to File a signed statement that I,licensed pursuant to the provisions of the Comotctors License Law(Chapter 9 Sq. Ft. Floor Area a ua ion 4 $ (commencing with Section 7000)of Division 3o(the Business and Professions Codc)ser Nn he is exempt demfrom and dm bm'v for the alleged exemption.Any violation of 32630009 . 00 Section]031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not mare than five hundred dollars($500). ❑1,u owner of the progeny,or my employes with wages u Noir ole cumpcnmdon, will do the work,and the swcure is not intended or offered for sale(Sec.7044,Business 106 _ SEWER .,C, W&W And Profssiona Cade:The Committers License Law does not apply to an owner of t(CgOR ectlons property who builds or improves thereon,and who doessuch work himselforthrough his 202 - UNDERFLOOR PLUMBING own employees,provided that such improwmencs an not intended oroffered forsele.It. 301 — ROUGH PLUMBING however.the building or improvement is sold within one year of completion,the owner. bender will haw me,burden or proving that he did not wild or improve for purpose of 302 — TUB & OR SHOWER stem.). 1,as owner of the 502 - FINAL PLUMBING ENERGY ❑ property,.B siness And convecting with:) no Ccontractors m cemwct me project(gee.]Baa,Business and ry who Wilds code)no Conmcmrt.Li.and 506 — GAS TEST cense hwdosr such not plymanownarofprctony wcensed sorimprowa thereon,and, 507 — FINAL PLUMBING who contacts Law.for such projects with a conwnor(s)limned pursuant to the Conmaoh License ❑1 em exempt under Sec. ,B @ P C for this moon Owner Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of perjury em of the following declarations: I New and will meinuln a Campeau of Consent N self-name for Workers Cumpem aatipn,u provided for by Senior 37W of the laver Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Context Insurance,u required by Section 3700 or the Labor Code,for the p rro m u ce of the work for which this permit is issued. My Workers Compensation lnsumntt carrier and Policy num her an: '.S ^' Carriers*I�T� tWvaa Policy No.:IS(egL f�W CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (1Llssection recd not w completed If the Permit 0 foronc hundred ordb rs(SI W) or less) I certify Nat in Ne performance of it work for which this permit is issued,I shall not employ any person in any roamer m As to become subject to the Workeri Compensation Laws or California,Date Applicant NOTICE TO APPLICANT:IL after making this Ceniliea¢of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,year must 7Z forthwith comply with such previsions or this Permit shall he decm[d rooked. Z 2 CONSTRUCTION LENDING AGENCY - I hereby aRrm that them is a construction lending agency rnnhe performance of Y, > Ne work for which Nis permit is issued(Sec.3697.Civ.C.) 31 Q Lenders Name z Under.Addeom ;)C) 1 ernify 0.11 have mad this application and sore Nam the Abu.information is E' cmucl,1 ague to comply with all city and county ordinances and state laws mixing to DU building convection,and hereby authorize representatives of this city to enter upon the >+ C ahow-mentiuned property(or inspection purposes. r (We)agree to saw,indemnify and keep harmless the City of Cupertino apinm (n liabilide judgmenu.costs and eaperems which may in any way seem against mid City J7 inconwquenceof Negnmingoflhispermit. _ .•77 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SO RCEREGULPTION vrr�aw, �an-. _ 9a9o3 Re-roofs Sign sere of ApplicanUContracen Dem HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or fumm building occupant store or handle hesarduus nuatmil As defined by Ne Camilla un pal Code.Chapter 9.12.and the Health and Safety Code.Section 25532(x)? - All roofs shall be inspected prior to any roofing material being installed. Will the applicant tar future building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove It he...dnus air romnmimnts u darned by the Bay Are.Air Quality Management all new materials for inspection. Multi? ❑YCl e 1 have read Ne hersai renals requirements under Chapter 6.95 of the Calder. Mal R Safety Ccxk,Sections 25505,25533 and 25534.1 understand that if the wilding Join not currently haw a missal,Nat it is my res,o nsihility in nod l'y the occupant of the mquiuments which Mibi an priarmiamamcafa Cndaeamoroceupancy. Signature of Applicant Date wmer rauthorizadagcum D Q3 All roof coverings to be Class "B"or better i • CITY OF CUPERTINO II 11 WREPIPE/SEWERS/MAIN SERVICE CUPERTINO PERMIT APPLICATION FORM APN# 3 q � O© Date: i-� Building'Address: /00,� Z) N 5TH i n �cQ . Owner's Nae: Phone#: W 44 a3 c4 6 Contractor:� Phone: License#: D IE I:ILVhmin 5 qcz� acla558�, Contact: Phone: Cupertino Business License#: Building Permit Info: — / BldgEl Elect El Plumb LI" Job Description: 2e lA0- n Al A• n LJk—IF-K, rKe3p'F,2 Td h o w5e Residential ❑ Commercial ❑ Cost of Project: qU0 • � Qty. if Applicable Fee ID Fee Description Fee Group PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e 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 2 l ° # 3� 3 8'S�