02120017 (2) CITY OF CUPER'rINO --- '
Isun,mrvc urvlsu3ry PERMIT CNTRAGTOR INFORy,WMATION
Bull OVA RD AQUATEK PLUMBING INC PrRMrr1,102120017
owWE$ 9T,fr:DENNIS L AND BARBARA J 1716 STONE AVE #E APPLICAT1131QSlR/ T U4Try 2 O O2
AiI
ZONE: 40th 295-7767 SANITARY NO. CONTROL NO.
ARCIII'IECfIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
woo
LICENSED CONTRACTOR'S DECLARATION
<�GI hereby affirm Ihat l am licensed under pm.isioms or Chapter 9(commencing RE P I PE Job Description
pt with S,clior7kAdoIDivi,in93o NC Busincs�aryl Profcainns Gulc.unJ mYliccnsc is
20�o, in toll torcs�nndplf sC1.•31V— x/Jc/ (e'a 5-19
? Liccnu Cl �J��rt Lic. '
OZ—W Dlc Conlfacl
ARCIIITECTS DECL ON
�a K< I understand my plans shall W used av pulls rc'I,ado
X01V
m 3 a Licensed Professional
ot OWNER-BUILDER DECLARATION ��••
za y 1 hereby affirm that I am exempt from the Contractor's Licence Law for the 6000
ti 6 p O following reason.(Section 7031.5,Business and Professions Code:Any exy or county y
$ which requires a permit to consuucl,alter,improve,demolish.or repair any structure
FI< prior to itsissuance.also reyures the applicant for such permit to ole a signed statement
that he is licensed pursuant o the provisions of the Contractor's Licence Law(Chapter 9 3SkI2B17f l56il A&0 Valuation
(commovrmg with S9clioe74My))of Division 3 of the Boowmand Professions Code)or
y that he is exempt therefrom and One basis for to alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant 10 a civil penally of PNN Occupancy Type
not more than five hundred dollars($500d. 301 — ROUGH PLUMBI G
0 1,t Owner of The property,or my employees with wages as their sole compensation,
will do the work,and Ne structure is not intended or offered for sale(Sec.70,t4,Business pyk1� ;18 ENER(3y
and Professions Code:The Conducmis Liccnu law does not apply to an owner Of 507 - FINAL v{vf �QeelI00S
progeny who builds or improves thereon,and who does such work himself or through his
own employers,provided Nal such improvements ate not intended or oncrcd for sale.If.
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not build or improve for purpose of
salt,),
0 1,as Owner of the property,am exclusively contracting with licensed contractors to �� a� ��
construct the project(Sec.7W4,Business and professions Code:)The Comunclois Li- �+/L11\1
celiac law does not apply to an owner Of property who Wilds Or improves Hereon,and.
who contracts for such projects with a conlrassor(s)licensed pursuant One Compactor's DEC0Licenseamlaw. 2-A 2002
❑ lam exempt under Sec. ,B&P C for thisrcssnn
117N)
wner Date {�1
WORKER'S COMPENSATION DECLARATION BUILDING
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insor for Worker'sCompen-
...a provided for by Section 37W of the labor Code.for Ilse performance of the
rk for which His permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
o1'HC Labor Code,for He performance of the work for which this Permiittiis issued.
y Werke nmpc sat n into lice came P nJ Polocy nup�er�tZ 1 ` —�
Wr. CERTIFICATE Or EKE IOKFROM WORKERS'
COMPENSAT INSURANCE
(This ection need nut he completed if the permit is home noodled dollars($lord
lir Icss.)
1 certify that in the performance of the work for which this permit is issued,i shall mol
employ any person in any manner so as m become Subject n the Workers'Compensation
Laws of California,Date
Applicant
NOTICE TO APPLICANT:II:after making this Ceniliaate of Exempion,you should
become subject in the Worker's Compensation provisions mf the Labor Codc,you must
OO forthwith comply with such provisions lir this permit shall the deemed revoked.
z N CONSTRUCTION LENDING AGENCY
F I hereby affirm that Here is a construction lending agency for the pertormance of
ai the work lin which this permit is issued(Sec.3097,Civ.C.)
ul 0Leliters Name
C. Lemdc'sAddress
0 Z
V 0 I certify that I have read His application and nate that the above information is
Hcones.l agree to comply with all city and county Ordinances and time laws relating I.
D V buildings coon.and hereby amhorlve representatives of this city m enter ppm the
F
0 fail ention mpeny for se
inspection purposes.
P, (We c a save,indemnify and keep harmless the City of Cupertino against
h Nabi ,lu me 's n eateries which may manyway anmc against sail City `�V
U z in co c of g (ting ul.fth,thi permit.
SAPPIL OUR A O NO A D W MPLY WITH ALL NON-POINT Issued by: Date
3.02
Ap Iran wool's Date10 Re-roofs
IIA RDOUSMATERIALSDISCLOSURE Type of Roof
ppficant r future Wildingrxcapantsmreorhandla hmudontmmcaal
as denied by the Cupertino Municipal code,Chapter 9.12,and He ucallh and Silly
Cuda,Section 25532(n)7
❑Yes '�J1
No All roofs shall be inspected prior to any roofing material being installed.
Will thea scant or future building occu and use e If a roof is installed without first obtaining an inspection, I agree to remove
pct s p equipment m devices wmm� g P
Dwrit hasarduus air comamirumu as defined by the Be,Arca Air Quality Managemcm all new materials for inspection.
i..da7 W / P
e No
He Irlowdou Is myuimmcnts under Chapter 6.95 of the Cali fon
mall Code,S tins 5 .25533and25534,1 undcmmnd Hmlfdm hold,.,
doeen y have a tem ed is my resp 'lily tat notify rbc Occupant of the
sequin It cni0camof cup .3 c Signature of Applicant Date
Ow won Iced agent D„e All roof coverings to be Class "B” or better