00070100 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
W. HEN WHY Hu I WAI ER INC
Ii1111.UING hn1 .... Plil<MIT Nt .
OWNER'S HNU AVE APPLICATI B M'2000
ONPI — SANITARY NO, CONTROLNO.
n C L ARCIII'I EC'ETNGINIUM BUILDING PIdRMIT INI0
O CO 13LIlG Elxcl PLUMB MECII
FF u fy J L J L_.J =,
y�6
I.ICbhan I a,II to ACTOR'S DECLA of Chiu b Description
>- L ,bench IBrm IM1w I,3l icensedunder of mein
>• rr'v I 1 s WATER HERTE
o nen
a,_ly wlh tins 700M)ateir. onpnfl6c Ru,lnan mnJ Prvales,ln„s Gvlr,and my licunua
L cense form unJ clfna. -
x z:x a License Close Lic.x
O a O
Data Contractorw
ARCH I'I ECI"S DECLARATION
g 1 undcmmlJ,ny plans sh:Jl hr used a..public tecord.0
pO licensed]'mfcssinnul
OWNER BUILDER DECLARATION
a J 2, I hereby ullirm m
Thal I am e.mn,pt frothe Comacmr'a Licence L.aw far,he i
following reason.(Scelion 71131.5.Business and l'rofeaions Cade:Any city nrenunty
Sat O wilrl 1 panni,l 4 lacr.improve,dino0holl.or reparany structure
ce3m prior tn ,Ixt y II applicantI p ,ill I b dauancnt
than licensed forward w nthnuoision,ofthe Central l wl (Ciminero Sq. Ft. Floor Area Valla
(conamencing with Section 7")of Division 3 of the Boinc%s and l'mfcxs,on,Colic)
or that he is exempt hcrefrom and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant fm a promo.objects Ire applicant to a civil penalty
of not Blore man five hamh,l dnuan.(55(x). Occupancy Type
❑1,e,ownerad the xoNrr,m rI,employees with wages as the,,ole cn upwron ine.
will do the work,and the suuaure i%not intended or offered for sale IScc.70M4. 2 PA� P ,1 yI Q C
Business and Processions Code:The Cnntmcmr:Liccoe Law docs not apply u,an 50G — F I Nrnt;ylSllctlllW. 'N1MnY—N
r of property Who builds or imro
pve,thereon,and silo does.such work M1lvuelf 506 — GAS TEST
int rough his own mapinyca..pmvhiul that.orb cuts mems are nut intended nr
on'ered for sale.It,N wmer.the htdldd,g m inprovanem i,sold within one ycaf of 507 — FINAL PLUMBING
ortruction,the ownerbuilder will nine the burden ofproving that he did net build or
improve for purpow of wle.L
❑I,as owner of the property,an cachmisely woman,with licensed contractors to
,,brcl the p,,,j,,,(Sec 9044.It... d ncux an1'ruleseiuns Cnde:)The Cummc,w's
Licca.a Law utas on,apply man owner of pmpco,won mulds or improve,thereon.
and who contracts for such projects with a commichar )licensed pursuant In the /
Contras o',License Law. !/.0
❑I am exempt under Sec. .B&1'C for(his msmn /
Owner Dam - 4
WORKER'S COMPENSATION DECLARATION
1 hereby ullim,under penalty of perjury one of Be follnx ing daclamtinnx:
I base
as and will Inamann u Ccruneue m'Conlon, as df-i.,ara for Worker -
mpen Bunn, as provided for by Section 3700 of he I.Id,or Con,, for the V
lerlk,rmm�ice of rhe work lar which this pern,il is i„ucd.
❑1 have and will maintain Worker'.Crcuita inn Insurance,as required by Section
4 371s0 of the Labor Code,for,he performance of the work for which this permit is
.wed,My Worker's Cmnpcnuaiun Laurance carrier and Policy canner am
Coria, Policy No.:
CBRTB'1CATION OF EXEMITON FROM WORKERS'
COMPENSATION INSURANCE
('This 111h a need ani he nn„planed it the Perin is fn;one honored unlit...
(S 100)of(ccs.)
I cenify that in the parminuarre of the work for which this permit is isxuaL I
shall not employ any person in any manner so as u,became subject to IM Workers'
Cnmpenmtion I.awsof Culdernia.Dore
Applicant -
NOTICE TO API'LI CANT:IL allin tanking this Candleacof Usent,inI.you should
hecnnm subject In the Worker's Co..l,armkm pmvi>ion.,of he LaM,r Code.You,east
Q O forthwith comply with such provisions or this pem,il shall be deemed revoked.
F ^
CONSTRUCT
i, ON LLti ING AGENCY .
C berehy whch that titereinaissued(Sce. Icndingagcney forthe perfunnanrc
r+ of the ami for which Ili,pernnl is issued ftica.JIM)].Cs.C.)
L Q Lender's Name
5 Z Lender's Address _
1 mnify(hat I have rend this applicat inn and.sloe that the abuse informal inn is -
L++ Lru,aeGl.I ugrcc m.unity widt all it,and ,,I y unlinunmx and slam laws¢Inning
Q U In bulldog nnsuucdon,and newly aulhnricc c,wwnntivcsnf flux city o,emcrefoo -
Fthe aMrvenxmirned property for inspection pugxne..y (We)agreeit,.ave.indemnify and keep minutes, he City of Caperton against
rt. liabilities,j.di mann,c...is and exPenws which may in any way mane against said
V Z, City in cnnw,ner,corthe gorntir,al'this union. _ �����'
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Data
SOURCE REGULATIONS.
Signature of ApphcunUContmaor Dae Re-roofs
I IA3ARDOUS MATERIALS DISCLOSURE.
Will Inc apphca,m fame buuding necnp,m,once or handle hamnlmr material Type of Roof
is dclined by the Cupenfno Muni lial Code.Clapler 9.12.and line thrall,and Sanity
Code.Seellim❑Yes 25532(.)7 El No
All roofs shall be inspected prior to any roofing material being installed.
Will he applicant or future mildir,w,opam ase egopormel or device which If a roof is installed without first obtaining an inspection, I agree to remove
e,nil nuanctom air cunmminanW as ddmial by the(fay Arca Air Quality Management
,1.161,'1 all new materials for inspection. Applicant understands and will comply with
❑Ycu 0 N all non-point source regulations.
1 have read the htiardous materials rey inamem,under Chapter 6.95 of the
Cali famia Ncalth&Safely Code,Satin),25505.25533 and 25534.1 understand that '
if Ibc he ill ins docs non c,,,'tinily halm n(mmol,thin i1 is ny I..ponsibi lit,In cul lty IM
cnp;ml of dm act innenu which most he act prior m issuance ofa Certivaum of
Occupancy. Signature of Applicant Date
Ow net or authorized agent Da,c All roof coverings to be Class "Bt•or better
C