00110142 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING AUDRILSS: PERMIT NO,
sTnKES AV BUDGET PLUMBING 0011114
OWNER'S NAME: AI'I'LICAI'ION SUI)DATE
ST 11/29/2000
49
PHONE: SANITARI'NO. CONIBOLNO.
1 R—
BUILUING PERMIT INFO
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yy I,SLDCONfRACfOR'SDECLARATION Job Description
p Z w' 1 bemby ulElin,rrtn Chet ani Iicen,W under provisions of Chuplelu
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with Section 7000).1 Division 3uflhe Hu.incoinl Orale.radmy license .
Cis m full Butt and effect.
zea Lieen.+e ala„ Lie.g WATER HEATER
q O Date Cmltmnnr
u�3 LL y ARCHIFECI"SDECLARAIION
5 1=so g 1 understand my Plans shall M used as public records
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uF1 I homM1y afiitm,ha 1 a entpl Iron the Comracarr',License Ivw for me
tza fallowing reasnn.I Section 7031.1.lasinoss and Pr ions Cole:Any cirynreoumy
$$F o wfirth re,im,apcnion to ort,lowt, Iter p....c.denaulkh, am,en, y unicam
oc ce pant , epursuant
'L 4 II '"I" II : 'hp 'll IIsigned"al tan
a. 'hat he lcnsedpurs t, the linvisions saiCanduacon,1 I Wh,rurr9 Sq. Ft. Floor Area -Valuation
Imm,nenung with Section]INNp of Division 3 of the business and I mess tans Cada
or mal he i,exempt memrrom and the basis for the alleged exemption.Any violation
of Seen-1031 5 by any npplrental or u pe....it s.bjc,i,the applicant to u e.,,I penolly
of Tia,Ti than five Itandred dollar.S500). A PN Number Occupancy Type
❑1,as owner of the pmpcnr.or my employee,with wages as their side compensation. 7� / 4
will d ,h k I,h t is notintended offered ISr sale ISer 7(k . — —
Business and lmee,' t,C Is Ili Cnn- , . I ,c Law doe. noa,ly n,to Required Inspections
x r of,.,,.y Who build,in ini,ancv,bereon.and who da„such woo.himself
or through his uxv empli provided that such improvements am not intended or 502 — FINAL PLUMBING ENERGY
ulcered for sale.IL however,the Molding it,intprovenem is old within one year of _
ontplction.the owner-builderw111 have the burden Til proving that he dill not hand or 506 — GAS l EST
improve tin pugavc nf,ele.).
FINAL NRL PLUMBING
❑1.a,owner of me property,an emecontractors,ively contracting with bee,ned contctors to 507 —
nnstmet the project(See.1(94,Business and Pme—ons Code:)The Contractor',
License Law does not apply to 1 owner of pre sed,who hinds nr improves meteon.
and who commis or such pntjecls with a contracmr(s)licensed pursuant to the -
Cnntemmr,License law.
❑1 am exenm,under Sec. .H&1'C for,his mason
Ux.Tier.Date FINALED
N'URKIiR'S C Date ATIUN UECIARATION
1 hereby affair under penally of perjury are of,he fill—ing deel.unione • b^ 2001
O 1 have cad will maintain a Cenci til Consent to cell.'tnlare for W'orker's OCT 1
Compensation, as provided ear by Section 31W of the Labor Code. (or the
perfommnee of the work for which this permit is issued,
❑l have and will 9uinmin Wnr1 r'%Cmnp.mz,ion l ictuses as required by Sen ion BUILDING
3701 of,he IaMrt Code.for the perfornunce of the work for which,his permit is _
sued.My Worker's Compcnmtion Insurance curtier and Policy numMr aa:
Currier. Policy Nn.:
CERI'IPICA'1"ION OF rXIN1ln'1(3N FROM WORKERS'
COMPENSATION INSURANCE
('Illi.kation nc..I not be cnnlPlatod it the permit is for one hundmd dollars
($IN))or less.)
I certify than in the perlumoutee of the work Ion ohich this permit i,issued.1
,hall Tint employ any parson in any nanuter so as to Iccunm subject to the Workers'
C.... au'ativ.Law,of Colikenie,Dam
Applicant
NOTICE TO APPLICANT,IL cher making,his Cenilicma of E.sentpitn,you should
Zaccount subject to the Worker's Confirmation provisions ofthe L.Mlr Cale.you most
O O fordwuih,r Fly non.ran peltm„hwl be drw,ncd re—ket.
Z CONSTRUCTION LENDING AGENCY
7 I hereby alfnn that there is a construction lending agency for the performance
tali the wntk lot'Ideh thl,pi,our is issue)Sec.3097.Civ.C.) .
0. Q IsnJer'.Nana ,
7 Z 1croer,Address .
f, O I certify,ha I have mad his application and state that the above itdonnatian i,
(w — correct.I agree m comply with.1I city and somuy ordinances mW xuuc awe relating
Q U to building einsluctlnn.and hereby notharlre representatives of this city to enter upon
W the aMvealmmioned property for inspection pulpum.,.
Ey p,t (We)agam in wee.indemnify and keep harmless the City of Cupeninn against
V] fmbdhMs,yalgnlen0,cost,anti capcmd which nary in any way a...uc ag.inw,aid
t„) Z City in eun,,,toa,c of the gnuuing of this panni,.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE,REGULATIONS, y'
Signature of A,fla,unt/Contractor Uma Re-roofs
IIAZARDOUS MA'I IFIALS DISCLOSURE
Will lncapfriction nrfuture building arnpool ,am at haulmlevitation,mmedal Type of Roof
as defined by the Cufunino Municipal Code.Chapter 9.12,and the Health and Safely
Cotle.Section
25532(:u1
❑Yd 0N
All roofs shall be inspected prior to any roofing material being installed.
Wi 0 the applicant(it htmm building occupant use equipment or device.which If a roof is installed without first obtaining an inspection, 1 agree to remove
unihil hnmrdons air o rtmno.utd ns dufmal by the Hay Are.Air pant i,y Management
l,tdae - all new materials for inspection. Applicant understands and will comply with
ore. El No all non-point source regulations.
I I,ve rend the harurJnn,materials m4uiremen,.5 under Chapter fi 95 of me
Cali I's In.Ilcalth&Selmy Cole.Sections 255115,25533 and 25594.1 r Is,mend thul
if me buildingdie.,no,cunenlly have a tenant.,het it 11 It,,r ,pon,ibdhy tonotil,the
ccapanl of the mguimtri which most M arch prior to issmnrm of a Ceniftcam al
`keu'mus, Signature of Applicant• Date
Owner or authorized agent Date All roof coverings to be Class •B" or better
OFFICE