03110156 (2) CITY OF CUPERTINOs
eml.otrvc nrvls)ory PERMIT CONTRACTOR INRORMATIONNNN- .:i
BUILDING ADDRESS: CUPERTINO PLUMBING PERMITNOO 3 110 15 6
10 43 E ESTATES DR
OWNER'S NAME: PERMIT ISSUE DATE
IMOTHY AND SHIRLEY HOEY 10297 S DE 11/26/2003
NE: SANITARY NO. CONTROL NO,
(408) 253-0618
ARCHITEC ffNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
loo LICENSED CONTRACTOR'S DECLARATION O O O
C to[= 1 hereby affirm that 1 am Bccved under provisions of Chapter 9(commencing Job Description
i P2n with Section 7")nfOmision 3 of the Busincsx and Professions Code.and my license is
in fell mm and erren. REPIPE & WATER SERVICE
iq= License CI G`?iw tie. - / /G;S
s
p Dare If'� r'�' Conl onto ®�v® ®
'fnJs 'J RCHITE SDECL ON FINALE0
f m< I undcrxta y ens )I' usetias� I c mcnN, o to
at,
ass LiccnW is e I DEC 1 6 2003
g (� OWNER-BGILD[R LA ATP.
2 a E 1 here .alfirm shot I oto exempt fru a Dior.( (cense Law for do
❑o following mason.(Section)(IJ LS,easiness antl cmv —Cmle:Any city or county -
e m which mqutres a permit to convect,alter,improve,demolish,or repair any nruchm 0 0 0
u�i prior to its issuance,also requires the applicant for such permit to file a signed statement
iE: tt
that he is licensed pursuanothe previsions ofthe Contractor's License Law(Chapter Y Sq. Ft. Floor Area
e (commencing with Section]IXl(l)of Division 3 of me Business and Professions Code)or
Q Nat IC is exempt therefrom and the basis for the alleged exemption.Any violation of r�p n'nc�o
Section]031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 r9spLn lYOffi8er 0 0
not mere dam five hundred dollars(SSOLL Occupancy Type
1,as owner of the pmpcny,or my employees with wages M thea mle compensation,
will do the work,and de swctum is not intended or offered for sale She.7010,Business
and Pmf=iom Coda:The ComeacmrY License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
Own employees,provided that such improvements are not intended oroRered for sale.If.
however,Be building or improvement is sold within one yeti of completion,Ne owner
builder will have the burden of ponying that he did not build or improve for purpose of
sale.).
1,as owner of the progeny,am exclusively convening with licensed contractors to
comwn the project(Sec.7000,Business and Profession Code)The Contractor's U.
cc=Law does not apply to an owner of property who Wilds or improves demon,and
who contracts for such projects with o contracmr(s)licensed pursuant to the Contractor's
License law.
❑ l un exempt under See, ,B&PC Or musical
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the following declars:
ation
1 have and will maintain a Certificate of Consent to sell-insure for Worker's Cumpcn-
solion,as provided for by Section 37M of Be Labor Code,foe theta
penfomnce of the
work for which this permit is issued.
,have and will maintain Wmk
cr'a Compensation Insurance,u required by Section
7M or me Labor Cade,for de performance of the work for which his permit is issued.
My Workkrtss Compensation lnsun carzier and Policy number art
Came,.�l LIT( ytj Policy No.: �%Cra7�j:P�f
CERTIFICATEOFEXEMPTIONFROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not be compleed Rise permit is foram handled dollars t61IX8
or Mss.)
1 cemfy that in he performance of the work for which this permit u tasucd,l shall nut
employ any person in any manner an as to become subject to the Workers Compensation
Laws of Cut forma.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenificatc of Exemption,you should
WcOmc subject to the Worker's Com Notation provisions of the lobo Code,you must
z forthwith comply with such provisions or this Permit shall be deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
1 hereby alfrm that hem is a condonation lending agency for she perfommom,of
IL > he work for which his permit is issued(Scc.3097,Civ.C.)
D.1 Lender's Name
Z Lender's Addmas
U 0 1 ttrufy that 1 Kaye read thirty andmion and stare hit the above ows rmniun is
D. U cormn.I.glee to comply withall cilyand cyyufiyo omlitAsand tudsumlawsrelatingm
Q .1ho building construction.endf,eri authors npose, tosses u(mis city men¢,upon the
r � above-mentioned Pm lY for ipfpecuo a iia
E„s y (We) rte save,inpemmry d keep armless he City of Cupertino against
N Iiabiiidies.' tlgm s,costs 6th.1, 1 swhic ma in any way accme against said City
U incon n fibs ra ing pfd '
^ APPLI A U R A 05 W C WITH ALL NON-POINT Issued by: Date
SOUR yLTI N ^ '
naz re of Ano man oto,, m Data Re-roofs
HAZARD S AL DISCLOSURE Type of Roof
"Oosmapplicarimmuru uding Occupant store or handle hacaudous rommial
as nod by the Cupe mo Municipal,Code,Chapter 9.12,and the Health and Safety
We,Sceumm 25532(.).
Fl Y. ' All roofs shall be inspected prior to any roofing material being installed.
Will the applicam or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspectiorl agree to remove
It han does air conumimmu as defined by me Bay Arca Air Quality Managcmcm all new materials for inspection.
loom?
❑Yes apt No t{
Iff sac rtaJ+l,c ha msm r' Is ayuircmens under Chapter h.95ofineCalifor-
iiaHcalm Sof C .Sectio 5.2553asIM330.iundcomadiffe (Wilding
dors not 'ha a enan m
V. Y nesponi Misty m ani fy tic prom.. t of the
'e mm n fin tbe a ser ce ratcefgpapane-CC Signature ofApplican[ Date
,author,cd gem �� Dare All roof coverings to be Cla ,s "B"or better
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE (S
CUPEkTINO PERMIT APPLICATION FORM
APN # �,( Date: � I ,•� '�\ J
Building Address: lJ
Owner's Name: Phone #:
T --y- Shi r-1 etjZ--7z-
Contractor: d�LGC�
Phone: _ License #: _
Cv �►'� v �� 'Zhu, C�c i C�Z�I�CS
Contact: hone: Cupertino Business License#:
a-
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
Residentially Commercial ❑
Cost of Project:
•
Qty 'f
A is le Fee ID Fee Description Fee Group
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
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