04120025 CITY OF CUPERTINO x� stwc,+.n ce. �aa °- �'
BUILDING DIVISION PERMIT' COiTR� TOR=INF®�tMA�TO -
„�>.„ ,f, .. .1. � M(.
BUILDING ADDRESS: CONSOLIDATED PLUMBING •INC PERMIT NOO 4120025
20of VALLEY
OWNER'S NAME: PERMIT L$UB DATE
BARNHART 3732 D CHAR
ONE: - SANITARY.NO.- CONTROL NO. "-
` . (408) 978-3093 _
ARCHITE,CTIENGINEER: SUILDINGPERMITINFO '
- BLDO ELECT .PLUMB MECH
30o LICENSEDCONIRACIO 'IDf TION - IobDescii hon - '
I Mmby um that I mm line a ,Provision of Ch,Pyr 9(commencing - - p /r-
with ] )of DlWsion 3olN0 WPmf m"Cc E,endmyliccnmle U �, n
� in Lice tiers SEWER CSO ° `.:; • ','
? Litt au _ Is
Contractor
,
Dam Cpntrmclor (�
RCHI]ECI•
�i deisunJ mY Phu Shall M uarA u itis .-
. `tad Licensed Professional --
OW NER-BUILDER DECLARATION q���jjj
+� $ I Mahn.(Tum mel 11. exempt from the Contractor's o License Law for the O I _ _
Oo
following memo(Sectim 7031.5.Business and Peaioli Code:Any city at county l� 'fa,=1` (J•...
$(L whish requires a permit re cowroct after,Improve,h permit
erdemolish.or repair any structure ignmel cement y /t)/(;!
rzi pdarto its iensedprsu mgWthe theapplicantof for sucCon=nitmiele s Law(Chapter
F (maroon
cingwi Smdmmthe DMofDivsim3ofConuito License law(Chaptor9 Sq.Ft.Floor Area
N $ that
exe pt Scefm70 ndODivision]orthc Bunneemt Professions Cnde)or
.�3� Net M la exempt Nemfmm eM On Mala fm IM elkgW exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of - er0 0 - — Occupancy Type ”
nal mart Nm five hundred dollars($500).
❑I,mownerof JmpmpenY. mycroployceswlthwegesn Neirmkcmnpemdm. _
will On thework.and thearmume k notinumdd oroRered forsale(Son.70".Business -
and Pm(esslmu Coda:The Commences LI¢aue Law deet an,apply to an awmr of ^ - Required Inspects_qnS 'T-Fit••'Su H+, .C:1..
property who Mildsorimproce dmmen,and who doessuch work foreteller through his - -
own employees,Provided than such Improvements are,not intended oroffered forsale.If,
however,Ne building or improvement is sold within one year ofmarptedon.the owner.
builder will love the burden of proving that he did nm build or improve for purpose of
❑1.m owner of Jan property,em exclusively contracting with limned contractors or
comwct the project(Sec.]Odd,Bumeas and prollculam Code)The Conummr'a Li•
cetue law d.,not apply m an ownu of property who htild,or Improves lhemon,and
, - -
whaconuantsforauchprolbear with acormanm(a)licensed pursuant to On Consomme. _ .. . -
Lim Lsw,
❑lam exempt undo Sec. ,B&PC fee this mason
Owner Dem
WORKER'S COMPENSATION DECLARATION
I herby affirm under penalty of perjury One of the Following decimation]:
1 Mw and will maintain•Certificate of Ceent toself-imum fee WodmfsCompen-
mlon,m provided(m by Section 3700 of the labor Cade,for the performance of the
weak for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,u required by Schon - - -37M of of the labor Code,for me perfarmance of the work(gwhich this permit is butted.
My Wor oh Compenudon lneuanttes ' and Poli -Ir' Mr am:
CERTIR TE0 EKEMP IONFROM ORKERY
COMPENSATION INSURANCE
I
(This section need not M eomplemd if,he panni,la far ox hundred dollen(STDG)
err less)
I ceniry that in the performance of the work for which this permit Is issued.l shell not
empleyany per um in any manmrm as to become subject to the Workers'Compemadan
Laws of CoH(mou.Date
Applicant .
NOTICE TO APPLICANT.IL after making this CcnlBam of Exemption,you should
become subject to the worker's Compensation provisions of the labor Cade,you must
0z (oMwith comply with sach Pmvisiom or Nis permit toll be doomed revoked,
Z CONSTRUCTION LENDING AGENCY
ger
(-iThereby arntm the,thea it m coomectmn lending ageney foruc performance or
(Y..>i the work for which this permit Is isened(Sec.7097,Civ.CJ C�
W�Q Lenders Nunc
Lender's Addrtas
U Q I certify that i have mall this application and stem that the shove informflun is
Uy F ¢Incl.l Agree to comply with JI city and county ordinances and sum laws relating to
0 builduacmn17fls
b MmbyauthodmmpmsenudvesofthisehYtoenmlaPnnthe
r2.j above-mentiony for ImMcdon purposes
(We)agreeve,in nify and keep hat 11M IM City o(Cupenino against
T4'jy m eapemoi which mrykmy wayacerae opines uld GtyAt _U`� inconsequenrander of thispc A LIC RSTA DS AND w LL COMPLY WITH ALL NON.ppINT Issued by: Date
/G/� Re-roofs
S' eurcurA Ilan on ser Dam -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Jan applicant or future building occupant nom or handle hmudou material
u dented by Jan Cupertino Mugicipel Cade.Chapter 9.12,and the Health and Safety
ode.Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or ruwrc u1lJing occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
unit ova mo air conuminanu Oend by the Bay Area Air Quality Management all new materials for inspection.
Gunter?
❑Yu u
flaw the bu nusmamrlelartquimmcnts under COPmr6.95of the Cdirar
nit Health& afny Code, 'au 25503.2537 and 25534.1 Ounuund the,ifJte building
dnes an,co n0y h ve a t.Aso It h m rctpomihllity m notify IM recttpect of On -
mquim ms blah aR et psiartoi eneears CeNDcam of Occupanry.
� Signature of Applicant Date
Z
Owners .a ori>� a nl Date Allroof coverings to be Class"B" Or better
Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
� �UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
ZOSTO / e I o Z/ r -00 vS
OWNER'S NAME: A/ ;e,67- IPHONE # 30
GENERAL CONTRACTOR Er FAX # V69 9 7 G
I am not using any subcontractors: 14, % Y-D 3 —0�
Signature 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 etal
Sheet ock
. .Tile
r ontraior Signature Date
CITY OF CUPERTINO 2 ��
REPIPE/SEWERS/MAIN SERVICE "
CUPEkTINO PERMIT APPLICATION FORM
APN# 3 7-6 /� Date: '
Building Address:
Owner's Name: Phone#:
OodklV
Contractor: Phone: License#:
N u 0 0-- Xeg, 7S �D�1 OS/lo Y
Cont: Phone: Cupertino Business License#:
ta
dooms 5� z/o 972,5-
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
10 S" 70 F-
- �LG/9/✓ O✓�
Residential ❑ Commercial
Cost of Proj t
z3oD
Qt if
Ap6lilDlabie Fee ID Fee Description Fee Group
PPERMITFEE 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 Dis osal PLUMBING
BUSLIC Business License BUILDING