05120018 (2) CITY OF CUPERTINO ;c+vark�.� �✓ ''`* °tea '� '"' ` "'
BUILDING DIVISION PERMIT -7 Al
BUILDING ADDRESS: FALCONE PLUMBING & HEATIN( 05120018
1184 CR
OWNERS NAME: PERMIT ISSUE DATE
VENU BANDA 650 LI
)NE: SANITARY NO. CONTROL NO.
0 (408) 293-5676
BUILDING O PERMIT INFO
CHITECTIENGINEER:
�B ELECT PLUMB MECH
C l� D
LICENSED CONTRACTORS DECLARATION Job Description
II hereby dorm that I am limeud under prevision of Chapter 9(commencing
ate with Section 7000)ofDirlelon 3 ofthe Busims,ad Profession Code.anal my limaw is
'iT.t.am.�e? G? Ic.g OJT7 GAS LINE TO STOVE (301 ) b�C
DemCamrmmr A
ARCHITECTS DECLA ATI N
I undemanJ my plow still bo used u public tcoortu ® 70
b
Licensed Professional
OWNER-BUILDER BUILDER m ft caAT10N
9 1 bonny,(Rare than 1 1. exempt from Um Canon Co LiAny C taw For the
0 0 which re mama.(Scotian 713 I.S.Burin and Profession Cade:Any city m county
5 S r welch rtgaima a Permit re contlmc4 also.Improve,h permit t il repair ed ummunt %e%850
ZSr tpdar hat he iuissuance.
arms!pdw requires provision antfm auchpemit miam Law Catemem
< NetheiscingwitpStmantmthepaNeionofthe eBUld"143 Lkanehlaw(Chaeta9 Sq.Ft. Floor Area Va U
$ Endkp
(cohe In dngwithhenfan700dth DlvisloFr th alleged
ceempa4nd Pro My lCode)ar
— that be V esempt timtefrem uM the dela for the Welted evmptine.My violWne of
Section
e mart than Ew a"hunapplicant
far a permit
i It subjects the applicant m a civil penalty of p Occupancy Type
❑I,uowrcrofdmpmpmy.amywploym vith.g utimtrmle=penudne,
will do thawark and Naanucterm Is actin riled offered forced.(Sec.7044.Business Required Inspections
and Pafemiam Cade:The Cnetrsemrnm s LkeLaw does hot apply m an owner of q P
properly who builds or unpoves Enamor.and who docs such work himselfoethough his
own emplayses,provided that such improvements an:not Intended anoBtMd fm tele.It.
however,the building or Improvement Is mid within am year of Compiegne.the owner-
builder will parse alm kadmt of proving that he did ret build or impo m for purpose of
ale.).
❑1,as own of Bre property,Me exclusively enacting with Bmmmd mnuemare m
construct the pmjm(Sea 7044.Business;and Pofeadoro Cade:)The Com m er's Li-
an=Law dam sot apply an an own of proper"is,builds or imprews dwarm.and,
who contracts for such prejecu wish a contswunns)licensed"Must m the ComMatora
License Law.
❑lamexemplunderSee .BAPCIoethis.
Own Date
WORKERS COMPENSATION DECLARATION
1 hereby Wlo under penury of perjury am of the following dcolemtiaw:
1 its. eat ..loin aemi0ene or Cance,m self-min m fnwarkNaCmnpen-
codon,u provided tin by Section 3700 of the labor Cade,for the performance of the
work for which this permit b issued.
m and will maintain Workers Compensation Insurance•as required by Sectio -
7]n0of the Labor Code,far the performr eof the wink for which this permit Is lured.
My Wottda CompewWan Iwuunce writs aM Poliry qumber are:
Carrier�9'U7�2 D Poliry No.:
CERTIFICATE OP EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
rrhts section wed ill bocompleted If the permit Is fon one hundred dollars($I00)
or less.)
I censfy that in the perfomanrce of the work rte which this permit is issued.l call neat
employ any person in my summer an as to bcmmc subject to the Worker'Co niamssio
Law n of Caifarou.Data
NOTICE)
NOTICE TO APPLICANT:If.after reeking this Ce ions o th Faempeon,you inmost
become subject y the Woas pre Cons Compensation permit
awl
of the manor Cade,. nuts
,J O fanbvnth mmp1Y with such providaw m this permiahail M demand!mated.
CONSTRUCTION LENDING AGENCY
F 1 hereby sine this there is a mwmetine lending agency,for the perfamun of
Ix > the wink for which this pent!,I.caused(Sm.3097.CW.C.)
�W 0 Lendoes Noma
2 Landers AdNm
U O I ceNfy that I haw read this application and sum than the above Information is
!' correct I agree be comply with all city and county muluwm and sum laws retaing m
O building contraction.and hereby mthorim representatives of this city to encs upon the
{rl above-mendamd properly for Inspection purposes. '
LL ( eta cove I e dfy and keep humin de City of Cupertino against
W) Infle i Wj ts.e ipewa which may manywysmucaNwisaid Chy
U,Z in ca �wea meg pf this peml4
^' APP CANT U E 1S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU CE R A N L {GL
Re-roofs
Si mum of ApplicandConum or Data
/ HAZIROOUSMATERIALS DISCLOSURE Type of Roof
'VIII the applicant or future building ampanluare or Mndc huudM,•roamrld
u,dWmd by the Cupertino Municipal Code-Chapter 9.13,and the Health and Safety
°sae•Seen 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yin
WIN the applicant or future building a cupant ase equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit huvdom eir comaminu as de0oed by the Bay Arta Air Quality Management all new materials for inspection.
D wktT
❑Ya
mW she hva r materials mqulmmenu under Cmpmr 695 Of the Califor.
da oWtk dctyC tau 8505,7S533and3U76.l unhntand shtlifge Wilding
dLat''es retc ve an4 that It a my wihan,to madly aw occupant or the
squire m be mel nawcofaOrlifmam�( Signature of Applicant Date
ver oraathaNs a ent Data All roof coverings to be Class"B"or better
-� CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
i CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
Owner's Name: Phone: /d
Contractor: Phone: License #:
�i��ClJ�L� >>�✓•v, s. .� &47-c2 y�- 7lo
Contact: t Phon Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
Residential Commercial ❑
Cost of Project:
•
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 Re i e of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING