04110104 (2) CITY OF CUPERTINO - xAe
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION h
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BUILDINGADDRESS: ABLE SEPTIC PERMIT N`b4110104
10221 HILLCREST RD
OWNER'S NAME: PERMIT ISSUE DATE
JOE DONOVAN . 520 REED ST.
ONE: SANITARY NO. CONTROL NO.
(408) 377-9990
ARCHITECrIENGINEER: BUILDING PERMIT INFO
LDG _ELECT._PLUMB.r_MECH__
+x+00 LICENSED CONTRACTOR'S DECLARATION Job Description
-
in1 hereby affirm that 1 am licensed under proviu _ona of Chaplet 9(commencing P - '-'-'---------
with ti M)of Division 3ofthe Businarand Prufmimu Code.andmylicenscis
inr and errea 7 INSTALL CIO
z^K Da¢ 17- 7`1 - A7 Li, #mor r ! -
ARCHITECTS DECLIMATI N
3 w< 1 u�ReSund my plans shall be used as public Revxdss C
UElected professional`off OWNER-BUILDER DEthe C.O IDN - -
�olo I hereby affirm that 11. exempt from IPr Canons Cas License law for 1M
0 o following mason.(Section lam L5,Business and improve,
deruns Calc:Any city or county
y$� which reyuima a permit to cnruwcL alma improve,dcmnlisM1.m repair any swnure
,;Ur prior to its issuance,also mquims the applicant for such penniuo file a signed statement --, _ _- __, _--
that heislicensed punmanuothe provisions ofNCCmuracmriLicense law(Chapmr9 Sq.-Ft.-FloorArea V luation
�mFo (commencing with Section 7M)of Division 3 of the Business and Professions Code)or
i $
that ho is eacmpt dterefrom and the bssis for dm alleged ascription.Any violation of
Section 7W 1.5 by airyapplicant far a permit subjects she applicant to a civil penalty of 3401451�Qfo 0 Occupancy Type
not mare Nan five hundred dollars(5500).
0 1,as owner of du property,Or my Nnplaycu wish wsgn as door sok mmpensitlan,
will do she work,and tic swmure is not intended oroffered hassle Isms.7W.Business
and Professions Cade:The Conan
aars LicenseN Law does not apply an Ownar of - . . .Required Inspections
pmpeny who builds or improves thcreem.and who does such work himself or through his
own employers,provided that such improvements uenot intended oraRered fm sale.It.
howevm,the building or impromment u sold within one yeti of completion,Ne owner, _-
builder will have dm burden of proving that be did trot build or improve for Pur Ouse,of
sale.).
0 I.as Owner of Ne property.am"elusively contracting with licensed contractors to - -
contract the project(Sec.71)44.Business and Profcesions Code:)The Contractor's Li-
cense law docs not apply to an owner of pmpeny who builds or improves Nemon,and
who contracts for such projects with a coroomor(s)Iicaved pursuant to the CommicmbLicense Law
O l am aaempt under Sec. .B&P C farthil recti
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hcmby affirm under penalty of perjury arc of the following declarations:
1 ham and will maintain a Cen finte of Contain to elf-irsum for Warted Comfort-
. sation,As provided far by Section 3700 of the Labor Code.far the Pedmmame of the
work for which this permit is issued.
0 1 have and will maintain Worker's COmpnsai m Insurance,as requited by Section
3700ofthelaborCode,for the urformanttof Nmitit e work for which this perissued. - -
MyWo s Compensation Insurance carrier and Policy number am:
Grriair. Pancy�la-iz5h(5��o��
CERTIFICATEOFE%EMPrIONFR ORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is Income hundred dollars(SIM)
it,less.)
I eenifv out in the performance of to work for which this permit is issued.I shell not -
employ,any peso any manner so as w become subject to she Written Compcnsadon
Laws of California.
Applicant
NOTICE TO APPLICANT:If.after making this Ccnificate of Exemption,you should
became subject to the Workers Compensation provisions of the labor Code,you must
.J O forthwith comply with such provisions or this permit shall be deemed armla d.
z CONSTRUCTION LENDING AGENCY
'e+= Ihereby alrum that them is a construction lending agancy for on,performance of
C the week fur which this permit is issued(Sec.3097,Cr,.C.)
W Q Lendcr's Name
0 z Lender's Address
U O 1 certify that I have mad this application and sum that the above information is
PCavett 1 agree to comply with all city and county Ordinances and sure laws relating to
QU building covwnion,And Mackay authome apresemaies of this city to enter upon Ne
W above-mentioned property for impectiom purposes
(We)agree to sec,indemnify and keep harmlesse City or Cupertino against
F'h thliabilities,judgmenu.costs and expenses which may in any way accrue against aid City /
'n cone ucncc of the t per
U 7, 9 granting of this mit.
APPL ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO CE REGULATIONS.
ht!2) Re-roofs
Sfgnanum of ApplicenUCon ramor Dam -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or fume building Occupant store or handle huallous material
"MLaz defncd by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
cede.Section ns3z(an
0Yes All roofs shall be inspected prior to any roofing material being installed.
W -
r%Na _ - .. _
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
OIL hazaNnus air contaminants as defined by she Bay Area Air Quality Management all new materials for inspection.
District?
0Yes ®Na
1 have mad the havzNnusmauriab mquimme nu undor Chapmr6SS of the Califor-
maHcallh&Safmy Calc.Sectimu25505,25533 and 25534.I umkrslaM she ifdm Wilding
docs not curemly rte a tenant shat it u my mspensihility u notify Ne msupant of dm
requimmcntaw hmust hemet priorto issuance Ala Ccmfi rampancy. Signature of Applicant Date
"ry J} }
Dow All roof coverings to be Class"B" or better
Owner or amhorivcd ascm Dau --' '
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE c> ( � 0
CUPEKI INO PERMIT APPLICATION FORM
APN# ` / Date:
3Z / 6 ° . 11 - 17- 0 ~I
Building Address:
/o2-21 / CYC
Owner's Name: Phone#:
.?o �- •D-no VA n 4o16) 3
Contractor: Phone: License#: G -7 -7,q75
Ar3 /y 5 C qvq 3 7 `7-�1�90
Contact: Phone: Cupertino Business License #:
JZci Yn-m, \GC ZI`a - C§ loStgo7
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description: t
00.y� // et Py, rf V t i/I -C C�� c c,77— cDr t
Residential Commercial ❑
Cost of Project: �(
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A li b e Fee ID Fee Description Fee Group
PPERMPTFEE 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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