00060030 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
GM' S PLUMBING 00060030
OWNFA N NAME: APPLICATION SUB DA'I'L'
RTA RYAN 46 SARATOGA SUNN VAL RD06/06/2000
10NE: SANITARY No C091 Rol.NO.
867-6010
0-7- ARCIIII'ECrIIINGINEER: BUILDING PERMO INFO
BLDG ELECT PLUMP MISCII
Cl Cu11 17--:l f—T
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'5'�_ LICENSED CONTRACTOR S DECLARATION Job Description
O Z—p 1 retell,¢furor mal I ma wen.ed under prnvleinn.of Chup,ar 9lcannnnming
wish Sec,i.n](0(rof Divi,i Jof the Business and Profession,CnJe.and my license
Ye,in full force and el l ail. 6 1.1 1961
z a License em<x 3 Lie.. S RE—PIPE
pQWU
cte=u Dales_teA.R,.H_I CnDnln,LA! WN
_
lmndm..m: serNan.CDaul he used
.
a.p')him nand:
ce a a Licensed Po,ftcximal
z
OWNEW et m DECLDECLARATION I hereby uftinn exempt
that I am eaempt form the commCo License a t.w for the
followingem uires a Permit
t ]o3L5, alter mW pride de.......li Coda Any city or mum,
Y F C
which requires a permit to convince,oalter.improves h peassh.or repair any xwnurt
a. e
prior Ill pursuant
ngnlhwhovisio so for Contenders
Lice se Lmed statement
�3� Ibit
unce,censedpSectio to the Provisions or me it.Bu,irc,ancnsClaw(Chapletase) Sy. Ft. Floor Area Valuation
or Za a is a with t therefrom
om a of a basis 3 nitre alleged
x end Poscion Any vi code)
or that he is acme,Ihctefmm ane or ,Psis lot the alleged exemption Nr,I penalty '
or Senior,e lion v any dre doll rot n 500).Permit whjems the xpPlicam to n civil penalty
.Dues mon n,:m tae hundred d�dw,a($can. A PN Number Occupancy Type
01,asowour or pruseeny,mmy employe,with wages us Mair sole om,m don, 35921701
will do the work,and the suumtere is not intended or offeree set sale(Sec.7W.
11 one,and Pn,re..inn.Code:The Corrado,a Lieenar Law dna.,m upnly,a;Its Required Inspections
owner of property who builds or improves thereon.and who Jose such work rimsll'
or angllhi.awnemployeenpmvtiledd,at..cft mr,or,mnemsaren"intendedO0 202 — UNDERFLOOR PLUMBING
created far u,If.bowevm,me building or impow a,em is sold within one year of
Lnnpinion,the awnernuilder will have the burden of proving that he did no,harder 301 — ROUGH PLUMBING
npmae lion purpose of sale.) 502 — FINAL PLUMBING ENERGY
O1,aa awaarnf Na pr�mar,y.area..els,lval......techs,w No Eantsed'ononcoa,h' 507 — FINRL PLUMPING
onamthe project(Sec.Ruled.foulness and Ri.n
afema Calces The Coulm,un e
.ken,Law doee,nn;,,illy loan owacrnf property who bards or impmvea mere').,
sad who amarser,for such pmjeau win a aamranoro)licensed pursuant to the
Conrucmrs Licenw Law.
❑I em amnp,under Sec. .If Yz 1'C for this rrlua
Owner Dale
WORKER'S COMPENSATION DECLARATION
(nanny alRnn under penalty of perjury one or the following dcclarni.ns11/40:
I I have and will maintain a Cenilica,a o1Comenl Ia sell'-imure for Worker's O/
:ompensation, as provided for by Section J]IXI of the Labor Code, for the
performance of the work for which Ilik permit is i.isucd. O
0'1 have and�ill nearaun Worker',Com,cr a,ion luscmae,as rcgnlred by Section
3700 of the labor Cale,for the perfommnce of the work for which this Permit is
Issued.My W.rked Compmwm'mn Inxn.mce sumer mW Policy„umber ore:
cl,rder:_y_I(( w it taus,Na: t,,.C 11 2 y 03(o o
CERT IFICATION OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This.seniam need not be completed if the panni,is for one hundred dollars
S100)or las., -
I cefily Iha,in the ped on niece n1',he work for which this Panni,is Is md,I
shall not employ any Peron in any manner so as.t becmne subject to,he Workers'
C..........union Laws of Ctdirnrntu.Date
Applicat
NOI'ICIi TO APPLICAN'C 111 after making this Cenl6cate of Exemption,you should
Mmmesubject m,the Worker>Compan.mion provioi sof Ihu Labor CoJc,youams,
Q farthwitn comply with such provisions m this permit shall b:Deemed revoked.
G
Fa y CONSTRUM ION.,fireLENDING a AGENCY
x 1 heresy n1Eim.hanham its,sued(Sec.
Idi C agency for the prrlimmunee
ki orale work for wM1icM1 this permit is issued(Sec.31NJ].Civ.C.)
G A Lcndcr' NE re
= 7 I<nJer',Addec AAJress
V 1,unity sent I have read this appllemim,vel some that the above informal I is
R. [�
correct 1 agree to comply with all city and county ordinance,and state laws miming
C) V mhuilding"o,oacdon,.nd hereby mmhourc nprcaft,ame,of l hisa'try meole,upon
he anovo-mentioned property for In,pemiom pur I
[r G+ (We)agree,osave.indemnify and kap lmnnlcsa the City of Cupeninoogaie"
Vy City i,ice,judgments,amts and expense which may in any way acemc again„said
7. ChylnmNTUND RST gondolier DIhispcCO
" SOU7hi
L.
CRED LAT
ILL COMPLYWITHALLNONI'OINT Issued b to
SOU .G LAT ONS.^n� y�
ppliemalcoat'., Date Re-roots
HAZARDOUS NIX]( UNS DISCLOSUREe appraant or future building aac.pan,am e m handle loomsi u,m0enal Type rofRoof
as du ,he Ca,m,a Municipal Cale,Chapter 9.12,odd the Hw11n and Safety
Cale25532ftft1 ON,, All roofs shall be inspected prior to any roofing material being installed.
he appliamn or future building orcupant use equipment or device,which Ifa roof is installed without first obtaining an inspection, I agree to remove
nil us air cora minunl,as dellued by the Iluy Neu Air Quality Monagellum
Larall new materials for inspection. Applicant understands and will comply with
CNoall non-point source regulations.
mad ser mvarlon,materials raluiremems under Chapter 6.95 of the
Califomiu Health N Safety Code,Sreti.na 25505,8533 and 25534.1 and...emN that
if building due,not smeary have it mean,,that it i..my re,pm dela,I,n.,5fy he
,we.Pant.2 the mwimmems which moa No I pdm m issmnnee')f a cerliraam')r
O"n,anc, ' C� - Signature of Applicant Date
mon i,ed asM • C. 6 ,� All roof coverings to be Class "B" or better
OFFICE