01030193 (2) CITY OF CUPERTINO
BUIL77IN6bIVtSioN PERMIT CONTRACTOR INTORMATION: ;
BUILDING AiDDRESS: I .. ' PERMIT NO.
907 HLAZINGWOOD_ AV , JUST"WATER HEATERS NC 01030193
Owbf NAh1F.: . " 1 ,; APPLICATION SUB DArL,.
SUTHERLAND GAYI_E J AND J SEPHI 1:764 NATIONAL. AVE 03/30/2001'
PHONE'. . ' - . - SANIS'ARYNO. . CONTROL NO.
- (51.10)293-9901 .
.Zn'
AHCITECT/I;NG1NddH•:
F. •'`., - + IBJ .I�BUILDING PERMIT
INPO-
MCECHBUG ELECT PLUMB
Zeu
LICENSED CONTRACTORS DECI ARATION I
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O
00�'� I h by ff I I I c licensed mil d P f Cl a pl 9( eco g lob Description
whirS 1 7000) fD 'Division 1,red Code and cry anc uo
s ` bull nes. 1eRC n . REPLACE 40 GALLON GAS ,WATER HEATER.
Dat - C ul'a"
ce 3µFr ARCHITECT'S DECUARATION
land, t.ndhryPf :'hall heruedt,puboawenals , 'S
aMo Licensed P :- I
OW NF.IZ mf-55i'¢G I hereby effort nl 1 am loco"fIrothl'he Contractor" irLwfor
g (Section'Coil 5 Bsin ..P [ .Code A ,city Lumy
which
..
requires ap hit[to m. , One, 1 derohda,he refer
:Y'
ehruct
e, pec t , I. requiresth poitrachea pcat fl I Ioun,
Ina he I " the p ni fah Contractor, L (Chapter
, Sq. FC. Flo-
or Area
-
� Valuation
leingwith Sect Section 70M) (if the Business IProfessions eedel
orthat be 1, xtrup,Ib of and hehi r ed exemption Any v Hon , 4999
oScience]E31.5bany lltrnp l odn,cel,
fleaapicvnunacivil preally
Lrnntnrethen Eivehundred dollars(ssoo) APN Number Occupancy TY'
Pe
a rofhe pro enyrr carry lo)ccs with wayes a,heirvole coal nsmon LAM
❑!�do the L and the structure :hot mendenoffered or:le Sec,9044,
-
'
Broilers and PrUessions Code q he Conlmeler s License Law does dot apply to aa' Required Inspections
ownerfn f ty wl Hill: improves thereon towho a h kl'meelf m '•
:r In gl n, pi y '.provided that such nmrovel - tintended or .' 204 — -UNDERFLOOR FRAME -
lfe
fervid f a If,h (het 'Id g or npr,vemenl .sold lti year of '
ILdon,the nwnernndaer will have the buNen of ram,loon he did not build or - —
unp , n�� s - y01 ROUGH PLUMBING
Lnprovowner rpom art erry,o
11 La, fol p ply, exclusively contracting thl'ccledcmmmnrstn ,�03 — ROUGH.,-MECHANICAL •,
�1a n t if,p 1 nl Pori mad a 'ne 1 P 1 :Crile:)r1he Contractor's
Lice I d : t pply t f p p y 1 brink P .d reon. iO4 — ROUGH ELECTRICAL.
9�and n contracts h projects with acenactor( rd personal the 505 -PF3NALqELECTRICAL
•CL` , :Li Low, .
507 FINAL .
q pl der See - B&P C befits reason L FILUMIN --
Ow � Date 1 � 508 — FINAL,MECHANICAL
WORKER'S COMPENSATION BE LARATION5 L4. ' WORKS
. v
I hereby affirm under penalty of,anary one of me following declarations
�• O 1 have nadll annowin a Cern;flcale of Consent h; eelf-une,are for W ger',
Coefpcor,hint, 11 polith,d [ by S I 370E or In. l her Cole for the
pert e,fare eok fn'which hill'emit,,-s,aed. - • „
1111...u and will mninmin Worker's Compensation Insunmce,us required by Seelion n -
37W of the Labor Cade,for the perfor new,of the week for which this permit is
issued.My Warkee's Compensation Insurance currier and Policy carefree arc:
Carrier: Polity No.:
CERI'IPICAIION OF EXEMPTION FROM WORKERS' 'COMPENSATION INSURANCE ,
(feswe(m need art he co nplcl,d adurpnnit le to,ono hundred dollar,
(S 100)
1en'ry may he ned'n,mance nem work for n nm p t':':.lw 1 • - -
shall art cretin,an,Penon in anyarrous,an
«m
as In hee subject to the Workery
Cour,ch,atiof Laws ofCalif nu Dam
AOI' t _
N(y.IGE TOAPT 11 It Krogh C Yf a fh pl' Y 'h tIst lq
bee l ca with
to
the
WWoker C P :'t P t, : f Labor d y null
Q O fonhw'Ih cannily h hprova ons or lh,per nl had he dee andr nvokW.
FCONS eRUL I[ON LENDING AGENCY
a I I) 0' that d e lending' agency for the performance
-W Leal kf hl tl Peru,,,ls issue
eJ(Sc3(19] Cv.CJ _Leader's None
zIced ,Adore.
U
ll
Lr Fye con Il et,egret,
th tllpy with all 1tl fly
i retain,
"dia"e,d state h ' unificationIl.t e
� {J
to baildon,eonstvetol and hereby utter re or,,clancey ofilt,ity to enter upon -
" ly W the I t d'roprayf -Lief nPrp:, ( ..
p,l (W)ag.ill o"e.nalconfify Ikeep h 1.., he Cry rhCuptnaiho against - r
"fr Z liabilities,jual,arent,ciss red expenses watchcarry in any way accrue against said -
U
City nt comeruence at the granting of this pscralit.- '
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issuedb
SOURCE REGULATIONS.' y: Date . .
SignuuncofAppllcnnUCntnmcmr Onto• Re-roofs S '' s
HAZARDOUS MATERIALS DISCLOSURE _
Will the appnuWre
ml ur aMlild'mg nccupana sore or handle hamnloue malednlType of Roof.
- ae deoned by the Capmiae Amnicipnl Code,Chapter 1).12.and the Health and Safety -
_ Code.Section 25532(a)tp ,El yes ❑No
All,roofs shall be inspected.prior to any roofing in being installed.
Will the applicant or future bod Lang 000Pon uee,Iu'p 1 rde,iev,which If a roof is installed without first obtaining an inspection, I agree to remove -
emithazuNouaof, ontutninartsa,dab red by l he Bay Area An Qnahay Manngemem' - -
` niadat7 all new materials for inspection;-Applicant un'der'stands-and will comply with
❑Yc.
11 No I I -
all.non-point source regulations:: •• ' � ,
1 h.rve lead the lot,C . Ion 1 alts and Chapter 695 if the
dthan .�•. • _ "`
ifthe rano'Icing dote SolelyCde See on, no,,,o and 25534 1 d mmnd than `if
occ hto' gd .nmconts whihthest tmafl':oY2up responsibility notify me / },
- '
occupant a ftl requirements which mob Net Pr,rt isnwmc ofd Canlfmam of .
Occupancy. ,.• . _ ,. - -
.., Signature of Applicant '' ' � - � Date .
Owner nr 1.1hor"ed-pgan1 _ - - Date - All,roof coverings to be Class "B"or better
OFFICE C.