00100003 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PIiIt MIT NO.
OWNER'S NAME: ZAP 5 A `-a
IIIATIC)N"t AVE I'IIONIi: s '' SANITARY NO. - 'I
a mz ARCHI'rECnENGINEER. G ..t— nUILDINO I'ERIdu INFO
tw-O C BLDG ELECT' PLUMM
B ECH
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to
>F� LICENSED CONTRACTOR'SDECLARATION Job Description
2 O I hereby of Bin mal I into licensed under pmvionnv of Chapter'9 manouenciny
F_tw, x;70 satins 7alm nn)nh.ionlonlhe Baasmess and pmressions�ande.an by ueen.
5�m<3 is tau hneo tend ill' t �'�t
"u [)cut utas 3Ie_ C ` — REPLACE 50 GAL. GAS WATER HEATER
Da1C M I`�� Gnnlfat'tm
LLI d, L shall
Ise
used
F' I Deman np�plans.hall he used ax public me d, '
tett-O O Licensed 1'ndessionul'
a.c6e OWNER-BUILDER DECI,ARAr1ON
= 1 hereby alai rut Ibar I um exempt from the Comnemts License Low for the
F 1'okoving reason.(Section 7031.5.Bu,iness and Viormsinns Code:Any city or comny .
F't^❑ which requires a pemil to construct.alter,Improve,demolish,or repair any svuaum
atprint lu its Issuance,also regWmapplicant s the applicanor such lwrmil to rlcasigncd sevcmn
en '
a. mm M in bcenmd pursuant to the provisions of me contra.tor.Licenw l.nw(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Sealed 7010)of Division 3 of the Business and Professions Cade)
nr
had In,it cnen"s Iherefmm and et husk for the aueycd cm roma.Any Aulalom
of section 7011.5 by any applicant for a Iwded subjects tire apphl-in ton coil pcxally
of am none than roc hundred dollars 6500). APN Number OccupancA�p6
❑1,as owner of me grope^y.or my employees will wages xs bel sole compenwhnn,
will do the work,and the someone is not intended or offered Tor sale(Sec."IMA,
Business and rmmssi..na Code The anatmmn,s Lie enrc Law does not apply a,an 2 4R lied Inspections
amner of rmplady Who builds or imj+mm,thereon.and xhu does such ami,himself
or thmogh his own employccs.provided mat such improvements am not intended or
offered rut sale.B:howmec the baihlie, ,,improvtown,n sold wahin eche year m 106 — SEWER & WATER
completion,the owner-builder will have the burden of proving that he did not build or
`mp""l,forpama"anfsde.) 202 — UNDERFLOOR PLUMBING
❑Las rofthe propetat"esemsivelycontracting aithlicensed contractors m 301 — ROUGH PLUMBING
,nshoct the Innjeaa(sec.7044.Business:rod professions Cale:)The Commemr's
License Law does not apply to an owner of propenr who builds or hoproses lwreon. - 302 — TUB 8• OR SHOWER
and who contacts for.such projets cwith a contractors)licensed paroont m the
o,,erat,r'sLicuseLaw. B&Pea mtsreah 502 — FINAL PLUMBING ENERGY
506 — GAS TEST
0're, """ 507 —FINAL PLUMBING
W OKKER'S COMPENSATION DECLARATION
I hereby Biro..under pcoa,or perjury one of do,rnllnwing de,foatlon,
C I' I 'alt f' C Tt t f L c o l 11 f Won do,
Co pc :I pre d f by S t 7700 f th Lah Code, for me
per(r fm srAf bhtti:pv t - _ d
01have ared will ill n0. A Compensation 1 . .n qct dby Set,la /J1/O
37W of the ba Cull for the performance f th k for duch this .it is (((
Imued.My
w
o
rk
er s Co nP"(Wval ou lmsuemuc r.rr u and I a I'c)mt da.r.'c.
Carrier: \'W?I f"AL Ill'EXI'IMP'NION alb (1
COMIIENSAT1ON INSURANCE
('Phis el inu need nm be cma,leled if the permit is Ice one hundred dollars
I$[fit))or less.)
1 artily did in the performance of me work lar which this permit is issued 1
ashall at couple,any person in any manner so as m becume subject rah the Workers'
achall
haws rel'Calfid tia.Dam
Applcant
.No ]iCE:10 APPLICAN'L If,after making Ibis Ccriliame of Exemption.You should
become subject to the Worker's Compensalln I Iouvisions or Lahar Codd,you moat
Q O fon o,ill comply with such provisions or his peould hall be decennial revoked
F = CON STRUC'I ION LEN II I NO AG ENCY
ai > 1 hereby aRrm mot dere is a cowamcdon lending agency for the performance
o1'the work for which his pCmtiI is Issued(See.3097,Civ.C.)
L Q Lent..Nene
Q 'L Lender's Address
V 0 I certify that 1 have read this np,demioi and slam thou the dsoc urdarnatlon is
fa. E•.. correct.1 agree to comply with all city'and county onlinanees and sum laws mlaling
Q f) ,I building commotion,and wnchy orounim e,resen,ad e,ot this cilym enmra,vo
W he AWlenentioned pmpcny far inslaehnn purposes. w
G (We)agree to save,indcomify and keep halt the City of Cuperino again ^ '
to liuhildics.judgouenu,cogs and expenses which may in any way nectar against sold
�,) z cayincomegaenceogmr g fih
fflcispermn.
^ APPLICANT UNDERS'ryJOS AN)WI L COMPLY WITH ALL ION-1PO11NNn" Issued by: Date
URC� N ��gGl V
sig wremlAp - tour r- - ema Re-roofs
I '.ARDOUs MATERIN.S DISCLOSURE.
Wtn me a -am arc luwre Milling«cupml ram m handle haurdnus mamrial Type of Roof
as deraed by Ilse Cupertino Municipal Coda.Ch;tpmr 9.11.and me Health and Safety
Code.Section 25512(x)"
O Yea 0 N _ All roofs shall be inspected prior to any roofing material bei ng.installed.
Will the applicant our future Wilding eccupam use equipment or devices which If a roof is installed without first obtaining an inspec(ion, I agree to remove
emit hvanlno,our contammarts us ddined by the Bay Ami Air Guahly Manilm"'I t
District? all new materials for inspection. Applicant understands and will comply with
Cl Yes ON. all non-point source regulations.
I have read he hattSafety
Code. muton,2 req,25533ua nndcr 4.3 un erst ill the
CaliforniaI h Health&Safety axle,Section,255115.25511 and de,CI I mr 6 95 0IMI
'n the huiLling Jocv not ourrcntly uveumnnnt.mut it is my responsibility m notify the l
meupam of the requircnenm via h mu. be ran poor m issuance of a Ccriticam of \
Signatu er�)cant Date
- — - 4 All roof coverings to be Class "B" or better
age