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05090018 CITY OF CUPERTINO gx> x+* wg^ az- dgn-res'� s^. .axa : BUILDING DIVISION PERMIT „CON RRA•6 OR INFORtMATION r. sur l(r. BUILDING ADDRESS: DRAIN DOCTOR PERMITNO.O5090018 OWNER'S NAME: PERMIT ISSUE DATE NE: SANITARY N0. CONTROL NO. (408) 370-3082 ARCHITECT/ENGINEER: - BUILDING PERMIT INFO BLDOO ELECTO PLUMB MECHO LICENSED CONTRACTOR'S DECLARATION Job Description 1 bereby affirm that I am liccaud under provisions of Chapter 9(commencing wish Satioa7M).fDiviaia 3aflhe Busircuand (anions Code,and my license it in full tome and aQat. REPAIRv sat�-•,�� `'�S S SEWER . {� � z ueama slat Lia.« 6 Dn¢= comranor r� . .31 ARCHITECTS DECLARATION 'B -w I understand my plans shall he used as public records Licensed Pm(cuiuml SEP /3 2005 v, OWNER BUILDER DECLARATION 1 hereby aRmm that 1 am exempt fans the Contractors Liansu lesw for Ue Ra following news.(Soudan 70714,Business and Profession Cade:My city or county {�y. ti ) $ which requires a permit m consuuc4 altar.Improve,demollM,or repair any someone, 3000 F i<12 prior to its issuance.site requires the applicml(orsuch permit in file a signed statement .mow �yzFp< that he is liensed pursuant to Me provisions of Me Contractor'e License Law(Chapter 9 Sq.Ft.Floor Area uation d$ (commencing with Section 7000)of Division 3 of Ne Business and Professions Code)or 3 that hrz Ina is ampt therefrom and the basis for the alleged exemption.My violation of Section 7031.3 by any,applicant for a Permit abjccu the applicant m a civil penalty ofOGGU araC '�/ oat mese Na five hundred dollar($300} Occupancy -+Pe ❑L as owner of the property,or my employees with wags n Our ale conformation, will do the wart,and the structure is not intended or offered for Wc(Sec.7044,Business Required Inspections and Profession Cade:The Conuscmrs Liaae.law does not apply in an owner of q P property who Wlldsorimprovs thereon,andwha doessuch work hivuelforduough his own employees,provided that such Improvements arc oat intended matured fursale.IL however,the building at Improvement is sold within mm year of completion,Ne owner. builder will have the burden of proving that he did not build or Improve for purpose of ❑1,a miner of Me properly,ma ae,lusinly contracting with liaaed conusstan to construct the project(Sas.7044,Baines and Profession Code:)The Cmuanoes U. cane Taw does not apply m an owner of properly who builds or improves thereon,and, who contmcu for such projects with a contractar(s)licensed pursuant to the Contractors License Law. ❑1 me exempt under Sec. B&P C fm this reason Owner Dam 41WORKER'S COMPENSATION DECLARATION 1 hereby aRMt under penally of perjury nuc of Ne following decimations: I haroml will maintain a CeNRatsof Conenl wmlRlnare fm Workers Compen. salon,a provided for by Sudan 3700 of the Iabm Cade.for the Performance of lie work for which this permit is iaue6 ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code.for the performance of the woh for which this pnmit is issued. My Workers C•ompew/d-on Insurance artier and Policy number see: Ca�ptmt�7,s�/JJ.T Vr Policy Nb.-l' /s,..( 3 / CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Tris section need amhecompleled I(tk permit is(mane hundred doliars(SI00) nrlessJ , 1 certify Nat in the perfermanex of the work for which this Permit is issued,I mall net employ anyperson in my mmnerso a to became subject to the Workers'Compensmon Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Cmdriate of Exemption,you mould become Subject an the Workers CompcnsNesi provisions of Me Lakes Cade,you most 0 O foMwith comply with such provisions or this permit mall W deemed revoked. CONSTRUCTION LENDING AGENCY [-+ Ihereby of m that Vert is a commuctino lending agency for the Performance of lZ Mm work for which this permit 4 issued(Sec.3097,Civ.C.) 4 0 Landers Name z Lenders Adduss U 0 1 certify that I have read this application and mad that the above information is Ur E coned I agree to comply with all city and county ordinances and sum laws missing to 0 SUS building construction.and hereby authodm repreanuMves of this city an enter upon Me Ly aMvemendaned property for Wpecu n purposes. LL (We)agree to ave.Indemnify and keep hsmlas time City of Cupenino against ti cA IlabillMa,judgmems.casts and expenes which may in my way same against aid City incomue APPLICANT UNDe IPTANDS ArN�WILL COMPLY WITH ALL NON POINT Issued by: Date SOURCERE _ Re-roofs m m HAZARDOoUS MATERIALS DISCLOSURE Data Type of Roof Will the applicant or future building occupant atom or handle hasrdous material as de0ncd by the Cupenlnu Municipal Code.Chapter 9.13,and IM Heam and Safety Cede. [3,thaus32(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes No 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 mil harwdous air contaminants u dc0ncd by the Bay Area Air Quality Management all new mater'als for inspection. 7Dsvici?(]You ❑N1havemW tae husMousmaterish5533 mentnunderCMpurd.93oftheWildingfor- e HcolNaSScedns25303,23377md25334.1unMnwmdthatl(Me buildingos notcu ban I tenant.that It it my responsibility w nudly the occupmt of the yuimmen' hk metpri ceofaCertitude ofOccupancy. I tureofApplicant Date 0 runs aulhorizcdagent Dom All roof coverings to be Class"B"or better Community'Development 10300 Toire Avenue aClOF Cupertino CA 95014 Telephone(408) 777-3228 Fax(408)777-3333 UPEkT-INO Building De artment JOB ADDRESS: PERMIT # / E 0S-0 7661 OWNER'S NAME: /C,4q PHONE # GENERAL CONTRACTOR: h? 01 CG FAX # d I am not using any subcontractors: 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 Metal Sheet Rock j Tile Owner/Contractor Signature Date CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE �CUPERTINO PERMIT APPLICATION FORM APN # C / Z/ a Dates, Building Address/ 6, OwnerXje: CJ (iV Phone#: 7 3 �C G1�11 Contractor Phone:/ / License :' Contaci�n ns Q1 U Phone: _31g Cupertino Business License#: Building Permit Info: 1 Bldg ❑ Elect ❑ Plumb ®� Job Description: Residential Commercial ❑ Cost of Project: Qj -00 Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFDCTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING / BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING