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