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CITY OF CUPER'I'INO5++-
COIVTRAC""TORINFORMATI -°
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
Ey r-RRRN DR.
CONSOLIDATED PLUMBING INC.
PERMIT NO 03090068
OWNER'S NAME:
3732 D CHARTER PARK DR.
PERMIT Issue DATE
E:
SANITARY NO. CONTROL N0,
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S
Job Description
ut,PDECLARATION
1 hereby affirm that I am urns provisions of Chepmr 9 (commencing
P
fth. Bd
with 5 elion]dcllVbpivisionJo(the Buein/eAs��qd Pmfessium Code.mdmylilmseis
and err
_
u«�f LIc 91 _60_5j�
REPIPE (16 UNITS BLDG. #400 #415)
Dem Comrmmr
HITECPS s to TION
`lura I umy Ia a I urea pail recnNs
Licensed Pronal
OWNER -BUILDER DECLARATION
1 hcrehy from that I am exempt from the Contractors License Law for the
following reason. (Section IID Id, Business and Pmreanom Code: Any city or county
which mquiree a Permit it, construct, alter, improve, demolish, or repair any structure
prior b its issuance, also requires the applicant for Such permit o file a signed statement
that he is licensed Pursuant to the previsions or the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section ]000) of Division 3 of the Business and Professions Code) or
that he It exempt therefrom and the basis for the alleged co mptim. Any violsdon of
32609064.00
Section ]031.5 by arty applicant fon permit subjects the applicant to a civil Penalty of
APN Number
Occupancy Type
P Y-
not mom than five hundred dollars ($300).
- -
it] 1, as owner of the property, or my employers with wages as their sole compensation,
will do the work, and Ne suvcium isnot intended or oRemd horse. (Sm. 7W. Business;
—
c
md Pmfmoms Coale: The Contractors License Law docs not apply to in owner of
property who outlets or improves Thereon, and who doessuch work himself or through his
502 - FINAL PLUMB I E RGY
own empluyout, provided that such Improvements arc not intended croRered torula If,
507 — FINAL PLUMBING
however, We building or improvement is mid within one year of completion, the owner,
builder will have the burden of proving Nat he did not build or borrow for purpose of
.1. L
El 1, as owner of the progeny, am exclusively contracting with licensed eo molou to
_
v s
construct the project (Sec. 70", Business and Professions Code:) The Contractor's Lir
come hw doas nal apply to an owner of propeny who builds or improves themon, ma
who contracts for such prejeeu with a enmrmtogs) licensed pursuant to the Contractors
LKCnY
rj
Law.
I
❑ am exempt antler Sec. B k P C for this `ison
Ownu Data
WORKER'S COMPENSATION DECLARATION
I hereby alarm under penally of perjury aro of the fallowing acclaratiom:
I hoe and will mainuine Ce Bricom of Comenuo self -mm. Tor Workce.Coml3Cn-
sailor, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is lasum.
❑ I have and will maintain Workei& Compensation Insurance, u reyvired by Section
37M of the labor Code, for to performance or the work for which this Permit is issued.
'
My Worker's Compensation Instant crPJynumer.:
'
cr. yNNa.:Iry
.:
XMmOS
COMPENSATION INSURANCE
(Thtsseellon need not becumplemd IHh Permit is furore hundred dollars (SIM)
or less.)
I ceNry that in the performance of the work for which this Permit is issued. I shall not
employ any penton in any mmacr an as an become subject to the Workers Compensallon
Laws of California. Date
Applicant
NOTICE TO APPLICANT. If. arta, seeking this Certificate of Exemption, you should
Inatome subject to the Worker's Compaction previsions of the L ser, Crude, you must
forthwith comply with such provisions or Nis Permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby afirm that there is a construction lending agency for the Performance or
•the
work for which this permit is Issued (Sec. 3097, Civ, C.)
Lender's Name
Lenders Address
1 certify that I hew read this application and same that the above information is
coraco. I agree to comply with all city and county ominmeas and sum laws relating to
building eon ion,andherebyeuNohm mpresenuliwsofthis city mcnmrupnn the
ahove.mcmiunc Property rat IIp a terrariums.
(We) eg a to save. i dcmnify and keep humleet the City of Cupertino sgalnm
liabllitles,ludg nu, costa a expwmcf which may in my way ec. ageoul id Cily
in consequ ee f the gram' g or this per t.
APPLICA NDE ST NDS AND ILL COMPLY WITH ALL NON -POINT
t
Issued by: Date
SOURCE EC LATI N .
Re -roofs
n
urea icon C sera r Dat
HAZARDOUS ATg DISCLOSURE
Type of Roof
Will the accup3 material
applicant tar Intum Wilding occupant note at handle
aCu'
as defined by the Cupertino Mupi !pat Code, Chepmr 9.2, and the Hcslth and Safely
Health
Code, Section 15533(x)9r/y
All roofs shall be inspected to any roofing material being installed.
❑ Yu
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or device, which
t hmardous contaminants u defined by the Bay Area Air Quality Management
all new materials for inspection.
Grin]
❑ Yrs
I haw adth,h.. r smamrmhra immcnuundor Chumer6.95ofthc Califon
nix HcelO S cyCoac, 'was 155115.25 3uW 534.1undemandOuifthebuilding
dao not c ratty lin e t nam, that it is responsibility m nndt'y the occupant of the
m Immc i me at met dortnn ameea(aCenlnca apane.
Signature of Applicant Date
All roof coverings to be Class "B" or better
cr
tar authorircd agentDoc
• . •.
CITY OF CUPERTINO .
REPIPE/SEWERS/MAIN SERVICE
• CUPEkTINO PERMIT APPLICATION FORM
•
m
,)3'Yo "s
APN #
� 6
PLUMBING
,-6 -4 BPREPIPE
Re i e of Fixtures
Date:
BPERMFEE
Permit Fees
BUILDING
_—Bldg.
PFIXTURE
Pbl . Fixture
Building Address:
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
Owner's Name:
Business License
y
Ph ne #:
ontractor:
Phone:
License #:
_
ar
9
Contact:
Phone:
Cupertino Business License #:
�S �O
Building Permit Info:
Bld
Elect ❑
Plumb
sf
Job escri tion:
Residential ❑
Commercial ❑
Cost of Project:
Qty. if
Applicaoie�) Fee ID
Fee Descrintinn
Fee Cirnun
PPERMTFFEE
Plumbing Permit Issuance
PLUMBING
,-6 -4 BPREPIPE
Re i e of Fixtures
PLUMBING
BPERMFEE
Permit Fees
BUILDING
_—Bldg.
PFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUS C
Business License
BUILDING
0
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•
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u�3
CI'T'Y OF CUPERTINO
�" i 4tra sxMy'*c, 3 a'+—s"rr - v"
INFQRMATION
BUILDING DIVISION PERMITC4NTRACTQR
,
BUILDINGADDasss:
CONSOLIDATED PLUMBING INC.
PERMIT —NO
OWNER'S NAME:
3732 D CHARTER PARK DR.
PERMIT ISSUE DATE
E:
SANITARY NO. CONTROL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I� Q
LICENSED li.A.d under DECLARATION
I hereby lfrlm that I am licensed under pmviaiont of Chafer 9 (commencing
with5 stat($7111gB of Ivishm2l.f JS Buaincn dPmfcesisnsm��CoJc,endmyliccnw0
Job Descri tics
P'
FI
�Irire wdcff
--50_5J62
REPIPE (16 UNITS #4001#
Lk.
fli1�G.
Da¢ Cumrwtor
HITECTS TION
� �
- Z ' J 1
�un0 Jmy la 1 wJ
t11'fu1 �
s ecnrJs
Licensed Prond
�(\\\`\e1
OWNER -BUILDER DECLARATION
5?
1 hereby al'Orm that l am exempt from the Contractor's License Law (or the
following reason. (Section 7031.5, Buaitso and Profcasinna Code: Any city or county
which requires a pcmlit in com not, alter, improve, dcmoliah, or repair any someone
52500
prior m its issuance, also requires the applicant for such Permit o file a signed statement
that he is licensed Puwant to lM provisions($( NC Commcum's License Law(Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division J or the Business and Profession Code) of
Ntherefrom and he is exempt therefroand the bub for the alleged exemption. Any violmion of
32609064.00
Section 7031.5 by any, applicant for a permluubjects the applicant to a Civil Penalty of
- -
APN Number
Occupancy Type
nm more than five hundred dmbm ($5130).
...
P y- -'
❑ I, As owner of the pmperty, or my employau with wages u their sole compensation,
will do the work. and theaweture isnotiAwnded u offered for sale (Sec. 7W, Business
— ROUGH
And Professions Code: The Contractor's License law does sol apply In An owns, of
ct
property who builds improves Nes
or eon, and whodoessuch work himselfor through his
5 02 - FINAL PLUMB I N RGY
Awn employee, provided that such improvements are not intended or offered for sale. If.
507 — FINAL PLUMBING
however, Ne building or improvement la sold within One YOU Of completion, the owner•
builder will have Ne burden of proving that he did not build or Improve for purpose of
Asia)
❑ 1, As Owner of the pmpcny am exclusively contracting with licensed contractors to
Construct the Project (Sec. 7t3a.s, Business and Profusions Cade:) The Contncbfs Li.
cense law does not apply to an owner of property who builds or barroom theseon, sod
who convects for such pmjecb with A contractor(e) licensed pursuant to the Contractors
License Law.
1 em nxempl under See. , 9 k P C for this moon
Owner Data
WORKERS COMPENSATION DECLARATION
1 Mreby &Bunt under penalty of perjury on of Ne following declarations:
hew and will maintain a Cenifieere of Consent to selpinavre for Worker's ComPCn.
. ion, o provided for by Section 37W of the Labor Code. for the performance of the
work for which this Permit is issued.
1 haw and will maintain Worker's Compensation I.... u mf dmd by Seetion
37W of the labor Code, for the performance of the work for which this permit is issued.
My Workers compensation Inwm mer end P 'ry number are:
'
tar. No,:
CLA/ OF EXEMPTION FROM IkERS'
COMPENSATION INSURANCE
(This.Clim need not be completed If be Permit is rmone hundred dollars(SHO)
has.)
I cenify that in the perfotmanec of the work for which this Permit is issued. I shell nun
employ any facman In any manner an As W become subject to the WOrker3 Dompenaatian
Laws of Celifomie. Data
Applicant
NOTICE TO APPLICANT: IL after making this COf ificahe of Exeminion, you should
become subject to the Workers Compensation provisions of the Labor CMC, you must
forthwith Comply with such provisions or this perm it shall 4 deemed evoked.
CONSTRUCTION LENDING AGENCY
1 hereby affrm that there is a construction lending agency for the performance of
OR work fur which this permit is issued (Sas. 3097, Civ. C.)
Lender's Name
-
ISMer'sAddress
I unify that 1 have read this Applieoion and stare that the above information is
Correct. 1 agree to comply with all city sod county ordinances and ata¢ laws misting to
buildingcunsvu ion.wdhembyeuthoisePresenmtiwaar Nin CitymCnWTUMn NC
abovomcntiune propertyfo peclion purposes.
(We) eC e m save, i cmni(y and keep harmless the City of Cupertino egainat
liebllhiCS, judg An. Costs tl cxKnsm which may in any way accrue egainat said City
in consequ c f the grant C of thia Per I.
APPLICA NOE ST NOS AND ILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE EG LAT( N .
Re -roofs
.me teasC ton DA
HAZARDOUS IATERIALS DISCLOSURE
Type of Roof
Will the applicant or future huilJing occupant atom or handle haordous mistrial
o dcfinsd by the Cupertino MupiciPat Cods. Chapmr 9.12. wJ the Health and Safety
Section 25532(.)?
nJe,
All roofs shall be inspected to any roofing material being installed.
OdYG
prior
/rWh/+u^„
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment orJevicu which
arardnua ' content name as Jclined by the Bay Area Air Quality Management
all new materials for inspection.
it
❑Yes
I haw Wthchoa smastriahm immcne unJer Chepstr 6.95 a(thc Califar
ria Health S etyCMe, Limo 25X13.23 Jou1231Jq.l underlaM Nati( the Willing
JCcs not toy he a awh thnl it b msponsihiliry w m dry ole occupant of Jse
re Immets me al mel ArmbawenfxceNRe APwe.
Signature of Applicant Date
All roof coverings to be Class "B" or better
c, ser aulhori'r.CJ agent
Dam