04110150 (2) CITY OF CUPERTINO- - - a S' --
BUILDING DIVISION-
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BUILDING ADDRESS: SPEEDY ROOTERPLUMBINGY • PERMIT"04I10150� "-�` - -
-7411 RAINBOW DR
OWNER'S NAME: PERMIT ISSUE DATE
" LYN ROGER 2176 FAIRWA 4
ONE:
- --•r-.-e. . ,- _....,,,_,_.,�, SANITARY NO.., -.r.-. - „-CONTROL NO.�.a.
(408).234-8134.
'ARCNITECf/ENGINEER: - - - -:'BUILDING PERMIT INFO. _ -_-
' - BLDG ELECTPLUMB METH
' .. - ' ..__-.. Imo. .. .t�"-""-I� ••- 0 '
LOp LICENSED CONTRACTORS DECLARATION - - - - _. _ "
�+ 1 mby affirm at 1 am Ranmd under provisions n(Cl o ncr 9(commencing - --Job IDCSCCIp[I00 -
wishSecti 7 )of Division 3 of NC Bus Professions Code,and my hcenm8
.5 in pull to ass
deBe L/ z�� �/� 7e�tr�.3 REPLACE WATER HEATER WE -
i FFFWt'{E De // 1 - Conmecmr S -. --- -.---
5 ARC ITECTS D�S6ARATION
I command my plans shall he umtl puM1lisuds
7
3 W Licensed Professional
=q'y5
OWNER-BUILDER DECLARATION
E<f 1 hereby affirm that 1 1. exempt from use Contractor's Co License taw for the -
followingmason.(Secuun 703LABusiness and w.daiuns Codc:Any city or county .,_ _- _ --
which its ism a e,al.reconvict,cher.improve,h pounit t m mush ed mmtumment aT .�. 4'�O 0-
'hZiHe, _ ..
pdorW slicensedpuruntto the lhovisio ofnt fer such p,rmi'.Lit,ea Lndsmreme9
ss<
that me ccenmd pursuant provision of to Contracturend Pone Law(C Cutlet - . Sq.Ft.FIOOr.ACe2 ValU21U0I1
(commencing with Section 70011)of Division of the Business and Pro@ssinns Cndc)ur _"- --
• $ NN he B exempt therefrom and the 6usis for to alleged exemption.Any violation of
Section 7031.5 by any applicant for a permitsubjecm the applicant W a a nil penalty or a .... Occupancy Type
not mom than five hundred dollars(SAID).
C]1,to owner of she property,m my employees with wages as their sole comparisons, -+.•-
[' will do thewmrk.and thesuucture is notimanded oroRered foraalefsec.7W.Busins, _ -
and Professions Cods:The Communes License Law does am apply m an owner of '' Required Inspections
property who buildsorimprorcs thereon,andwhodoessuch work himselforthrough his -
ownerhplaycus,provided lhatsuch impmvemar is an nus intended or.ffmad forsake.If.
however,the building or improvement is mid within one year ofcompledon,lie owner- •"^ >-- - - -- --.
- »
builder will hove the burden of proving that he did not Wild or improve for purpose of -
.to.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.70x4,Business and Profession CMa:)The Contrmlw'a Li- - -
ccnm taw does not apply to an owner of property who Wilda or improws themme,and -
whocontracufor such pmjecut with a convaclor(s)licensed parsons to the contrmlore ' -
License Law. .. •-
❑Iamexemptunder Sec. ,B&P C for this mssmn
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby Kinn under penally of perjury ane of Ne following declensions:' .
I harc and will meinuin a CeNficam o(Consentio self-insure fm Workm'SCompcn-
cation,as provided for by Section 3700 of the Labor Code.for the performance of the
work for which this Permit is issued. - -
❑1 have and will maintain Worker's Compensation Insurance,as required by Section - - - - -— - - - -
3700 Ef th,Labor Code,fmr the pc form w f the work for which this permit is issued. ---^- ---^----- --.-. - -
W rkera pe tion I once cam end POR umber am:
r. Policy Np.: 1 t""V �•O f�f
CERTIFIC OFEXEMPrIONFR MWORKER /
OMPENSATION INSURANCE
(This section reed not hecomplemd lithe permit is forms,hundred dollars(SIM)
nr lass.)
1 certify that in the Performance of Ibe work for which Nis permit is issued.I shall not
employ any person in any marocrsn as W hecomc subject to the Workers'Compensation
Laws of California.Date _-
Applicant
NOTICE TO APPLICANT:If.after making this CeniRcate of Esemplimn,you should
become subject le the Worker's Compensation provisions of the Labor Codc,you must
wJ O forthwith comply with men provision or this Permit shall W deemed revoked.
'�
..i 51 CONSTRUCTION LENDING AGENCY
[+ I hereby affirm that there is a construction lending agency for to performance of
(Yi the work for which this permit is issued(Sec.3097,Co.C.)
W�0 Lender's Name -
z 1<nder's Address
U 0 I cenify that 1 have read this application and since that the above information is
spy F correct,I agree Ire core ith all city and county on inane and sink laws misting to
0U Wildingconsrocti ,an amity authorim mpmsenadwv of this city to color upnn,the
kk7 shove-mentioned rope fornowtoWn purposes.
(we)agms to rc,indemnify keep harmless um City of Cupertino against �.
liebilitia,juas ,cost and expen hich anyway accrue egainstaoid City
U 7 in conmgyEnce We grmtiet trut permit - - /
fi AP ICA RSTANDg D W L MPLY WITH ALL NON-POINT Issued by: Date
E AT ONS.
Re-roofs -_
n arc ApplicanVCmntrecmr
HAZARDOUS MAT LS OISCLOSU Type of Roof
Will th apPliam lir for Wildin upanlsmm or handle henNous nomrid
defrnfd by the Cupertino Municipal Cbapmr 9.12,and the Health and Safety
mtic.selves 25532(a)]
❑raAll roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which -
mit hazardous aircorwroann as defined by the Bay Area Air Quality Management all new materials for inspection.
Gimlet'
❑yes tt7ss,�
I ad thehnsrdour materials requirements under Chapter 6.95 of the Califon
ria Heil Safe,Cada,Sectio 25505.25533 and 25534.1 undenmnd thatifthe Wilding
d cu sly home mne that it i y ponihility m noufy the occupant of the
men whicr�natW etpri .ss carer c,rdraml a �cy. Signature of Applicant Date
O
ncr lir antunisd ager we - - ---- --- - All roof coverings to be Class "B"or better-
CITY OF CUPERTINO S�
` WATER HEATER
CUPEkTINO PERMIT APPLICATION FORM
APN# 0 Date:
- 2 l 2---
Building Address:
7111
� Pk - C.0 PF P_71 AIC) efA
/Z,q-/ti/vo
Owner's Name: / Phone#:
Contractor: Phone: pfd 9 License#: (f 3 ,6
SPFEP WUiLP' f4-4451A/ -7Y8-91 e 7qy 3 3 i
Contact., I fPhone: yo S Cupertino Business License#:
1Ctf4-xD 7y8 -S"8 1
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech ❑
Job Description:. if
Residential Commercial ❑
Cost of Project:
Strapped On PlatformAE3— Bonded ❑— -- —
New Location 13Re lacemenf"
Qty. .
A cablq Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING