02070155 (2) CITY OF CUPERTINO - ' ' .
BUILDING DIVISION PERMIT CONTRACTORINFORMATION:
Bu160�ODJES TOWN DR ALL VALLEY PLUMBING PERMIT
N82070155
Dx NE:GLADYS V 170 BRANNON DR APPLICAT20?LB.�Tf
sy12002
PHONE:
(510) 376-4816 SANITARY NO. CONTROL NO.
C c Z ARCHITECT(ENGINEER:
a 0 0 BUILDING PERAIIT INFO
U BLDG ELECT PLUMB MECH
n« u c_I L. ") u
S y i LICENSED CONTRACTOR'S DECLARATION tY L�
;i Inimb,ifiim+that Iamlicensed under provisionsofChapter9(commencing REPLACE WATER IAT Iption
rata withSmion]000)of Division 3mfthe Bmimessand Professions Cale.and my license
!x f j in lore and cR A.
i s a Liam Lie
a
O Dam Can..cmr +
3 a G ARCHITECT'S DECLARATION
0, 1 understand m I h II be used as hb,records
aay� ypansspu
a
1.8 Lice.. Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License law Im the
r Z< following reason.(Section 7031.5,Business and Professions Code:Any city or county $600
toC which requires a permit m construct.alter,improve,demolish,or repair any suucture
a.B, prior to its issuance,also requires the applicant for such pc signed EL _ - _ _
dra he is licensed puisuannoshe pmislons of the ContracmisLiceme,Lw m Code) a `" r 3UW r' "7'�.` Valuation
+eau statement
(commencing wire Scotian A000)nf Divisionlof the Busip Chapter .1t It. ," .11 k_-`.: �til.l:,
or That fie ii eiempt theafmm
and the basis for the alleged vempfoa.Any violation - '
-ar Section 70315 by any applicant for o permit subjects the applicant m a civil penalty-.
:afoot mora man five hundred dollars(558oe 5 0 2APN WdA61I Yoccupancy Type
❑I.asa+neraf me property.army employees with xagesas their soteaampensmion, 506 — GAS TEST
will"do the Woek;and the swcume is riot intended"or oRe ed'for sale(Sac ]Ota; _
Business-star Professions Cade:The Conmmor's License law ams oat apply la.a spectioiis -
.1Owner through
.. .
f property Who builds repro es thereon. d who dos h i k himself b
A
or thr gh h ow a ply .provided th t h p eae t rc ria tended nr, ��i/offered.! le If h ee the bald' P g r'm o i sold within year of
c mpl t n N W
mer eide II ha the burdc f pro g mat he d d a W Id or a. - r
mpmvc for purpose of sale)
�I,e a of the progeny m exclusively cont as ng with licensed contractors In ��
construct theproject(Sec ]060 Business and Priori Cone 1 Tha Conlmaor s 6
LicenseLa does at apply m e Owner of r openy who Wilds or improves thereon, d t
_ad wh ciiIncl for meh Prof ¢ M.er c teaem+O le mcdp ant m the _- _.__ _ ..._
Co marc ! License Law .. . .._._.. _.\b/' .___.. O
01. mptridr$ec ' B@PCfo his reason Vc 0�,,,,�1)t
Owne
• WORKER'S COMPENSATION DECLARATION ,Y
_�• I hereby,Rrm under pcnahy of perjury one of the following declarations:'
j 1harc',nd will maintain'a Canifeae'of Comcnl to self-insure for Worker's
eri,4 I omp<nsation, as- m
pvidea-fo, by Section 37M of the Labor Caere, for the
performance of the work for which this p.I,is isaned.
❑1 haveand will meimuie Wader's Compeitea�ion Iesurana,ii required by Senioa
3700 0!the Labor Code.for the,petbIm...a of the vod'for which this permit is
iss cd My Worker's Com,croamons Insurance carrier and Policy number Lie
' Policy No I ..• I ,
CERTIFl.:.0 NOF ATION nONFROM WORKERSL 1, ,. - x' 1 J +. j{, 1 ',t •r l;i' r'..,'vr' ..it. .t 1. h -• — -
--:u-:t-:: •r-.-COMPENSATION WSURANCE'.'_._`
ct'
section need not W cam leted it the permit is for one hundred dollars
ISI000io rlessJ " ,
,1:,
+- 1 c n ft'mai ei the perform ce of the orf f r which th s mut
ih II ria em Io n ry p�afa M 1
Aa'� P Ia Y.1�If a.pjmnn tv W de . .
• i
J 1`
NOTICE LICANT If'i k th Cen'fcet of -- - _
tie m u the Worke s C i iat6 pt o y u shmust t
zZ o provisions ll the Lobo Code you must -
0 fonhw N comply with each provisions or this perm t hall W dttmMok d_
h
CONSTRUCTION LENDING AGENCY
ae u I herebj fEma that them s co strum o le d n8 8e dY f the ped rmp'c ,,,, .
ytti f the orf for M1 ch this Permit isued,(S c 309]:Civ.0
G <meer,Neme ...
Z Lcaac sAdarcss .. , . . _.._._ _.__ _ __ -_ _. _, -.. .__. _ ... ._-
I cenfy tor l have mad the application and tamthat fie above information is
tzn E+ correct I ageee to comply wid,all city and on-MY.-Ohmanceaods to laws relating
0'V the abra -me wet 'penyfand hereby rho ie p trues of th 'tyre ter upon
the eW amet ned.pmperry for inspection purposes.
r S f We)°gra m,ave,mtlemmify end kttp hartNess the Ciiy of Cupentno agu^n
rA' Ci,ilitiu,just cars.costs end expenses which may in any way eecme against said
U Z City in con xquanceo(tha gmnfngpemul. •' //''�
APPLICANT IL\DER$TAND+S AID WILL COMPLY NTTH ALLNON:POI6Tc
SOUR CE REGUCAI Iw+• Issued by: Date' M—
SO
Stiyarfiara of AP➢PPL�Ca PottK Plein ' ,]
HAZIRDOUS MATERIALS DISCLOSURE
j °` Re-roofs
-i Wllthc gacvpanlnortorF�Mlchaaalloim aadI . Type of Roof
as defined b theCu n Municipal al Code.Chaps 9.12. d the H elth and Safety -
CodeS cton2553 (a) _ i . . - _ .
r'.',
ty..+,
-' All roofs Shall be Inspected prior-to an ,roofin material being
u '• :W 11 Ne applicant a f tort Wilding«cup t use equipment or devices which - y g installed.—..
<mnhemrdous Zi mnimims u defined by me Bay Area Ait Quality Managemen If a roof is installed`without first obtaining an inspection;I'agree.to`retnove
QDtilria
`✓ "1 five ..all new materials for inspection Applicant understands and will comply.with
❑ as tl¢lursvdo materiel.reqs rtments linda.CTmpmr ti 95 of all non-polnf source regulations. .. - - "'---'-' -
Y N
..Nc
Calilam a Huhh@ Sefa Cade;Sections 25505Q5533 and 2553x 1.Mcrstand that
+f the b Id g does
na '"m IY have agnea thas is my respo sblryt notify the - -- -
eac pe i or be r qmust
e be el P o to I suence' (a mficam of0. ._ _. .. . ..... D +
mint �.
11
DZ , Signature of Applicant
,r ate
th zM nt D t All roof coverings to be Class "B or better "
s .. ..
OFFICE _. ._.... .. _