01030085 (2) CITY toFVONND
NG DIISIPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRCtiS: PERMIT NO,
1175 S STELLING RD WATER QUALITY PLUMBING 01030085
OWNER S NAME: APPLICATION SUB DATE
RI-ITHER IRENE A AND HETN2 W 1860 ALMADEN RD 03/15/2001
, THONG: SANI'I'ARV NU. CONTROL NO.
( B 67-9330
O O O ARCH)TECIniNGINEER: BUILDING PUMI'II )
L HLW ELECT PLUh MECH
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Lon[I.,I a I lilloRd model 5 DEC11s,N PION .106 DesCEIpl100
Z_ perch✓upinn thus urn IiccuveJ under ptnvhiunx of Chapmr9lcmmnennny
f•_�;u hien 9(MNp nfDlvi,ion3ofthe Bminex<und Pmfcsdunx Cole.and my license
oma
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IiCI"S DIiCLAI1rC\ N
J I.ndenwnd n,plan shall he "'d:u puhlic record.,
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Licensed I'mfc,sional
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> OWNER BUILDER DT;CLARATION
an
n 1 hereby affirm that I um exc.npi Insist the Contractor's License hw for the
r• following mason,(Section 9031.5,Business and Pmr„Jon,Gale:Any city or ommy
O is hlch regnirex a permit m construct.alter,impnwc,drmolish,or repair any aunclose
da
pr or it,itsalso rNtines the pTcu s l i M1 in f l g l omemert m
theithe islicensedpunuantinckMovt. ms ftheC smte,License Uchaprar9 '
(coli at, 'sh Sttni 7(Xkp Illi ,it l f,hcB , dPr I ..' nx Cads Sq. Fl. Floor Area VitfUa
or dun he is exempt 1hcHio..I and the basis fur she alleged aangnum.Any vio[ni I
of Section 7011.5 by may applicant fora penes subjects the applicant nt a civil penalty
of not more than rive hundred dollars($50)1. APN Number Oc Uycy Type
❑I.ir-oor of the propeny.n my ernpinyccswith wage,an.tncU,oleconsEct,sion. O'S: e
will do the work.and the,acture is n intended ur offered for sale(Sce.]MJ, -
sat, and foo a% x Gale;'rise C ma,mrx Lice,,Law does.,of apply to Required Inspections
owner of property W honhuil<k or'inspruves thereon.und who does such work himself
or through his own employees.prat idea that such hnprovemenu arc not intended m 106 — SEWER & WATER
of emd for sale.IL howcvc¢the budding or ianprnvement is.old within one yen,of
in.tnplemon.theowmn.buHder will bate tat burden orpo,in,that he did rept build nt 202 — UNDERFLOOR PLUMBING .
tpmve for°har"a.e nr.ale.k 301. — ROUGH PLUMBING
❑I,ux swore or the pro,co,um exeluximly cortm,do,with licensed comoumors to
met the Project(See.70).1wc,.ineand Prot—im,Code)The Contractor. 302 — TUB & OR SHOWER
consumes
�e a Law does not apply to un nwa or property who build-c impm ,,hereon.
mJ sono,nnUmns for wdt pmleuts with a mmuvanr(r)Ilcens,A
ponunt ,,the 502 — FINAL PLUMBING ENERGY
01 air
Count License h0).
❑Iwata exempt under see. ,BxrPefor 71st'mason 506 — GAS TEST
o ser Dae 507 — FINAL PLUMBING
WORKER'S COMPENSATION DECIARA'ION
1 hereby anima cast,,penalty o1'perjmy ung of 1h,following declmution.c
❑ I have and will ntaimain a i2c,mr am of Comam to,'el6inwr, for W ake—
Coml<mation. as provided liar by Section 3900 oI the Labor Code• for the
penormance or the work for is Inch this permit is issued.
❑I have und will.uulomin Wnrke, Cooap..Isla n In.uru I,c.as required by Section -
3700 of the labm Code.liar the pedommnce of the work for which this permit is
issues].My Workers Cnntpen,mlon Innunance carrier and Policy mmnbcr am:
its crri<uNrrl Ppit.1fi?tL wh134yt1Z.'_1$ Q
CER9 iCA'1'1l1NOp EKEMPrIONI RON WORKERS'
- C(NIP[NSATION INSURANCE
(This section need not he completed if the permit i,for one hundred dollars
IS tont nr le".)
I certify that in the performance or the work fns which this permit is issued.1
soill not employ any hereon in any iammr w a%to beconm subject to the Workers
Cn.mpemmioo l.cwe of C.dilomia,Duro
Applicant
NOricE TO APPLICANT:If,ah,r nwking his Cerro icam of Escmpsion,you Emold
OOhccome.uhjsO to nhc Weikel,Cotnpemmloo'n'skions(It the Lahor Gine,y....mat
Ganhwith comply Is hit such pmvisimn or this",rout.%hall be Jcemml reouaid. .
z
V�
CONS TRisis laNLENDI NO AGGNCV -
� � 1 hercar million that there its ttm,d(Site097.lending Co, .) for the perinntancv:
W
Leader's
work for which this permit i,,issued(See.J(y7]. .Cd
a z Lender'.Numc
= Z (sender'.Address
U O I canny 16.a I have read 11111 uppllcatlom and'late that the.hove infnrntaion i.
C P: r fres.1 agog m comply with.11 it,and r ordinances mad,tree law,reming
O r_1 In hanhimg consrwtion.and hereby amhonce rcpesenmtivmof this city m cmerupm
Fshe ahove.tmrnmpropertyd, edproperty for hnpeaion purposes.0. (We)ua.it,ca,a,indetnni I will keep haonlc,s she City of Cupertino apron,
p) liuhiline,judgments,costs and expense,'Inch may in any say accrue against said
C, Z Chy cn WgEn ce of tic grunting nr thin permit. /j$ `/
l' CF.RF.GUpaiLAT STA 'D$AND WI..CO .`LY WITHALLNON•I'OINT Issued by: DBIC V�SJ
g emmdi p thnetm Dale Re-roofs
IIA%Arfumm Mding ecem )ISCLOSURG
Will tic,C.,wt or house building occupant marcor handle H=tious nmtcnal Type of f
as Jefinal by the Cupertino Municipal Cndu,CM1npnu 9.12 und she Ilcal(h und Safety
Conk.Section 25532(al”
0 Ye, 0 N All roofs shall be inspected prior to any roofing material being installed.
Willthc applicamo,fume buildingocems,n u,a c,tipmam is dr 0)c,which If a roof is installed without first obtaining an inspection, I agree to remove
emit hmurdous air conmmiwnn a,dehned by the Bay Arca An Qnolay Management
rnxtnce all new materials for inspection. Applicant understands and will comply with
❑Ye, Cl No all non-point source regulations.
1 have read the haeurdon,materiak requirements under Ompter 195 of the
California Health h Sulcty Code.Section,25505,255]3 and 25534 1'am,"and thus
irthe Nilding J«rnutcunentlyhaveamnantr asisiunymspmsibilitymnotirpthe
am of she milmmosent which mu,bo +prior to issuance of a Certificate of
°`;rpaacy' S dl-
Signature of Applicant Date
— nror..t cmc All roof coverings to be Class"B" or better
OFFICE