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05060053 (2) CITY OF CUPERTINO h ';*" s+w:a .T, F + -- BUILDING DIVISION PERMIT ��1N,%T12 C�tT 4NF'U5 IATIQN `_ BUILDING ADDRESS: WATER QUALITY PLUMBING PERMITNO OWNER'S NAME: PERMIT ISSUE DATE NE: SANITARY O. CONTROL NO. ABC HITEC MNGINEER: BUILDING PERMIT INFO BLDG 0 PLO lMECH � 6 LICENSEDCONPRACIOWSDECLARATION JobDescri tion i� I herby affirm lost 1 am limned under provisions of Chapter 9(commencing p i with Section 70111)of Diviriren J of the Business and ProfcuiomC IM my filen is <� mrm.Clma. md ;LTT\ REPIPE & REPLACE WATER HEATER 5�? LiccnsuC s Lic.N Vw if-- Dam Canmaemf COPPER INTERIOR U� 0 q ARCHITECTS DELLA r ION A tl.a r` fn I undcuund my plans me he used a puhlic rccnrds D i G Licemed Professional s'y Oat I am BUILDER DECLARATION CommeON Y [ 1 hcrthy v(Sect Net 11. exempt from the Conuasmlo License Law for the 90 ZOO5 F.00 whichfollowing Rstaa.Permit i BHLS, t.slam{and Professions Cada:Any sm Or county ante GG�� $ which requires•permit inconstruct.t,alter.Improve,h PemW,we a signedtwment _ Fly thiwmiuutuam0.aharcquirhe thcapp0canr for suchpctor'lLicams Law V F G (Comm Blkn With pucmant 70th)provisional of theContractor'sBusiness Limnmisw(C Code) Sq. Ft. Floor Area U Ilya VdIUB- 400 that he Is (Commencing with Secifirom it ofbasisDivision l the Ne Busineeand Professions Cade)of '7= .. that he ts exempt sherefrmm and Ne bah far the alleged emmption.Any violation of J L II��a` Section 7071.5 by any applicant for a permit subjects the applicant in a civil Penalty of APN Number Occupancy Type not mom than five hundred dollars($500). ❑La,ownerofthe property,army cmployces with wallows Neirmleeompentadon, 35604017 . 00 will dodos work and the s"turn is not inunded oroRsrtd forsele(Sm.7044,Basins and Pmfcsslam Code:The Convacmfs Limine Law dins not apply to in owner of Required Inspections property who Wilds orimprove theram and whodmainchwork himselforthrough his - ownemployes,pmvided6atsuchimprovemenssarenmimm.dr4wonemd(wr lf. however,the building or improvement 4 mid within am You of cemplcdon.the ownor. builder will Mw,the burdm of proving dust he did not build or improve for purpose of sold.). ❑1.as Manor of the property am emimively contacting with]!meed conmmuma to com n ct the project(Sec.7014,Business and Profession Cade:)The Compasses Li. cense Law dare not apply to an owner of property who builds or improves themon.ad. who contracts for such projects with a com momrO licensed pumoant to the Conummes License Lew. ❑I am exempt under Sm, .B&P C for this resmn wner Dam WORKER'S COMPENSATION DECLARATION 1 hereby,affirm under penalty of perjury ane of the following delwions. 1 have and will maintain•Cerifeme ofConsam m self-imu a for WonmesCompen- mtlom.a provided for by Section 7700 of the Labor Code.for the performance of the work for which this permit is Issued. ❑1 have ad will maintmn Worker's Compensation Insurance,as myuired by Schon 5700 of Ne Labor CMM,for the performanm of the work for which Nie Permit is Wood. My Worker.Compensation Inssnm ca r and Policy number talM:gqW Ceder. Poll EJ(EMey RTIFICA •OFITION FROM WORKERS' COMPENSATIONINSURANCE (Thusection reed not be completed If Ne permit is foram hundred dollaa(5100) or fuse) I unify that in On performance of the work for which Nil permit u issued.I shat]not employ any person In any manner an as m become subject to the Worker!Compemadan Laws of Celifamia.Dam Applicant NOTICE TO APPLICANT:Ir,after making this CemOcam of Exemption,you should become abject to the Worker's Compensation provisions of the Labor Code.you must O O forthwith comply with such provisions or Nmis M i shall be duemcd revoked. 'Z .. „ CONSTRUCTION LENDING AGENCY y (—r 1Mseby arfne Nn Nem Is a caruuucdon funding aRney,for the Performance or (Yi> the work for which this permit Is Wood(Sec.5097,Civ.C.) L0 Lender,Name =z Lender',Address U Q I cerify that 1 have read this pplication turd slow that the show Information b ilr^ cormm.l agree Or comply with all city and county ordinances and sum[am mining m Q SU' building convection,ad hereby euthorim mpmanutiw,Of this city to Omer upon the Liz above-mcndoncd Property for inspection purposes. (We)agree to ave,indemnify ad keep harmless the City of Cupertino against r IA labilitlu,judgmemu,costs and expenses which may In any way acme against aid City t)7 In consequence of the granting of this permit. Fi APPLICANT UNDERSTA ILL MPLY WITH ALL NON-POINT Issued by: Date OURCH REGULA t/� C ,A ` I Re-roofs Sltnuwe(TrApplicadiffrommilmor Dam HAZARDOARDOUS MATERIALS DISCLOSURE Type of Roof Will doseCuentser future WildingOccupantChaptswmorand Health and u de0ued by the Cupenlna Municipal Code,LTaPmr 9.17.and the HcaIN roti Safety ada.saedamzss5z(.17 All roofs shall be inspected prior to any roofing material being installed. ❑Yeo Will the.:pliant or foam building m:uPam use equipment or denim,which If a roof is installed without first obtaining an inspection,I agree to remove Smit harsrdnua air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection. Distric97_E]Ye. �No I have mad the Weardws materials requirements onderChapwr495ofthe C.lifom all Health&SalnyCodc,Setiau 25505.75555 and 7351/.l undentaM lou franc Wilding does not currently have a u n m.Wt it as my a ihility m notify the occupant of dos mjg�m(remcnta which mum van fir,certificate ofocswaney Signature of Applicant Date ownerora NS� m (nC All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 &CO Fax(408)777-3333 �UPERTINO Building Department JOB ADDS-71RESS: Sr' PE O a 600 s'3 OWNER'S NAME: ►NM @ Cd PHONE# _g GENERAL CONTRACTOR FAX# Co IF, a I am not using any subcontractors: St ature 7 V1Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring. Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing V*0!MQ—Q HW 4Z41 Roofing Septic Tank Sheet Metal Sheet Rock Tile Contractor Signa a Date M IOr CITY OF CUPERTINO psis S REPIPE/ SEWERS/ MAIN SERVICE CUPER,TiNO PERMIT APPLICATION FORM APN #�t O , (9/7 Date: Building Address:�Ya(/p�3 Owner's NamePhone#: V8 tO o q3 Contractor:` /�✓✓���/ License#: J / Contact: �y Q� Phone#: Applicant//Contractor: (1 Building Permit Info: Bldg Elect lum Mech Job Description: Residential: \ Commercial: Sq.Ft. Floo Area: 21o0 $/Sq.Ft.: o Architect/Engineer: Valuation: 5Y O D cY0 • Type of Construction: Occupancy Group: Qty. if Applicable Fee ID Fee Description Fee Group PPERMITFEE Plumbing Permit Issue PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPFIXTURE Pblg Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING 43 r4=!. \v 1� BUSLIC Business License BUILIDNG �,q 3 0`2,