05040036 CITY OF CUPERTINO
BUILDING DIVISION PERMIT , CUNbCR .C'�ORIN�ORMAURN
BUILDING ADDRESS: PERMIT NO.
AQUATEK PLUMBING INC 05040036
WN
OERSNAME: PERMIT ISSUE DATE
JERRY ZRANn 1 :716 STONE XV9 #E
NE: SANITARY el OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
K 0 ELECT'
PLUMB MEOCH
>]Op LICENSED CONTRACTORS DECLARATION Job Description
I hereby Affirm Nat 1 em licensed under provelon t of Chapter 9(mmmeneing
ith Section 70110)of Divl#V Sof the Business And Profesawa Code.And my Become is
in full Tome andeR
n'z LicenseC1as "� � uc.e 6 �� 6 INSTALL GAS LINE TO REPLACE 3/4 "
Dam C}--71—CumnctoARCH PIPING TO GAS MAIN
ITECT'S DEC
1 undersand my plan,shail to used As pat X res
3 G Licensed Pro a amnJ
Oat I Am exempt
from
DECLARATION
1 Mosby.(Siem that 11. exempt from O r lcamms Cc Licence LAW for mw
O 4 following mason. emit h 71131.5,Businessafter.
and Improve.
de o demolish.
Coda:Any oily Or county
$
which requlmanpmnitncwmtthe construct,Wer.Wprove,deermitt flnpaf edumcwre
F�Sn priosreitaluuaKp,elmrequims the applicantfee CQuAracee-Licea,Law(Chapter
that he Is licensed pursuant to Ne ptoHaiosaaf meCBusinesand Pro Law(Chapum9 Sq.Ft. Floor Area Valuation $0
3a
(commencingIs exempt
Section nfirms 000)nf basis for
of ae Business armor.My
mlatdr)ion of
Wt h 4 exempt 1Msefrom and Ile beta for Rw alleged exemption.My violation of
Section 7031.5 by arty applicant for a permit ubjects the applicant to a civil penally of APN Number Occupancy Type
not more was,five hundred dollars(55001.
❑I,aowner.fmwpmpwy,wmywployaowith"tesulhl„okeampewdan, 35913079 . 00 .
willdo the work,end Nestmctum Is not lnweded oroRemed fonam(Sec.7044,Business Required Ins Actions
And Profession,Code:The Canmaoes License Law does act apply re an owned e of q p
property who bulldsor Improves thereon,and whodoesmols work himsel(or through his -
ownemployees,provided that such impmwmcna are notintended marrows fmasm.If.
however,Ne building or improvement is sold within one year o(compledon.the owner.
builds MR have the burden of proving Oat Its did but build m improve for purpose of
am.). / \
C I,as owner of the property,am exclusively contracting with licensed contractors to
mase La Ik project(Sec.A,go owner
W property
who Wild.
code:)The Coousetor,nd S
ceme Lawestinet two
with
Aofpmpeny whosedldsorimproves Rumor,and,
whonse Lacs for such proJeC7e with a canusetodq licensed pucewm recess Gnuaaors
License Lew. \�
❑Tun aempt undo Sea .B.R PC(m Nis moon
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby Affirm under penalty of pmjm y one of Ore following declarations:
I haw and will maintain a Certificate of Consent towit-imure for Workers Camper-
uuon,As provided for by Secmon 3M of the Labor Code,for the performance of Ne
wosk for which Ni,permit Is lamed.
❑1 Taw and will maintain WmAces Compensation Imm�ntt,u required by Section
3700 of the labor Cade,for the performance of the work for which this permit is Issued.
My Workers Cam emaman Insuruxx aria wed Policy number art:
Cards \ ' Ce �\7 PORaybw.: P%9\2Aq-90
CERTIFICATE OF EMPTION FROM WORKERS' '
COM ,ATION INSURANCE
rDtissecown need not becomplemd If mw permit Is foram hundred dollars(1100)
or less.)
I certify met in the performance of the work for which this permit is issued,I shall not
employ any recent,in Any manneran As An become subject to the Workeri Compenumon
Laws of Coif ends.Dam
Applicant
NOTICE TO APPLICANT.If.arm,making his Cer i0am of Exemption.you should
become subject to the WorkeY,Compemadon provisions of the Labor Code,you most
Z forthwith comply with such prtvkiom or Ni,Permit hall 4 deemed revoked.
z O CONSTRUCTION LENDING AGENCY
Themby ADirm NatmicmisAmnwmctinnl MinSagciayfof NopMosm of
f•L> the wuh for which this permit is issued(See.3097.Cih,C.)
6Wi Q lander,Name
Z)Z Landers Adder..
U Q I modify that I haw mad this application And sum mut Ran above information is
U,t"' COMCL I Agree to comply with all city and county ordinances and slow lows totaling m
0 U Wilding construction,and hereby anthorim representatives ofthis city rectum upon the
` W A Wve-mendoned property for inspection purposes
FC+ (Wed Agree to taw,indemnify and keep harmless Ne City of Cupertino against
y Iiabili u, gmenta, andexpeme,which may In any way acerae against said City -
C) AP eUNDa a(ANDS ANWILLWILL COMPLY WITH ALL NONPOINf Issued by: Date
SOU GULA S.
()')'OS- Re-roofs
Sin ppl'anuCon rar Dow ,
us MA IAIS DISCLOSURE Type of Roof
me Applicant or future Wilding occupant tram m handle haudous materia
u de fined by the Cupenlno Municipal Code.Chapter 9.12,and the Health and Safety
Code.SmRan25532m)7 ` All roofs shall be inspected prior to any roofing material being installed.
❑Yes 6Nu
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hvardnus air cremmmanu u dcMed by the Bay Area Air Quality Management all new materials for inspection,
Iania7
❑Yes [{Nu
It NelunNmemawrid,requirements underChepwr G95of the Glifor.
a Catic.Scemom23505,25577 and 25574.1 mndcaloed thuifmv:Wilding
c y he.•un Nat It k my responsibility m notify the occupant of Ne
re hkhmust he dOireIssuance oracmtifiesuorocmpancy. Signature of Applicant Date
c egem Dau
v All roof coverings to be Class"B"or better
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM 05D �13�
APN# 3 S 2 _ O-)/g Date:
Building Address:
Owner's Name Phone#:
,Serc z,1r,o o� Lis -G30
Contr tor: 9'� Phone: g S7 b License 6-T-1 5-� ,
Contact: \ t• Phone:
�tCupertino Business License#:
lick ev12 ` c�wc2 C� Scl -O o
Building Permit Info:
Bldg ❑ Elect ❑ Plumb sC
Job Description
p
Residential Commercial ❑
Cost of Project:
Qty. if
A licable Fee ID Fee Description Fee Group
PPERMI'I'FEE 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
� �037