01050120 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING AI DRESS! PERMIT NO.
8137 RESIDIO DR CUPERTINO PLUMBING 01050120 '
OWNrR'S NAME: APPLICN'ION SUI{DATE
DE ANZA RL 05/14/2001
1910NIi: SANITARY NO. COMBO.,NO.
. —
Q eeZ ARCIII'rBCVENGIN1iliR: BUILDING PERNIFE INFO
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Ii1.DG ELECT `LUMIi MECH
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FNj LICBN'SED CONTRACTOR'S DECLARATION Job Description
pOO7_p I hereby aline that I am licensed under provisions of Chapter 9(commencing
wish Fcdinn]INlll)or Uivisio l dnc�llunincsp and I ss adc.' ry limine
6 in full liarcc and 1.
yyy
:,., 1,i«ten COPPER REPIPE
j VrN Dole ,. CnnlraCnn_
K '��-7-tl-1 neclu'rl:cI'SDnCLARAn,N WATER HEATER & WATER SERVICE.
1 understand my plans snag be used as public record..
ce
'LLY
a S p Licelncd to t...lonal
OWNIiR.BUILDIiR DI.CI.ARAIION
a I hereby affirm that Ism commit frown the Contractor's License Low for the
following reason,(Section]Ill 5,Business and Pmfcasions Cudc:Any city or county
S x❑ which requires it penuit to conuri n,alter.Improve,denmlleh or repair any urucu:re
i prior na its issuancc.aka,requimethe applicant forsuch permit o file asigned statement
that he is I cen.wd pursuant tothe provisions(if cnatmcne's License Law(Chapter 9 Sq, FL Floor Area Valuation
to:anuanenciogwishScow.71X1'))of Division 30 he lm,inc,and , fesslo ,Code)
or Ihm he is exempt therefrom and the hasiv for the ollegcJ exemption.Any violinion
of Section 703 IS by any applicant for a wornit subjects the applicant to a civil penalty
ofinal Imam than five[it dollarsStill)) APN Number Occupal �
01,as owner of the property.or my employees x ith wages as their sale compensation,
will do the work,and the vtructme is not intended or oBcred on sale(Sec.7o04,
Business and Promsmm�Ct.Ie:'rne Comlm torN Llcer,Law does nal apply l..to. 3561 1084 R gired Inspections
owner of property Who holds or improves Ihercnn,and who docs such work himself
or through his own employees.plaided that such improvam lmtart not intended or
olremd trn xalc.It.Luwevcr.Ihu build'mg or hnpreso
nwcnnl is ,,lot withiear
n one yof
nrnplwion.lheowmrhailder will havehhc burden.1 proving thin he did not huild nr 202 — UNDERFLOOR PLUMBING
mprove for purpme or tele.).
301. — ROUGH PLUMBING
visas owner of the Pmpeny,ten ex.hnivdy d Porife,e with EcemW emtunnars to
.m..mm the project(see.7aa.lwameaa ane lhoeasi..m craJe:)'rne e..mincprzs 502 — FINAL PLUMBING ENERGY
License Law does not spit,to an owner of pmperty who huilds or improves Ihercnn.
CI sit ,comet roti s.ee ....,.cera wan,m....nma....fn) we-ed mr ham m the507 — FINAL PLIJMB I NG
Cnt onrmmor Lieenrc Law.
01 am enemp,under See. .B k 1'C for this remain
Owner We
WORKER'S COMPP,NSATION DECLARATION
I la..cloy aff.n:miler penally of w ary....,of the IidWwing dslan t,mi, E D
0 1 have and will maintain a Certificate of Consent to self.insme for Worker's FINAL
Cmnpensadnn, as provided fur by Section 3700 of the Labor Code for the
pedianninec orrhe work for which this parmil is Issurd. ��� am ,k Y )1 C001
01 have and will maintainG Worker's Conapensatiam Insurance,as required by Section
371X1 of Inc Labor Code,liar the perrnnnunee oI' he work to which(ill,penis in
_;,eta�� .yeNi:� policy� nertt�m�[ne BUILDING
CERI IPICATION Oh EXFMMON FROM WORKhKS
COMPENSATION INSURANCE
('this s,oua near ern be emmplcicd of the perndl in roti one hundred dollar,
S1ad or Iced
I v,td, on its the per ouree..I'the work Em which this permit is issued,1
shall not employ any perms to any maoncr.<n as in become.mhjccl m Ne Worker,,'
compensmion laws of caliromin Date
APpllcmnl
Non ICE 10 APPLICANT.IL after making this Cen team N liscnhpnoo.you should
Mcomn
e subject ,the Worlds CompensationLabor provisinof the Iao Code.you mud
Q O furrow It comply with such provisions or this permit shall lac deemed revoked,
z
r_ CONSTRUCTION LENDING AGENCY
ai I1 hereby which that them isttmem( eleading agency hrt the performance
of the wu,¢fur which this pcnnil is.v ioamd(See.3197,Civ.CJ
L A Leaded Name
7 z Lemlds Address
r, Q 1 mnlfy rem I have read thin appllemlon and cram Ism nae above iat'ommion iN
Lzs E.. co)leer.1 agree In comply with all city and county onllmnces and state laws relating
O f) rebuilding......ruction.and hembyaulhmim mprcmmallvm aflhiscity menter upon
tis] Theuhovey....Ii ad Property for inspection P, c,
tWe)agree in save.indemnity and keep earmdess lire Ciryof Cupertino agaiml
Cn liabilities,judgments,costs and espemev which may in any way aveme against said
G Cil,in umwqucnce of rhe p erring of this Peonil.
AI'PLICANIUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT' Issued by:
SOURCE REGULATIONS.
Mpunum of A,,liaanUCommunn' untie Re-roo/istailed
HAZARDOUS MAlliR1A1S DISCLOSURII
Will the mppkemd on future Wildio,oc apron wore ti r eawle ha:mon,m demil Type o
is delincd by the Cupcnino Munlcipul Code,Chapter 9.12,and the Health Ind Safety
Code.Section 25532101"
G Yes 0 No All robe inspected prior to any rooting material being installed.
Will nacapplieam..rr,rrmm laundn,g..anpnm uaerlwpanenrme.nias wlav'h If a to without first obtaining an inspection, 1 agree to remove
emit Imcmdnms air conmminams as defined by the Bay Arca Air Quality Management
Di..dm all new materials for inspection. Applicant understands and will comply with
❑Ye, 0 N all non-point source regulations.
I have read he hazardous armon.b regmmmens under Chapter 6.95 of the
Cali into is Health 8 Safely Code.Sections 25505,25533 and 2557L1.1 understand That
Q,1,cd h`s nor canca Y hove otenant,'hat it Is any rc<punsihll ity m not lty the
11 m eq 'reme v x hich rtor M met prior m issmntt of a Certificate of S! U Signature of Applicant Date
owner..): In ,cJ agentl Date All roof coverings to be Class 'B"or better
OFFICE