04020106 (2);3
0
z
F
tri
G
U
U
CTTY OF CUPERTINO,
op
U
<�
�CUNTRe�CTOTisIN'T3M'AT�g11T-
BUILDING DIVISION PERMIT
40..1'F T+.,<T�w,+`L. �e�k•mt,t. � tv tt, ata'
BUILDING ADDRESS:
BELL PLUMBING INC
PERMIT N%4020106
OWNER'S NAME:
PERMIT ISSUE DATE
*OL
ONE:
SANITARY C NO.
AR CHITECnENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 herby affirm Nal Tam li¢asod under provisions of Chapter 9 (commencing
with Sued.. 7W) of Division 3 ofthc Business and Pr wions Code. and license is
run eRett
ri
torte ens
uansereem C t Ua& ri- %Y'
INSTAL SEWER FROM HOUSE �� +EP``[G NE
AF
Dau' Con
e
ur L
! - ARCNr1EC1'S DECLARAT ON /
i1
undersunJ my plain
•lY --�
FEB 1 7 2004
•
Licensed Pmfcrei... I T — i/
AWNER-BUILDER
i
� DECLARATION
��.I hereby, am. that 1 ma excmptsmm'thd ComrarYs license Law far rhe
Io
foRlnj!e O.(Salim1031:5,BupinessandPmfmomesCode:Any city orcounty
BUILDING
d%
which meal.�a7pormiCta cdn-,OCL aper. improve: demolish, Or Trish my awmum
;y
PH., m its issuance. elan requires Ne applicant for such permit to file a signedtatement
COmosetr'a Lignac MW(Chapm 9
Sq. Ft. Floor Area
Valuation
Oat he is licensed pursuant In Me provisions of lM
t $
(commencing with Section 7000) of Division 3.f the Budneas ood Profeuiaru Cron) ter
that M u exempt therefore. and dte basis fm the alleged exemption. Any Anhdon of
3 -y it�ero o
Occupancy Type
Section 7031.5 by any applicant fora permit objects the applicant o a civil penalty of
trot more this fm hundred dollars (11500L "
❑ I,MvOfthepmpmy,mmymploymwlthwgea.NeUwlecompewdon,
Required Inspections
dothewowk, andth 7o M. Businw
an,
Law&ply.
and Professions Code: The Cantramts License law don weak appty If an owner
and The Commons License
q P
nigh his
property whom. Ida or irepmvu chimer, and who dmuuch wink himulf is
ed f
ownemployees,pmg improvements aremt for WeIL
year ofdmOEered
the building car I.o sold within one )ear Of completion, the awnen
or i prover
provinis
sultan will Mw the Wrdm of proving No he did nor Wild m Improve fm puryose of
wilder
role.).
1, u Owner of the property, am reclusively connecting with licensed mntramta to
construct the project (Sec. 7044. Business and Profusion Code:) The Container's U.
cease law don not apply m an Owner of proper who builds or improves Mccon, and
who contracts for such projects with a eonuaeror(s) licensed pursuant to then Contractor's
License Law.
C i am uempt under Sec . B k P C (are this roan
ner Data
WORKER'S COMPENSATION DECLARATION
1 hereby aloin under penalty Of perjury ane of the following declaradome
1 have and will maintain a CeNficate of Consent to self-Insure for Worker'. Compen.
ion, as provided for by Section 7700 of the Labor Code, for the performance of the
IC33"737.,W
eak for which this permit is Issued.
1 have and will maintain Worker's Competuadon Homes, as required by Schon
of Ne Ube,care.for the performance of Ne work far which this permit is Issued.
Warkefaciernpensas lmwuran9cartiere Po cv. diem.Tar:
rtier: Iry No.:%lr=
CERTIFICATE OF E%EMMnNFROM WORKERS'.
COMPENSATION INSURANCE
(This sceflm recd not bin completed lithe Mono, Is fora.. hundred dollars(3100)
or less.)
1 certify Nat in the performance of the work for which this permit ts Issued, I shall at
employ any person in my moneran m m become subject to the Workers Compensallon
Lawsofcalifomia. Dar
Applicant
NOTICE TO APPLICANT: If. after making this Cenifmnc of Exemption, you should
become subject to Ne Worker's Compensation provisions of the labor Code, you must
.
`L
forOwirh comply with such provisions or this Permit be dam.d revoked.
Q
CONSTRUCf10N LENDING AGENCY
a^N.n
I hereby eRum that Nem is a coasWninn lending agency Ins the performance of
r7
the work for which this permit is issued (Sec. 3097. Civ. C.)
ALender's
Name
z
Lender'sAddress
'1
Q
1 certify that 1 have rad this application and alar that the above Information is
caracc4l agree to comply with all city and county oNinmces and elate laws misting to
V
building construction, Ona hereby oNorio representatives of this city o enter upon the
{yi
above-mendoned proper for Inspection purposes
(We) agree to save, indemnify and kap hoolers the City of Cupertino against
jj
liabilities,judgmems. costs and esp. which may in any way emrm.pimn mid City
Z
^
in cortsegucnec of the ¬ing of this permit.
APPLICANT UNDER STA DS D L COMPLY WITH ALL NON-POINT
Issued by: Da
SOURCE E ULATIO 1—
o
y;Re-roofs
iBhat of Ap li wcmr Dale
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building Occ.pra mom Or handl.Im mous mauaitl
m defined by the Cupertino Municipal Code, Chapter 9.11, and the Health one Safety
am. Section n5324)7
❑Yes
All 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 car rum. buiidi Occupant use equipment or devices which
it haramnn air comuminints m recd by the Bay Arra Air Quality Mma,morn
all new materials for inspection.
isu icR
❑Yeso
I have rad die Maawdeus materials requin mems under Chapter 6.95 ofMc Cali(or.
nia Health& SafctyCOdc.Soedou 25505.25533 and 15534. Imacrsund Must (the building
Jun not cuneoil, ham a tenure that it la my maponthilily notify Me occupam of Me
requirem tswmmhma pre lar sane es '0
/ G
Signature of Applicant Date
l
All roof coverings to be Class "B" or better
Tar solos < serer Date
171
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS.
PERMIT #10�� a
a ua.uvia..�
SUBCONTRACTOR
T
OWNER'S NAME: -
PHONE #;ZS
GENERAL CONTRACTOR:
EAU
I am not using any subcontractors: v
Signature Date
nnA romnlete the following information:
1 1cGJC
Ulcl.[�
a ua.uvia..�
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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
ner/ Contractor Signature
10/28/03
Date U�
11
1
CITY OF
CUPERTINO
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
r
APN # 2) — 5e� O C)
Plumbing Permit Issuance
PLUMBING
Date: —
l
Building Address:
BPERMFEE
Bldg. Permit Fees
BUILDING
BPFIXTURE
3� s
PLUMBING
311
Main Water Service
PLUMBING
Owner's Name:
Sewers
fPhone
, 408'
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING
Contractor:one:
License #:
bin
'510)
�3tf 5000
-)-Y 7
VO
Contact: L Phone:
R0�J2
`i 0
Cupertino Business License #:
- —7o-\ o
/08'7
00"`/
Building Permit Info:
Bldg ❑ Elect ❑
Plumb
Job Description: t55 c a -k c-�I —13
fo F.�
0-P e ie v
5 �q r (vi I ^r v`� A 7 X ! . � � 1 I-rc, v
8oajr—
U 7 ler
(/ C' fes! fLj .2 C /cc ti
_
Residential ommercial ❑
Costo roject• � � �
Qty "
An r le Fee TD
Fre ilrcrrintinn
Pa. i:rnnn
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Re i e of Fixtures
PLUMBING
BPERMFEE
Bldg. Permit Fees
BUILDING
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING
2 03-
,"Aj