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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