00070144CITY OF CUPERTINO
'
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
RUILDIUGIADDRESS;
PERMITNo,
OWNER'S"!10903 WILKINSON AV
WATER HEATERS ONLY
APPLICar1001 7,01.44
GATTO MARIE M TRUSTEE
500 AIRPORT BLV
SA"ITAR`077/24/2000"f''
nacHlncCrnLNGINEER:
( 415) 349-3747
BUILDING 19iRA1 T INFO
BLDO El Cr • .0 IH MECH
FF
i LICENSED CONTRACTOR'S DECLARATION
fob Descriptio((
I hereby a11um that I am licensed under provisions of Chapter 9 (commencing
ce wish Section 7000) rf Division 3.f Ne Inosines, nmd find .,inn, Cade. and my license
in roll hn,c anti elraaa.
.
< License Closs I.ic. M
U D,ne
DECLARATION
WATER HEATER
ARCHITECT'S
I undenaland my plan..ha l k hoed as public record:
o Licensed Profesiond
LL OWNER -BUILDER DECLARATION
,
L to rehy affirm that I am cacmpt form the Comaeors License Law for the
GIblloOng reason. 7031.5. Business and Profe„im, CWe: Any city mrcounty
O which myuoe. a perms(u,...... ose(, alcor, on i' deinrhot, or m'Pna ony ,,mount
poor m its i....unce, also re,moc, thenpplicam fur.wcM1 Ic.iuo f ile a sigmud,mRmenl
Sq. Ft. Floor Area
Valuation
— Nal he is licensedpuauentmtheprovisionsoftheContactorsLicenseLaw(Chapter9
I conhmencing with Section 701 of Division 3 of the Easiness and Pm(wirn%Code)
Or that he is cumhpl Intel in and the basis far the nllcgcd excinplion. Any violation
of Section 7031.5 by any eediranl lin a Penni, >nhjvcd the aPp1i... I to a civil penalty
APN Number
OccuptkVWTapc
of not more than five hundreadollars (SRxH.
❑ Las owner of thepropenyl or my employees with wages as their veto crmpemution.
'..p.,
3561.3026. I[,f cLvt{UIrCd IntipCCtlOnti
will do the work, mad the uwemre is it intumdW or offered for sale (See 70,14.
mras and 1'ndes.ions Code: The Comme'aN License Luwdocs aol upPly,, sn
:I.
owner of progeny Won MhiWs or innpmve thereon, and who does such work himmH
or through his oxo employees. provided that weh improvements are not intended or
opined for sale. If. hav %co, the building or improvement is said within one year of
nnpletion,meowner.bndderwillhawthebumernfpmvingthathedidrenhandm
502 — FINAL PLUMBING ENERGY
n,pmvc for puHvrsn of sole.).
50E — GAS TEST
❑Eric, the to
%nsCodensed
hernf
)TheCoauoro
jectscert7(94,bdmiveymwaehng
r%
Code) The Les
beset the pmjmt face 71,14, Busies and try
507 — FINAL PLUMBING
theror's
Ohioan
Lleemn Law dads nal apply m un mvnw who builds m improves thereon,
a cony
for ouch pmjccle whh a amvmnorlsl IiccnncJ pnr,uam m the
uW who cs will
License Law.
Cor131
O l am exempt under ace . H & 1' C for phis mama
a exe pt under
Onvoc, Lee
WORKER'S COMPENSATION DECLARA'I'IDN
I helnhy affirm mover penalty of perjuq one of Ne fnlhnving daclaationa:
I hove soil will i nlnain a CcnlTmatc of Consent tin ndl'in.ure for Workers
mhpensntion,'as provided for by Section 3701 of the Labor Code, for the
performance f thework for w Inch this connit is issued.
❑ Ihave and wh. m Worker's C ripen I I by Section
e
yfianalSects
k lrequired
37tH) f theh rd d p T re, f tl look r h b is
,wu1. My Wt oker. Ci pmi'moon insurance -and Polit, h
`((
Cm bre,. Policy Nn:
o7liff11'ICAI'IoN OP EXEMPTION FROM WORKERS'
'
COMPENSATION INSURANCE
(This section need not he conhplcted if the permit is Lor tine hundtud dollars
(51 WE or less)
I ceniIy mat in the Imrmrm:mce of the work for which hits peril is —ad. 1
shall not CImpinY any person in any tmminner ,n as la banns, shoos( it, IM1mWorkeri
'
Cnmpensmimo laws of Culifihmia. Ube
Applicant
Not IC17 To APPLICAN'P If, after making his Ceniticam of Esrmptien, you nhauld
Mame soles( to an Wo, kcr'a Connpcn.tion poo s ors "I he Labe, Cod, you ren%
fanhwitlh comply with irh,umcmans tin this permit shell he dermcd revoked.
O CONSTRUCTION LENDING AGENCY
I havhy affimh Ihat there Is a comwctiun lending ngcncy for the perfurmamcc
of he work nn which this prnmh is i..oed (Sea. 3097. Civ. C..)
] Lender's Name
Z Lender's Address
J1 cerdly Not I hove mad Il ie Implication and state that the onowe infnrmtion in
macot. 1 agree ,, comply with all city and county ordinance, and stem law, rioting
J In Evolving coustmelion. and hereby ruthnn,representative% nl Ibis city b) enter upon
ii the AwwrmcntiurOd property foriepecdon nativists.
L (We)agree to save. indemnify and keep harmless the City of Cupertino against
n liabilities i W'ane's, cants and capmow, which tnny in any way ,teems ngainu said
City in conseyncocc ofthe gmni ng ol'this pennh'
AND WILL COMPLY WITH ALL NON -POINT
ISSUCd by: Date
SAPPLICAOURCETUNDERSANDS
Re -roofs
Sigm,larc ol Apphc ntrcmnmelo, Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future huiding uecuptmt smmc or handle hacmvnus nmtenal
Type Of ROOF•
us defined by the Cmpcnino Municipal CWe. Chopmr 9.12, and the Hcallh mud Safely
Cale. 25532m)7
pits ❑ No
All roofs shall be inspected prior to any roofing material being installed.
Will theapplicant orfummbuilding(wee,o l use cyuipmem ordevices which
If a roof is installed without first obtaining an inspection. I agree to remove
coni, bmrdoi s or conmminams a, defined by the Hay Aura Air Quality hlongemem
biome?
all new materials for inspection. Applicant understands and will comply with
Elves °Nti
all non -point source regulations.
1 have read the hmadhv.s materials requirements under Chapter 0.95 of ,he
nmnd that
Secns 25505. 25533 d 25534. 1 adem
California health & Safety Code. Section, an
If the building docs not currently Neve it leant that it i, my responsibility to notify lM
vulgar of he, myuimmena each toast be noel pour in issuance of n Cenilic le ul
Oc'upaw'.
Signature of Applicant Date .
All roof coverings to be Class •`B'• or better
Dwnennnmhtnhhri=idagrnt Date