01040113 (2) CITY OF CUPERTINO "
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: - PERMIT NO.
2238E CUPERTINO RD REDWOOD PLUMBING 0 INC 0104"0113
OWNER'S NAME: - APPLICATION SUB DATE
STOECKENIUS JAN H ET Al- 1590 TACOMA WAY 04/23,/2001
IONIi: SANITARY NO. .CON'IROLNO.
W n00 ARCHITECI'IIiNGINEERi, HWL[)1NG PERMIT INFO
,
EkC w 'a BLDG IiLECI PLIJMH MECH
LICENSED CONTRACTOR'S DGCI.ARATION
�� � n by la Inthtl fntsed I I s.rchnd"11a.aam"un, - Job Description
F M C w tl S f 70001 f D' 3 f the Li I I [•setons Code,and ny lic rr,c
a'yy is in full force and eH cn '
%o ff Posen= Cl .. G Lie." + REPLACE 2 60, 000 BTU FURNACE ADD 2 3
toARCH II EC'S DECLAR TION .. - '
�yy , understand Iny Plans shall be used as public records
'SPO Licen.ttd 11'elexain Of - , - •• _ •^
°Ca OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License law for the
(=Z<
following nu. n (Section 7031.5.Business and1 f: n Calc Any city recommit '
f F I]
which requires a Permit In construct,aIt pr ve demolish,or repairy struchare r
i3 m prior to itsissuance,aI. y [he applicantf r such permitt flsignedsmonart
man he c: IP It hetp n Ithe Contractor,L Law(Chapter9 S Ft. FloorArea
(..oncein,will,suuo,Its In or Dive, Sofllc Brone dEnd es:me Cade) 4- Valuation
or mat he is exempt therelmm and the basis for the ul l.ged esmPan ,Any viola,lint
of Section 7031.5 by any applicant I,),a Pamir wbjens the rpplicam vt a civil penalty
of..,a,..than five hundred dollars($500). APN NumberOccupancy yp'e
_ ❑I.as nwnerof the property,Dir my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered-for sale(Sec.7044, -
Business and Professions Calc:rat.C.ntmctnr's Licen,e Law does not apply tp:it, Required Inspections,
owner of pngteny Who build.or Itnpr.ves thereon,and who toes such work himself _
.r through his swncmploye.s.providedthin such Til anoints am not itnendedor 301 — ROUGH PLUMBING
offered for sale,IL however,the building or impmvename is.sold within one year of
completion,the awaer-bradnwdlhavetheburdenofPmdngthathedidn'tbuOJor 303 — ROUGH MECHANICAL
improve for P.",c"(sale). - -
oLaa it,ire,uI Om property.an esclusi„eiy.....earring with licenoed.mnnn.r.n 304 — ROUGH ELECTRICAL
construct the project(See,7044.Business:,at Poll..tar,C,am:ante Ct ourrin505 — FINAL ELECT R I CRI_
.License Law does not apply fo an owner of pr)peny who builds or improves thereon,
and wit.enI m�s tar such pnjens with a rnmeann(al li.dsed pu....a,tome 507 — FINAL PLUMBING
Cram a.rs License Law.
❑I tptu .B&PClesions reason 508 FINAL MECHANICAL
5 er Dam '!_. -Ot • _ .
stat
WORKER'S LY)MI'ENSA'1'ION DI!CI,ARATION '
VVV '
I hereby affirm under penalty of perjury(me of the following declarations: - FI N A LE D 1
.] 1 have and will maintain a Certificate of Consent to self-imam for Worker',
Compensation, m provided r.r by Section 3700 of the Lams Cede, for the
permearra of the weak for which this permit i,ivawd. MAY 2 9 2001 _
0 have and will nmintaln Win da 1 Compensation boumnce,as,c,ai,rd by Serd..I - -
17W of me Labor Code,hn Ibe perforianee of the work for which this permit is "
arced.Mttrkea;.mpenntd.n,n,atan.ecarrier and Policy 4�M/r -OG BUILDING .
'ere Policy No.: 0� ,
CERTIFIC TION UPEXEMPTION FROM WORKERS'-
COMPENSATION INSURANCE
fl'h Is se.lidn need nm he competed if the pcnnit is for one hundred dollars -
I cenify that in Ne prfmmence of the work for which this permit is issued,I
shall not tampdey any Person in any manner so as m become subject at the Worker'
Compenenti.n Laws of Callfnmin.Date ,
Applicant n -
NOTICa'ID APPLICANT.IL all nurkie,talo CcniOunc of Hxemptlun,you should
become suhjem m the Work.i a Cotnpcnsmion pnrviniom of the LnMn Gde,you must
Z O Ginhwith rontply with such pruvivinns or ilii,Iennit shall be JecnsJ revoked. -
L•^ Zi CONSTRUCTION LENDING AGENCY - -
a 7 1 hereby affirm thin them is aeomtmdion lending agency for the ped"onnance '
-(If the work Ibe which this permit is is,dcd(Sec.3097,Civ.C.)
alQ Lender's Nnrue t
'Lenderts Adthesa - -
0 I certify that 1 have read this application end este that the gswe information is "
wren.I agree to comply with all city and county ordinances and nate laws relating
0 C.1 m building construction.and hereby authorize representatives ofthin city to enter upon s
the above-mentioned property for inspection Puary,.se,,
d (00)r,me mal abyandkeep hiI::the cty l Co,mino against
Vi liehilt "aftneens,c fuIt1 p acs wlirt, ,try't any a,: roc age Isaid ' -
r..) �ytY y cc nl h gmailing this Innuil -
APLICANI F .T DS AND WILL COMPLY WITH ALL N -POINT -
SO RCB RFI :' I '112 3 J� Issued by:�0E QflJ7JA.�L1CCi Dale
re.rnpplicant)contnnor [)area Re-roofs. .
HAZARDOUS MATERIALS DISCLOSURE
Will ma upplitantd,nnum huudingecnlean,loot or handle hannhs..mmenal Type'bf Roof
as defined by the Cupertino Municipal Cede,Chapter 9.12.and the 1lenlllt and Safety s s
Code.Semon 25532m)7 -
°Y`" All roofs shall be inspected prior to any roofing material'being installed.
Wi 11 the applicant or drumhum lding occupant use equipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
emit huzardous air contaminants as de0ned by the Hay Area Air Quality Mawm
gecnt g P g
DisncB all new materials for inspection. Applicant understands and will cam I with
°Yee ts 1,non-poinurce regulations. pp' P Y
I have read the hazardous materials requirements under Chapter 6,95 of the
Califon is health&Safety Cuda Sedtions 25505,25533 and 25514.1 undeatand that
i(the building does neacmrcn0y hate.tenant,that it is myresponsil ility to notify the
11 upant of them ,e s which nnisr M mer prior m Issuance of a Ci nificate of aF V
O, parry. - -
nature of Applicant., Date
.r anthmized agent Dater All roof coveringsato be Class"B" or better
OFFICE
a.