00120104 (2) CITY UIo DING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING A l S' I'IiRAtIT NO.
���8 ORANGE BLOSSOM DR SAN ,TOSE PLUMBING 001201.04
OWNER'S NAffls; AI'1'hICATION SUE DNI IT
t�fL-LARD ROI_F S AND SHIZU TRUST' 151-99 IINIOV AVE, SI)I rE #612/18/2000
• PHONE: (408) 296-1820 SANITARY NO. CONTROL NO.
zA ARCIII'117C'IYENGINHER: BUILDING PERMI'I'INftI
O BLDG HI PLUh111 MECII
'du I_I CI L LI
G¢d
_ finudesI?DIlicensed
icensd under
Job Description
z_ 1hcnhy Xbaf Division
Incensedunder p red Prnnsol'Cbaode9(commencing
x;m Section lhom gnd cl 1. inn 3 none Hlh,ter,,and(-mfr„n,nh,Code.and my license GAS LINE
6 ii:w5't iv'in lull Innc nnJ el t. -� I
OP
Dam�'�,;� Cnnaucn,r_ 1' b'«' r—
or u H ARCI{I'I EC'I"S UIiCEARAI'IUN
1 undcmmnd nay plan.,ha11 be aced u,in blm nn,rd,
ipl0 Licensed Proles ional
OWNER BUILDER DECLARATION
W= 1 hereby affirm that I ton emnipt from he Contmcmr's License law list me
�7¢ toll: t.net.......fS i 70319Rosiness and P f:. 'C I Any city mI,
C wl...I I II ,,'oo'utna. flon. I I "ll,tam,J,' y. cue
pr iTo it, wnn,c..ko rcpt ns the:ppl'can tmamh R-hi IInl4.t.ib,Woat nem
that he isborn.nl pnrsnmmnme pmsiotis of me eomwool',License law(Chapter v Sq. Ft. Floor Area Valuation
mommencinf with Section 700)of Divi,inn 3 of the lbome,and Prof e..in.,Code)
or Thal he i,cunlpt menfmm and he ba,i,for the Alc,d eacmplian.Any violation
of Section 7011.5 by any applicam for a peanut subjects the uppl icant in a civil penalty
Of cut mnre ln:m five hundred dagaa 6501). APN Number Occupancy Type
❑L::, nfanrp,nprny.n ,hnyenm,myrew;nhwage,;:.mro-„Iermnpem:nli�,nh. 36611094. 00
mill Jo W,wmk,mal the amcmn is nal intended or uE2ned for vole IScc.71,14,
Bovines.and Prnfm,bnv bale:The Cnminclnrs Lirensc law doc,a,,,apply u,;at Required Inspections
ownernfloocrty Who builds or improve,theman.and Is It,,does such work himself 106 — SEWER & WATER
on mmugh hi,own employer..pm pled man such impmvnnents an not intended it
ffered lm ewc.E:however.the building m improvement is wild within orm rra,of 202 — UNDERFLOOR PLUMBING
Iompletion.the owner-builder will have the harden of proving that he did not build or
mprove for purpose of sale.). 301. — ROUGH PLUMBING
01, h,no,en,antra,m,ivelyromntetin,Ivan cen,cdcnmmetnnhm 302 — TUB & OR SHOWER
o
n..hurt the pmjecl(Sri.71,14,Rat s and Prof..was C:s1co The Comrneor'v
Liecme law does ton ap,l, ,,annxartrol'property whit huldsm itnproc,amnion. 502 — FINAL PLUMBING ENERGY
and who comenal,for such pmjccn with a contmcors)licensed pursuant In the
Contactor,License Iaw. 506 —
GAS TEST
❑Iamexempt under Sm. .HKI'Cfor this reamo 507 — FINAL PLUMBING
Owner Ume
Won KERmole'$Call,ol NSA11QN UECLARAIw n,
• I heathy onion mole,Peu:Jly ul ParlurY intent am following aeclnnhlinm:
Ib end 11 I Certificam of Consent l,sillimin%ure for wm\r's
,effor
Compensation. pro Wcr f by Sen p00 f the 1 b CN Ins the /
perfo 'n f the ,hk f h h Th' par l is sued.
❑1 h 1 ,It reinmin Worker's C by ai I nrr,as milairedby Sc tion O 1
37(X) I The],;,hot Lod f the P d vh f a k t 'I' this I nt 1 In ^
issued.My Workers Cotn,eenn,aalii�on Insurance conics anti policy:mouser nm: V
CitrirrrryCl n"OM1()�'Epolicy
oli vNo.:4VChFROM 3_RPS O
COMPITNSAI ION INSURANCE
(-this action need not be etmplcmJ if the permil is for one hundred dollars
(51(1)or Its,.)
I reffy that in the pcIfnrmmnce of the work I'm which Thi,hermit i,issued,I
shall nm employ any 'n any montes m as ns benytu.wh'c'�nyl� �hpwntker
C all ma cion law, ¢ 4_
npplicum_ _
NOnCE1bA 1'1,1 A I':IL SRcn nn Thu Cisions o of EsemphCuse.yu you should
must
become m...upyect the Worker's Cmhan,en ada,provisions of the devoted
na,okd must
O O InnhwilM1 eonnply wlah inch pn,viviom nr nth Benoit,hall M JeemeJ revoked
7
CONS'ere is a c INLction IGAGENCY
> hereby whish this torn is n u,..d(See IW7,C ngcncy tic The perti:nnmrtc
of be work for which This prmhil is i,zucJ IScc.l09].Civ.C.)
L Q Ud%nderName
.L LcndAddress
t.7 O I«Wily(bar 1 have real this application and state that the aMrve inlbrnmtion is
Car t y cornet.I agree I comply with all city and cunnry Indiaamcv I,late laws rel:nmg
O WThe ob c-mm�,nnerinn,andbenhy nutharimm,mrnlalivee ol'thi,city mrcmer upon
A. The nno(We).,m to a,,.my fns inoHy niton p ham lc t
.r„
A. (We) ts.cont inJmnnily and which
hamay in me City y aCupcni against
said "O
tq liahilitie,,juJgnmmn,coca and npsne,which may in any may accrve against mid
C,7 Z City in conxyucnce of the(mating of Thi,permit. ' ^
C A-170G
APPLICA )ERSTANDS ND WILL AMPLY WITH ALL NON-POINT �
.SOURCP .CATIONS, Issued by: ✓ wl.JG( Date
Signulhnn rel nppunhnT2: Dale Re-roofs
Will he IIA,torfrom Saulddn,,tr LSa1tl,shInon1.mOSl,ndlh
alhamaterial
Type of Roof
as ,Sed by he C.,nrnMuncipal Code.Charter Y.R,and the Health and Safe,,
Grde,
Section 25532(a)^.
°Yes All roofs shall be inspected prior to any roofing material being installed.
Will the apprcat or futurebunningoccutantuseegnlpunaordevic-which If a roof is installed without first obtaining an inspection, I agree to remove
coni ha,molous air I latninall:, Aulin thyme(lay Arca Air Qmlity M:magancnl
• ui,lric,I all new materials for inspection. Applicant understands and will comply with
QY" 0N all non-point source regulations.
�hive read the hetandou,materials requirement,under Chaplet 6.95 of IM1e
Czlifomiu Ilealth M Safety Cale.Seniors,25505.2553]and 8534.I undemmond that
ifthc bullJlug Jscs n currently have a tenant.that it is my responsibility To notify the
nnpanl of the re eau which must le mut prior to io ance of a CfnlllcmC of
O"apmmy
Signature of Applicant Date
owner„ramlt,ri,edagmn V ])air All roof coverings to be Class `B”or better
OFFICE