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05050034 CITY OF CUPERTINOTMa t,kgvtw w n1i" a z 'h o BUILDING DIVISION PERNIITCUNTTRACTOR,I�,,�, t, It ADDRESS: PERMIT NO. GREAT AMERICAN PLUMBING CO INC 05050034 OWNER'S NAME: PERMrrrSSUEDATE ONE: SANITARY OL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO Q ELECT PLUMB MSCH O �oo LICENSED CONTRACTOR'S DECLARATION Job Description rd 1"i I bereby afnrm Net I am licensed under provisions of Chapter 9(commencing i with Section 7IXXB of Division 3.1'die Besinw e�Professium Code.And my license is poi iI'maxfall(oFdafm L-,.I (o PROPERTY LINE CLEAN OUT Da¢ ContramOr. A O Ay ARCHITECTS DECLAR ,eQg°f N J to 6 1 um ranand my plans mall W u used public..an, 7 ;0 Licensed Professioul ^ OWNEmBUILDER DECLARATION Ea IWrthy.(Real Nati1. exempt Isom iWCstant Coe:License My for the �0 OO fallowingumaa(Smits 1(171,5,construct,aluar, antl Professions Co de:Any oily orcounty �. \ $ which myulres•permit re resthealma Improve.demnlbh,or repair any ned W;mnC L _iP, prior miu bwanm,alwrt he the theapplicantor forsuch the Cmrwwr*s Lrile a cense Law(Chapter mem y�y�< hat helacing wit pursuant he the provisionsorCons and PrelawtCode)9 Sq.FC Floor Area .� Valu. On' t•O tcom els exe pt hedion 700D)tof he basis the the Businessand P,ofcsalansCMe)of 33$ that io b campy therefrom and the bum for Ibe subjects alleged seaman to Any it penalty of Section 7031.5 by any hundred for a permit subjects the applicant t.a civil penalty of 3.7A-nr i.4111 910 0 Occupancy Type not mom than nw hundrttl dallan($300). �J'4L"O`���' ❑I.u Owmr of the pmpwy.or my wployeu with wgu u their mu eompenudon, will do thew.rk.mtd lheswcum boot intended oraReced fomic(Sec.7044.Business Required Inspections and Professions Code:The Conuscloh e Liam law does not apply m in owner of q P property who Wilds or lmpwvea mancomand who doessmh work himself Orthrough his awn employee,provided thmsuch improvements..at intended araBered forum,If, however.the building or improvement Is mid within an year of completion.the owner. builder will have the,Wrden of proving Out he did am Wim or improve fa puryux of u-,.). ❑1.as Owner of the property am exclusively contracting with licensed.0mmcmrs m convect the projem(Sec.7044,Business and Professlau Cnde:)The Contractors Li. sue law docs not apply m an owner of property who Wilds or improves thereon,and, who contracts for such projects with aanutcmr(s)licensed puramnl m dm Contractors License Law. O l am exempt and.,Sao ,B 6 P C far this rtuon Owner Dam ._ 1031. WORKER'S COMPENSATION DECLARATION I hereby aBirm under penalty of perjury am of the following dmmntions: I have and will maintain•CeriReu of Consent to self-insure for Wo,kersCamped. "00 tian.u provided for by Section 7700 of the labor Code,for we performance of the rk for which this permit is issued. 1 haw and will maintain Wmhfs Compensation Insunnm.u required by Section of the labor Code,for the performance of the work fa which this permit is issued. yWorlmetCampeuarm i once cerior and Policy number art: ller, ..�.. Polley No.:PJA CE PI "Vl XEMPION FROM WORT °CLRS' COMPENSATION INSURANCE (Thbsectlon need not W completed if the permit is foronchundn d dollars($100) or les.) 1 seedily that In the performance of the work for which alb permit is fund.I shall not employ any parson In soy manner an u m become subject to the Woherf COmpomman Laws Of California.Dam Applicant NOTICE TO APPLICANT:IL after making this Ceminem of Exemption,you should Wcome subject at we Worker,Comfewdon provisions of the labor Cock.you mum ,J O forthwith Comply with such provisions or this Permit Mall W deemed revoked. z CONSTRUCTION LENDING AGENCY [—r ry. 1 thereby aamm dust them b a construction lending agency for and performance of C the.,it for which this permit is issued(Sm.5097,Civ.C.) aLenders Name Z finders Add. U O I certify that I have rad this application and sum the the W.information is ly context.I agree to comply with all city and county artimancea and sure yew renting to building convection,and hereby authorise MNCSeflWiwa of this city m enter upon the D7 shove-mwdimcd property for inspection purposes. gy (We)agree to sew,indemnify and keep harmless the City of Cupertino against v) liabilities,judgments,costs and expenses which may In soy way acme against aid Chy U 4 in APNC mnccof the UNDERSTANDSOf AND this Permit. lLL COMPLY WITH ALL NON-POINT Issued by: Date SOURC EG / Re-roofs Si art ppll H on ATERIAIS DISCLOSURE Dam Type of Roof Will the applicant or future Wilding occupant pore or IUM-,bacartlou material As tlennM by the Cupertino Moniripei Cade.Chapter 9.13.and the Neale sed Safety Cation sem en 25552(a)7 r All roofs shall be inspected prior to any roofing material being installed. [3 yes (U Ne Will the applicant or future Wilding Occupant use equipment or deviw which If a roof is installed without first obtaining an inspection,I agree to remove It hexad..ori,contaminants u dclumd by IW Bay Ama Air Quality Maugemem all new materials for Inspection. DistrimT ❑Yu u y I haw mad the haaamnus materials requirements under Chapter 6.95 of the Califor. , nia Health at SmctyCodc,Sections 355)5,75553 and 25554.1 understood that if the Wilding docs not currently have•Conant.that it Ice my responshillty to nMl'y IW occupant of the myvisem uwhie anaofaceNncemofoccupancy. Signa tureofApplicant Date wmr ser alas.gen Dim All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 o Fax Fax(408)777-3333 �UPERTINO Building Department JOB ADDRESS: PERMIT# fOSaD3 V OWNER'S NAME: PHONE # 7 GENERAL CONTRACTO • AX# I am not using any subcontract rs: Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting • Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock er/ i'[{iacto ature Date