00070102 (2) CITY OF.CUPERTINO -
BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMITNO.
OWNER'S NAME' APPLICAFION SUB DAT17
10310 BONNY DR JUST 'WATER HEATERS I C.. 00070102
10N✓: - SANITARY NO. CONTROL NO.
LAWVER DARELL J AND DIANE J 1764. NATIONAL• AVE . 07/18/2000
w O O ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
<.V (51 0) 293-9901 BLDG ELI ECD. PLUMB MECH
<N
Z S m Z LICENSED CONTRACTOR'S DECLARATION Job Description CC y 1tion 70 aBham thin 1 wn beetiodeeJ under ,provisions of n,CaleJ fa,mmcndng
_t-m with 5edio. ad of Disisiun3nflM1C BuxinessunJ Profexsiom Ctxle,andmyG<enw
�Cal< Lite full forec and eff 1.
�6 LicenwCsx �����- Liv.M
O i O Date"r. V C wn.eacmr LL - 1
a y ARCInrrc sDEc tan ID – REPLACE 50 GAL. WATERHEATER
I d .t Imy PI hall be usedaPblc curs,
z�64Is
yap Lic dP f.. nal
OWNER BUILDER DECLARATION -
w a e hereby ow (fim on 1 exempt f theC tmcmr'a License Law co the '
F Z loll -nB crown.(Section co S t.alt e J Ptt(:: ns Cole Any¢ty nr county
Y C p
which re9vires o permit it)e,also re eomwn,applicant
improve,for such
h knell t,m repair tiny settlement
cture
a —
hat
slts cense pursuant to
theres the
ovisioso for CommnninLwie a ax,Law(ch.""9
aim thin he is licensed with Section
70fw)ofD provisions of e m arms,anrnxe Law lcnamery Sq. Ft. Floor Area - luation
(commeneis exempt
Saerefro and the bass n or t the Business mptionfAny vi Csde)
or that io is exempt tecrefmm and the basis for the as the exemption Any t violation
of Section 7031.5 by any hundred
doll for 1 pcm,it wbjcN,the arplicvm m a civil penalty
of oath more man fi.e nanarea annars lash). APN Number Occupan$cy.Type
❑1,d owner of and
the ,ofmyemployees isotitwilewages a.theirsolemmpmntion,
82
will do the work,end tnc ase:Th is not intended Li or Inhered Law for sale(Sc. to 4.w
owner of am erty Who b ctde:The Contractor,.was w Law dao ntd apply to an Required lnspec[ions '
tofrmisowembuihkntimidedtthereon,mprwend«nwnwinknimdf 35914046. 00
or through his own employee,,emulsin thin such improvements is sol are not tare aw or
orrereJ far sale.IL however,the building in improvement of, nl is what within one year of
improve for the oanervbide.).will have the hunlcn of proving Ih:n he did not build or
improve cut pntpn,e of nine.). 204 — UNDERFLOOR FRAME -.
' ❑I,as"her of(be prope weexclusively cnntructingwith Icensedcouniourim 301 — ROUGH PLUMBING
a,mmrn the project(Sec.764,Business and Professions Code:)The Contmemr's
License Law does not apply to an owner of propery who bui Ids or imposes(action, 303 — ROUGH MECHANICAL
and who contracts for such projects with a contrai licensed pursuant to the
Commdnrs License Law. 304 — ROUGH ELECTRICAL
❑I am exempt under Sec. .R&1'C for this reason 505 — FINAL ELECTRICAL `-
DWeC
WORKER'S coHrr snTloNDrcLnRAn<iN 507 — FINAL 'PLUMBING
IFormyaffirm tinder Penalty ofpmj one nthe rnun ingdeemtati„ns: 508 FINAL MECHANICAL
J I have and will intimal, a Cenmeale of Control to sdrimine For Worker's 514 — FINAL PUBLIC WORKS .
Oompemndon, as provided for by Section 3700 of the labor Gale, for the . .
pcaor n oto of the work for which this forcer is Is surd.
AGI have ansl will maintain Worker's Cnmpemation Imamate,as required by Scenre -
3700 of the Labor Cade,for the performance of the work for which this permit ix
vii My Workor's CCton,cco,wiun Imumnce.,lett and
dPPoll'lcywmhcr um:
Currier:.� p[�pp Policy No.: _Q3154.1Q'�
CERTIPICATrON_OPF.XEMI`TION FROM WORKERS'
COMPENSATION INSURANCE
(This section aced 1101 he a nade,ol it the pumtit is for one hundred(1ullarx
SIM)at
I certify thin ri tile petforanuarC it'tl k har atich los poinil's'nx1rJ I
aM1all nor oa,la,all,M1at aloolulawar1 a,to h e,thly,yt�l ��� I .
Cn p sal nyY,'s ll Col t U t �� l - .
N(ylICy��,Ry/�ryAPPLICANT: ri srstroaakin,11n,CiMToo set........y.. eho Ill
stein iTnlat m the Workers C l n.-t 11-11411110 the Lubin oda You t cut
Q fonnvim u,all,with car rots rdso shut nedeel cd revoked.
F CONS'BUC'1'ION LENDING AGENCY
ai I hereby affimt tem acre Ix u eonantetion lending agency Iia the perfunnmme ,
of the work It,,which this pemuh is Issued(Sec.3097,Civ.C.) _
Ctt Q Lender's Name
7 z lender's Address
1.70 I<nfY then I haveIlhis ll,li,aliw unittl that the it allays
res Ea carte t l Brow to comply e II city n n c J and state I t 1g
Q V cub Id b consolation. 111em by M1 repmpre emt a TIF-ityt m rym
lee wame-alwhisnaidp pony 1 �rocp p
_
.}moi W (W)'g t nJemn pe nil kap h :. the City f c Capri g nw .
IA liable consequence
Landing of
may in any y accrue against.can _
C,7 z City in consequence al the graining of thtn Permit.
tr APP 'ANTUNDERSTA , ND WILL MPIYWITHALLNON.POI issued Date
5 EREGULATI INS. �"yT Y'
ugnatum of Appliiduat-omrachor If Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant share or handle lemmas material Type of Roof
as defined by the Cupenin t Municipal Cale,Chapter 9.12,and the Hrollh and Safety
Cale.Section 25532(3)7 -
DYm ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or furore Milling mcupam uu aryiptnem or Jcviccs which If a roof is installed without first obtaining an inspection, I agree to remove
mit haeaX.,air contaminant,as defined by the[IV Area Air Quality Management
rnmee all new materials for inspection: Applicant.understands and will comply with.
oYes. 11 No all non-point source regulatiolfs,
1 have read the hrardous materials requiwdnents tinder Chapter 6.95 of the -
California Health&Safety Cole,Sections 25505,23533 and 25534 1 understand that
Fife building does not currently have a hall that it is my responsibility e,notify the
occupaty of the na lirememx which must be met prior to I,xoanee of nifiewe of
Lety. Signature of Applicant Date
act a,namna.ed agent - - - D. All roof coverings to be Class "B”or better