00110018 (2) CITY OF CUPERTINO
BUu.DtNC DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADURGSS: PLRMo NO,
OWNER'S NAME APPLICATION Sup DATE
1.0430 MILLER AVENUE AAAA—DRAIN PATROL 0011003B
)NE, SANI rARY NO. CONTROL NO.
CAROLYN BOWRER 1701 S 7-1-1-1 ST 1 J /03/20Ql0
tt Z ARCH]"rECI'ENGINEVIR BUILDING PERMIT INFO
OO III.DG IhLFCT PLUMB MECH
<dE (408) 989-6005 _1 u u I_1
G«
F N j .ran iuSrDCOMHnCrder DECLARATION NI C1oN Job Description
'dyo' herchy0)ofn Divi1tunol11hecI undo Pica11..le,fue,CdeCharter 9ndni,hoeing
C�
is s..lin.h 7atm ID 3„tole Bmll.us,and rahrealn2m node.Alm.hny E.
Is in full force an leZZ/J en
C 6 Lieen,eC' Y�_ Li'.
O O U.nu – Q Cnmmanr
5 u.ti ARCIIII'Ii(Lr5l BizARAI'IUN
t °3 Imal...nttda, I[in,shall used as SEWER. LINE ” // /
/�u�i 5 p O LlcunscJ Profce,<innal a
0.a OWNER-11 ALDER DECLARATION
I)ii to to I Immhy afRno 111111 I al»escort Gull)the Coolriefor'x.lame law for the ,I�
t G following mason.section 7031.5.Biwinec,and Pfucssiofw Code:Any city or county �/ O
xo nirch nouims ape iii to construct. Imp,improve,defoolikh.or deporany%amwe
i 3 m prodt)its woriatice.alto requires the ppllcu t for such,runt file 6 d.t mmem
than he is 1 it pur,uI I It,lh1 v m t 1h,c roa,lor,r 1a (Clapmry Sq. Ft. Floor Area Valuation
mnmmencing with secllon 7og0 of Division 3 of the Btw a and Pauldesomw Codd
or that he is exemrr lhan-fmm nod the h»i,for the nnegcd c saw,ion.Any violation
of Section 7031.5 by any applicant for a permit Subjects the applicant to a civil penalty
of not.nom than Eve hundred dollar.($500, APN Number Occupancy Type
❑I,a.,owner of fie pmpany.or my ennployce%with wages a,their sole compensation.
will do the work.and the.fracture is nor intended or ofiemd for sale(Sec.71114.
hh,me.,and 11 fiv,,mns Code:I he Ccenr e.o:,Li.aw Law does not apply a an Required Inspections
r oI pooy who boed....... o,c,menu.,amt who does such wore himself 37505040. 00
o r tlm ,,
,ugh his own en,ployces.provided that each improvione
nts arc not intended nr
offered for sale.If,however,rhe(wilding ,,impnmemenl is sold within mc Ycar of
`ampleliun,me owner-W ilJcr will have the IwNen of proving that m did not.mild or
..into,lorpnl srutode.l. 1.06 — SEWER & WATER
❑I,as owner of rhe property,am exclusively contracting wish licensed conamfor,to ,
mann the Fray.et(Sec.71W,Rus and Proms ,Collite Contractor's 202 — UNDEP.FI.00R PLUMBING
consumer 30t — ROUGH PLUMBING
Li who mhaas Int'such pr jvo%with a.oro ctoas)licensed par uunf 1u the
c.mle on,A,tlocLaw, 302 — TUB 8 OR SHOl•JEP.
O 1 ant exennpl order Sec. ,B&I'C for his reason
()...,—Date 502 — FINAL PLUMBING ENERGY
WORKI?KS COMPENSAJ ION DECLARATION 506 -- GAS TEST
Ihereby afrnnunder penalty ofperary one othe following declarations: 507 — FINAL PLUMBING
I have and w111 ululation o Cenilieum of Cnwcul ah.self-irwm for Worker's
C9nnpcn'alirn, as pnrvl led for by Sc,liun 3700 of the labor Code, for the
performance 91 the work far which phi,peril i.,i...ed.
KIFI have and will maintain Worker's Cumpamntion Insurance.as acquired ley Section
of dlu Labor Cud,.for he Performa,,of the work Ibr whish tho.penial w
i...ed.My Worker's Com 1.11 /�M1.Orme,cavi and policy nmmA a .
Canicr C/ Policy No.: �3—aft re
CERfI1HCA'OON l p HXEMP ION FRI M WORKHRS'
COMPHNSAIION INSURANCE -
('Ibis section need non be connpleted if the permit is for one hundred dollar,
(51 WI or lc,,.)
I tinily Inst in d"performance of Ibe work liter which'hiss ,air is issued.1
shall not ennploy any wrwn in any manner w a,to beconm subject to the Workers'
Cmmpensalion I.aw,of California.Dam
Appleaul
NOII IC17'1'0 APPLICAN'L If,after making d o Ccnlficale of Eennplinn,yen.build
We..sabyea nit the Worker',Cnmpensalion provisinn,it LaMar Code,you must
Q Q forthwith comply with such provi,inno or this .it shall W deemed revoked.
ti CONSTRUCTION LENDING AGENCY
I herchy aftirnn failure 1'44 enndmcfion lending agency fir the redimnuna
of the work lir which this peril i.issued(See.3097.Civ.C.)
6. Q larder's Nmme
7 .Z, I,rdkr's Address.
V Q 1 ccnify that l have read this application and state that the above in orrunion is
as. F. coma.1 agree to campy with all city and county ordinances and stale laws relating
Q V moulting co.oloidion.and Mmby:wiliouempu,coodver of this city In enter often
Ilse`Alleve"n untion"I p[npcity Int i napeelio.....upou,.
rt}„ A. (We)ngree,ome,itidenmity and keep harmless One Ciyol Cupcnino aguin.l
V) liabilities,pidgmcnl..casts and expenses which may in any way accrue againa said
V � Cory in.omryuencc of the gmming of this brit.
AI'PLICAM'❑ )' S' VILL COMPLY WITH rt1.�.NON"YUINr ISSUCd by: Date l
SOUR(' Giy_
sig�7rt.o pp ommam Re-roofs .. .
HAIAN000I N All MAIN DISCLOSURIi
Will the.pph...m or filowe h.ddmg'aminal atom orhanale roundna.acurial Type of Roof
as defined by heCa,t Municipal Code,Chapter 9.12,and nm Ilcallh roll safm
Code.Section 25532(x)? `/
O Ye, ' All roofs shall be inspected prior to any roofing material"being installed.
w.0 me it,li,nfor to huud.ngo.ctmanl use egoipmem or devious 1111e1i If it roof is installed without first obtaining an inspection, I agree to remove
emit ha ardour air alma niran»a,defined lm the Buy Arca Air Quality Menagenenf
[Awrict7 all new materials for inspection. Applicant understands and will comply with
0 Ye, 7C" all non-point source regulations.
I have rcrd the miardotu materials mijoire orals under Chapter G 93 of the r
California Health&Safety Code,sections 25505.25533 and 25534.1..&,,and that I
if the building does not currently have a mount,mat it is my responsibility to notify the
.spam of the regnircn.cnl,which nN.1 be fact prior to i"cane of a cedificaa of
ede.apalncy.
Signature of Applicant Date
G�iilror aelh."',udai JDate All roof coverings to be Class "B"or better
OFFICE