01040152 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMITNO, t
22078 HIBISCUS DR BUDGET PLUMBING 01040152
OWNER'S NAME: r APPLICATION SUB DATE
KUNIKO ,_TUDA 28695 ROANOKE `ST 04/`}27/2001,
C PHONE: ' SANITARY.No CONTROL NO.
(510) 30377847.',
M-'ZO ARCllfl'ECTRiNGINEER:'' _ BUILDING PERMIT INFO
- BLUG ELECT- PLUMB MCCH
Z v=miZ LICENSED CONTRACT OJUS DECLARATION 10b'Descrlptlon
O Z—0 1 herchy affirm that I nor licensed order p of Chapter 9(wain crone, .,
—Cw0S i ]nJ01nfU lithe lL d Pefe,dinoCodi.al license
M LicenseCla ode t. « P6F�6 "` a. WATF�R HEATER • REPLACEMENT.
Date C unwou
ARCH['I'I-C'I'S DECLARATION
h 1=' I unJemand m Inns shall be usnl hlic recnnls
�<gJAN 1 6, zUR
pro p
Licensed Pralcssinn;J
OWNBR.I{UILDItR DECLARATION-
' I herchy it that 1 am exempt from the Commcuu's License law for the -��������
>j a following remora,[Section]031.5,Bmincss cold 11 m Ions Cole:Any city or crmnty „
F pro whiff'i rululres u permit to cm,xwct,alter,improve,demullsh,or repair any xwcture
i3m priorio its issuance,also"llim,th applicant fsuch pv a rile a road amement
_—
hat his l ]pirstownl they . . flha C I Ir',Lima:eL (Coiner9 Sq. Ft. Floor Area ,. Valuation
Ic b h Se I ]INNp I D 3 l II H J 1 f onx Cade) _ $600
or that he is ex anpr therefrom and the basis for the alleged exemption,Any v olation _
of Section 7031.5 by any applicant for a permit subjects the applicant m a chit penally
' efmmaton,than fimhundred J.dlam(551x1). , ., AP.NNumber Occupancy Type ;
❑I a ne fttieP pony y pl ytt: @ g. .th r Tec mpn'Inn, - 326021-1.00
Will l;the rA and the structure t included or offcmd for sale(Sec.7044,,
.
Bushels till r fie t'Gal.. rile Contractor x L ce we Law dews not apply I to 'Required Inspections'i.
Owner of property Who build;Orcallouses thereon,and who does such work chimera 502 — FINAL- PLUMBING ENERGY .
or through his own employees.provided that such improvements arc not intended or ,
ofned for sale.If,howevar,the building nr in mostal i"nld within line yca,of 506 — 'GAS`. TEST' .
compledan,the owner builder will sure One burden oI'proving chat he did not build or 4
improveforpurposenfxale,l. 507 — FINAL .PLUMBING
❑1,as owner ul'tha prnpnny ant rs,l ivaly clan mi irg whL limusN comrnemrs to
construct the Profen(Sm.7N4.Business and Professions Cldei The Contractor's - ..
License Law does not apply to an owner of prepeny who builds or improves thereon,
iced who coot encs for such pmj¢ete;wlth.0 clatua ls)Iiconmd pursuant to theConnector's License Law. , - -
❑I um exempt under Sec. 11&P C for this season
Owner Dote .
WORKER'S COMPENSATION DECLARATION
,. I he b,adfir ide,p a1,y f pe i Yaccof the f II g l P mdo v .
1 have ad 11 man m
C ire m of C rent I msu L( for
Worker's
C nip n' i n p J d f by Section 1]1X1 f ch ]labor Com.. n the
pxf armof lite work,bar wltelt thistlerot isus.ed
❑I have and will maintain Worker's Cnngscrodion Insurance,in,required by Section - ` -
4 3700 of Thu I.;c Cndq fill the gwrfunmmce of the work lin which this P,unci_l in
Smcal.MyW..ka,,Ganpmomlion losurimce earlier and Policy numlzr are:
Carrico Policy No.: -
CCRTIPICAIION 017 B%EMP'I'ION FROM WORKERS'
COMPENSATION INSURANCE
c (Phis colon recd it he it dcicd it the parotin is Gil one hm,drelf dollars
1$100),cr less.) ,
1 miffy that in the performance of the work file which this permit is Ostend.I -
shall nut employ rnr Ivist n in any manner an as iso become subject m the Workers' '
Compensation Laws of California.Date
I Applicant .
NOTICEToAPPI.1CAN'1111:nits mnAin,this Ccri franc of)is cngnion.you shnulJ
be xuhjectm the Woricev Cmnpurt colon provisions of tire Labor Conm
Code,You Q 0ecomforthwith comply with such prevision,or lois prourn shall be deemed revoked.
CONSTRUCTION LANDING AGENCY 1. ° w
I herchy a1Rrm Thal Item is a mnsmctinn lending og n,for the Iocifonnance
of the work for which Chia permit ix issued ISec.30)7.Civ.C.)
,d (� Lender's Name
.Q z Lendcr:v Address - ^
L.7Q I minify am I have readths application and stmththe M form Inn is _
.oml.Ime t, orr,ply fill all cry: I tydo
nun d II Iws million,
Q 61 •to building cottonwood.and hereby noorim representatives 1 this ty to enter upon
yy W the aNicementioned pros for inspection purpose'.
L p. (We)r,mc lo.,or, m1con.ill lind imp h I:sthe City I CHiscoloonIncult
"Errs V)
firlifille,und,rawrim cew,add copcow,I hich may in any way' c gains said
City consequence ill the granting of Itis peon. -
APPLICANTLATI TA. AND
WILLCOMPLY WITH ALI.NON-POINT U 5
' souRCE REcuLnnons. t'. ' Issued,ray. � - Dale .
Signawre cf ApphcnnJComtain Date Re-roofs s,
HAZARDOUSMATERIALS DISCLOSURE
Will the applicant in more huudiag,xvapam None or handle ha,ardoun material _Type of Roof
as deRned by the Cupmims Municipal Cade.Chapter 9.12,and the Health and Safety. ,
Code,Section 25532mu'
. ❑Ye' 0 No � - All roofs shall be inspected prior to any roofingmaterial being installed.
Will,lbeapplicant or future brilding necupare use equipment or devices which If a roof is.installed without first obtaining ail inspection, I agree to remove
earn It I c m. : f Thy the Bit,A am Qlly Mnaetnc
Di ro -
all new materials for inspection: Applicant understands and will comply with
�• 0ye ON - all non-point source regulations. '
1 have
mad Ih ha,uMnm mater til mccom routs under Chapter 695 of the
California Health&Safety Cale.Sections 25505.25533 dad 255]1.1 undmai n l that
if the hadding Liles not currently have a tenant.that it o my responaihifiny tonmiry the
oma, of there .....it,wh'mh must he met prior to ixsuunco'if!.Cerdhuum ofOccu -
paney Signature of Applicant Date
Owner orauthorized al Date All roof coverings.to be Class "B"or better'
r OFFICE.- t -