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00120004 CITY OF CUPERTINO BUILDING DIVISION PERMIT- CONTRACTOR INFORMATION: BUILDING ADDRESS: I'ICRMH NO. 7 I Q)L71 121210 OWNER'S NAME: APPLICATION SUIS Exrr FN TAMES M ONE 'r T /, 'T l ' '/ 2 I PHONE: __ SANITARY NO. CONTROL NO. —OQ Q ce O ARCHITEC1713NGINEER: BUILDING PERMI I'INFO C li f%: ELECT PLUMB MECH Luka I=1 CI CI I_I zw `t S V LICENSED CO,VI'RACI0R'S DECLARATION Job Description m thun O Z—a 1 herehy all"rat 1 ain licensed der pm ino ion, f Chuptnf 9 monomaniac with Section]mgt of Division 3 of the limine,,and Nofirs.uan,Code,and my licenue C I,in full brace unit effect. zo6u i'umccla„ I.it.# REPLACE 40 GALLON GAS WATER, HEATER >° O w F Date Contract to ARCHITECT'S UECLARAI ION t ovj 1 undcoend my plan,,hall be..it an public reard, u S p 2 I,inmsmJ Pnilcsinnal o nOWNER-RUILOIiR DECLARATION 1 herehy affirm that I inn exempt fmm the Contractor's Liverre Law for the C Z< following remora.(Section 91131.5.Bu%imes and Professions Code:Any city or county dm which requite,o Iwrnhit u,con,wd.,,free,inprove,demolish.or repair any structure Or n priuoiml,,ar u,. .,no, ire,the applicant im,uelt pclntit m til,usignal,ulmocnt ca. that he ixlicensed lmr.namit)the movi,ire,xnrline Commences License Law(Chapter 9 Sq. Ft. Floor Area Valuation marnmewing with Section 7")of Division 3 of the Hudde.and Pram,vion,Code) r that he is csmhpt therefrom and the havi,for the alleged corruption.Any violation —re A Seen 701 1.5 by any applicant Gra a pamon wtecel,the applicant In a ,,it Imrmlty, ret an(more(hath Ewe hmndred della,,($sten. A PN Number Occupancy Type ❑1,as owner of the propcny,car my employee,ream wage,a,their mile compensation. will do the work,and the sumemroffered e i,not intended or lot Ole(Sec.7(W. - ' 00 thlxine„and prare,.imr,Code:The Comann ',i.w."m Law doe,mot apply In an Required Inspections ,,.act ofpngxn,Who bulhk or improve,Ihemon,and who does inch work Ii ulf or through his Own employee,.provided that such impmvement.s are not imonded of 502 — FINAL PLUMPING ENERGY latest for sale.If,however,the building ar impnoianent i,mild within one year of hcompletion,the owner-builder will have the harden of proving that he did not build or 506 — GAS TEST tprove for.,.mattof,mea. ❑1.a,ownerifthe pmpany.rateselm,melyenrader 6 „mrcensedlammemr,tn SD7 — FINAL PLUMBING ,Rua the project(See.7(w.ownrBusiness and any who Gdc:)The Continuumthrams Liame Law does no apply m an owner of propcny who) roc or Improves lhc,, he Cod who contracts,Licfor such pryede wish a avnmctnr(xI liccn,wd punuam In the 01 am exempt Licunde Luw. / ❑I am exenhp(under Sec. .N k P C for this reason Owner.Dale WORKI?R'S COM PIiNSA'I'[ON IIIiChARAI'ION r I hereby affirm under tonally ,I perjury one of the following declaration, ❑ 1 have and will n mmhin a Certificate of Consent to elf-invom for Worker', v Cmupemxaion, :s provided for by Section 3700 of the labor Cade, for (he per!mmuce of the wok for which Thi,permit is i„Bed. ❑1 have and will maintain Worker's Con,pemation Inwmnuc,as required by Section 3710 of the labor Cale,torr(hes ps,douncince of the work for which this hermit is sued My Wader',C( von,aion In,urun c currier and Pole,number are: - Cra fee Policy Nu: CERTIFICATION OF 6CEMP ON FROM WORKERS' COMPENSAnON INSURANCE T his Oction need not he emol)[cled if the Iwo nit is for one hundred doll— IS I(10)orless.) 1 uceify that in the performance of the work for which this permit i,issvlid,I ,hall nut employ any Iturxm,In any manner so e,Io become,uhjccl 6,the Woken.' C.....Ili nn law,of Calllornia.Uta, Apphcam Not ICE TO APPLICANT:If,a0er making this Certificate of Eaatption,you should become subject it)the Worker s Coupenmtlon provisions of the limits,Code.ynu mus( Q O Forthwith comply with such provisions or this permit shall be dean ed revokal. FCONSTRUCTION LENDING AGENCY . a ' I hereby M.that(hem i,it conurvon..lending agency for the Pero rnm nce RlA of the work for which this permit i,issued(Sec.3197.Civ.C.)If. Londe”,Nmnc 7 z Lender'.,Adams, V Q 1 certify that I have read this application and Mme that(he above information is k6 F. Bonnet.1 agree to comply with all city and county ordinance,amt slate laws relming Q V m build....m...u-nn,and hmrchynutI non m,ramntntivc,of this city,,crime upon - ythe above.Imananned pn,pmety f......pmok n Por,osas. (Wel agree to unc.indemnify and keep harmless the City of Cu(nnino against rn habit itics,judgments,costs and expmmse,which may in any way raceme against,aid U Z City in canon mocc of the granting of this permit. APPLICAN'1'UNDEIts I'ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. y' Signature ofA,licanUCoomis, Date Re-roofs HAZARDOUS MATERIALS DISCLOSURE Will tla,al,li't iar mom htdld'mgneenp:an,orear hitnnle haumdat,maw.al Type ofRoof :is delimit by the Cupertino Municipal Code,Charter 9.12,and the Hcullh:rod Safety Code.SectioOYcsn Ls532Wf! 0 N All roofs shall be inspected prior to any rooting material being installed. Wdllheapplicaa... mare,building nccnlrama,aegnipmeoardeviou,which If a(roof is installed without first obtaining an inspection, I agree to remove mount hmanloo,air coula ninam,as lur m d by the Bay Area Au Quality Man agamcnt • Dotrlc(p all new materials for inspection. Applicant understands and will comply with 0W, ON. all non-point source regulations. I have Icall me haaarda nnacrids o aim:ncan under Chapter 695 of the California I ieanh&Sam,Coda Suctions 25515.25513 and 25531.I tudemtlud that if the building does of curmatly base it maim,that it n ony m,,,n,ihility it noify the occupant of the requirements which mus(be met prior to i,nuemce Of it Cenihcate of Occupancy. Signature of Applicant Date Owner of euthormed agent Dat. All roof coverings to be Class "B" or better OFFICE