00090169 (2)CITY OF CUPERTINO '
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDINGADDRfw9.t e PC--
WATER HEATERS ONLY
rr:RMIHNO. 000901.69
OWNER '_F:AMISCHUETZ CHARLES W AND W
NIFRED 500 AIRPORT BI_U
APPLICATION S09,A127 /2000
SHONE:
(415)349-37A7
SANITARY NO. CONTROL. No.
Z ARCHI"ITCVENGINEER:
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BUILDING PERMIT INFO
O
BLDG ELECT PLUMB MECH
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u u u
j LICENSED CONTRACIOR'S DECLARATION
.lob Description
o Ithereby nnlrmlbmlamherawdnnde, noi,mOutChapter 9Raurna,oci"g
WRTER HEATER
with Section 7001) n- Division 3 of the (Cosiness and Prolusions Code. and my license
rin full force and effect.
'
Ul.icnue Clues Sic. a
Ude Comracun
u ARC(fic I" DECLAMATION
I nnnenaaml rrr plans.anitdl rte ree d as pantie reea.e.
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pI-iecmcd I'nde..Innul
LL OWNER-BUILDER
caemrs ldansc Law for die
I a,n. fromthe RXI Contractor's
1 hereby :(Seen from mel
B.,opt
< .... ..
following usdane Cndc:Ar, city ureuuvice
_ which requires a permit e, nmewa, idler, intpmot demolish, or rcpdr any suanatn
,if... ,, hs issuance. also re:p:he, Ific upplicvm sur each Mm,inn Ble n signs] stetcnam
- that nn ielicensed pursued it) the pnoision.afthe Contractor's UeeneLaw (Chapter 9
Sq. Ft. Floor Area
ValualiM700
(commencing with Section 700) or Division 3 of'he Business and Pndessions Cock)
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ur That he In cacmpl iherceom and the hmis for the Wlcami eacn.p'iun, Any violzainn
of Section 7031.5 by any applicant far a permit subjects the applicant to a civil penalty
APN-PLP(_FlII(9046.00
Occupancy Type
arn"It ace than five.hnmlreddallam(s5(S).
01, as owner.Hite property. or my enmloyces wen wage. a.. mdr soR comrensa ion.
.
502 — F IRIf9girc0L@ PMt1"G ENERGY
will Jo Ibc wok, ani be nrac.... c is ern intended or life ra.I ka s;Jc IS,,, 7044,
Law does to
Business and Professions Cade: The Central License not apply aro
o.au,ot property, M'h, hadR rte improves beer, oil who rises such work himself
506 — GAS TEST
or dmugh his own emPlnyns, provided d,at such in,provcoscas arc not intended It
offered for ale. If. howo'cn the building oe improvement is sold within one year of
507 — FINAL PLUMBING
Iran p.... in, drat he did mot head o.
,rnpleaan, do owner-huilder wilntavc the buIdn o
improve rile forri ear
01. as owner of the proher'y. an exclusively contracting with licensed car racfes u,
onsul the project (Sm. VW, Business and Professions Gds:) The Contractor's
License Low docs not apply In an owner of prapeny who builds ar in,rnwen Liars,
vad who contract,% for such prelims with v contractors) licensed pursuant to the
Conine e, Liaise Law.
❑ I an, exemrl under See ,[Iklie rlhi, reason
Ow act Datc
WORKER'S COMPENSATION DECLARATION
1 hereby ofGrm un der penally II la ,try 011e of the fallowing declarations:
"L] I have and will ,,It Sin a Cvnificam of Consent In self-in um for Worker's
Compensation. as provided for by Section 3780 of the Lalxa Code, lin 'he
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serf ounce of the work for which this permit is issued.
01 have and will maintain Walker's Compcn%mion Insurance, a%required by Section
3700 of the Labor Cale. Gtr the crfurill of the work for which this permit is
sued. My Workers ConiKa%ation Insurance carrier and Policy nuilher arc:
Carrier: Poi icy No:
CIiRI IFICAI ION OP Ii EM1'TION FROM WORKERS'
COMPENSATION INSURANCE
(This .section need not he completed if the pemtit is for one hundred dollar
(S 100)or less.)
I certify that in the pert ronanca of the work for which this permit is issued, 1
shall nal umploy any -coon is It, m:mncr Is, as to bel6ou subject m ,he Wake,,'
Cannr<notion Law. of Caue,raia. Date
Anpl'Ic4al
N(YI'ICE TO APPLICANT. IL after making this Cenlficute of liscarnion, you should
Z benmm subject to the Worker's Contrcusat ion prov ion% of the labor Code. you must
., forthwith comply with such ao,kior, art (his per nil shall he deemed rooked.
A C.1INS1 RUCTION LINA NO AGENCY
once
j 1 hereby' affirm that is a construction lending agency for the lednnu
of the work far which this permit is isaucall (Sec. 3007, Civ. C.)
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Leader'sNorms
z Lenders Address
1 certify that 1 have read 'his application and swm that the atone inrnreemion is
I agree to comply with all city and county ordinances and ,are laws aiming
j i,rrect.
h Ik g c,)asaucucal. unitIseceby am, I "- tarWs 1 his 61Yt mer upon
he bo mem ed Property r peer purposes.
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s:
y (W)ugrm la s indemnify ahthe City -erecter against
liabilities. es.luJgt W e p use..se, htI any at an) Y' 61inst suit
:n bIme t., �
ZCity in comepence of the gmn'ing of this pem,it.
/� a�
VII—all I U
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT
Issued tf Date
SOURCE REGULATIONS.
Re-roofs
Signalarc of Applicant/Contractor Umc
HA]ARDOUS MATERIALS DISCLOSURE
Will [lie applicant or' mmrc mldeiog;aa,tanin Fla c ar handle ha,amooaratcrial
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Type of Roof
as defined by @e Cupertino M.,,icipal Code, Cbap'er 9.12, cad the iledd and Safety
Code. Section25532(x)".
❑Cl No .
All roofs shall be inspected prior to any roofing material being installed.
Will ,I dureI fidulloccutcn,osccgniunuiln,desiaswhich
If a roof is installed without first obtaining an inspection, I agree to remove
nit buzzon us aircontaminants a% defined by the Hay Arco Air Quality Management
all new materials for inspection. Applicant understands and will comply with
)i.stnefl
GYes C1 No
all non-point source regulations.
I have rad ,he haeardou.% i n serials requirements under Chapter 6.95 If the
California Health & Safety Code. Sectiors 25505, 2554 and 15534. 1 understand that
it the building does not currently hale a ¢tam, thin it is ray, spansibillty un notify the
cupmn if da, equ minus which mus, he arm prior Iis.narcv of n Cuniticnm of
Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owae,nr amhomed agent Date