00080185 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRI SS: PERMIT NO.
OWNIiR'S NAhti 0)27 TIP APPLICATIO. A 9
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IONe YAMADA KO W AND JOANN SANITARY. . �f ..D.
M-Z ARClll'1'[C'I'IIiNCINC4R: BUILDING I'ERMI'I INFO
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F' e-1 ra.li 1 PLUMB MEcu
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LICENSED CONrRAC'IOR'SDECLARAnON Job Description
5 — i heresy err oo that[.la Ycenced ruder p....kion„of Chapter 9(cnmmencns
uwith Section 7000)of Di vision 3 of the B.,mes Proms+io. odc.andmy license
<yf� i,in lull l9rec Je ce
p O U LiCen+�ey�. Co N
Dae.,y�� cammam BTH REMODEL/REPLACE EXISTING SHOWERS TC
a 3 er F' ARCHITECTS DECLA AIR)
t`ug 1iandemmod I,ld..cshelf baoIdasputilictecssrd, VANITY TOP, AND FAUCET
e.
p Licensed Professional '
°'-. OWNER BUILDER DECLARATION
1 hereby nftinn that 1 am cramp(Bun,the Cmarnao,',License Low for the
hdlnwing reason.(Section 70315.Branesc and ProleoimI,Core:Any city or rorty /
IFS hchr4 ty, itt I tall 1 Ioi p yst tum
m o 1 'or was otarre,aIn requiresth PPI a hl it to II,acso,c],laticuound
e, due be Is1lCensralPooLlout to the p + I flu Cond,naor', Chapter 9 Sy. Ft. Floor Area valuation
(,lanotacia, rhS,cfioa 70101 or Erl v, lel the 11 x',u di 1 .,',ns Code)
of teat he I,eacompa thamewn amt the Not,to,tee allayed a,eagvon.Any viomrlm,
ofStoi 17031.5 nyanynppheatn forn peroot,.Ije,,,teaapphettm bo a .,it friendly
otathan we handled dollar.155a8. APN Number Q cup• cy'1'ype
n,oom
❑I,le ower,of he pmpeny or any couplmyees whh wagas a+their Nae con,peawlinn 4500
wall Ja the xod,rod the swnure is not intended or offered Por wle(Sec.76 .
Business and Predes,inns Codd The Contractor's License Low docs sat apply to an Required Inspections
owner of property Who build or mural thereon,and wfra dms such work him.mlL 35928010. 00
ar thnmgh hi, win cmPlo,ei provided that such impmvnrrcms am am intended or
odertal liar silo.If,herea'a,the twilding ar impawr.rem is sold with;.ane rear of
Impletion,the nevner-huilder will hmc the burden of proving that he did not build or
improve for purpose of sale.) 1.01 — FOUNDATION
❑L as owner of the property. at C,CIus;,cly Cootmatil,g with licensed contractor,to 1.02 — PIERS
,.,.hline e nrojal 1Soo, (M
74, and P,am„ion,Codi,.)rhe Ciat
License Law Joes mot apply to an owner oI'pmpany who han(6 or iOlarwCs thereon 103 — UFER
It who cunaaa, fur inch prujecte with a onmrcan(,) Inansed punuant a,IIIc -
Cu...airn,tar.Lleen,a Law 104 — REBAR
13I cm c—als alt der Sec. .B A,PC mr thio re....1
105 — ANCHOR BOLTS
Owner
WORKER SCOMPYNSAYIONDECI.ARATION - 106 •— SEWER R' WATER
I hereby affirm,andert;enaltrofpe,jory'oneot he R,uoxingdeelataaon.: 202 — UNDERFLOOR PLUMBING
❑ 1 haoc and will maintain a Cemecote of Carucci to ae.iawre far Worker. 203 — UNDERFLOOR MECHANICAL
Comperisa inn. as prm;Jed for by Sadoa :nal of he Latin, Code. fm the
Itarformaneconhexorkmrwhlchthisparnatisisaucl. 204 — UNDERFLOOR FRAME
naraandwillmainwinN'orker'sCompnsmionlnsmm�ee.a> yuimJhysaion 205 — UNDERFLOOR INSULATION
Ip d the Labor Code,for the performunce o[the work lir which this pami(is
oeA.MY'Vorker,C, �n,-yti �,n,+uramc 'ariII Pnncynrmtier are 301 — ROUGH PLUMBING
Caniel�l�� A 7// Cr Nn.: �� 302 — TIJB R OR SHOWER
CEIu1�lnfoN OYE MPrlo, aGM woRK R. 303 — ROUGH MECHANICAL
COMI'ENSAIION IMMIRANCE
rod++aadata a call am be completed it lite parndl i,faforoml
a head dollars 304 ROUGH ELECTRICAL
41W)lrms.) 305 — FRAME
1 aced,diet in the tra fore anea of the wnrk nor which this parma i+;..red.1 306 — HOI_DOWNS
.hall amt c:nNoy any petvam I.any nowner>o ns to become.abject ,,,he Workers
Compensation laxs of California Dam 307 — INSULATION
A,phcant
NGmCLTOAPPLICANT:ILnfmrmakingthisCcnitia¢afli,cmption.you Jbwld 308 — SHEETROCK
becomearo
%obje ,n the worker's Compcahnn provision,til the Labor Code,you moa
O fonhx;thtoold, ith+rich pro.i,innsarthispertaitshall hebanned raroked' 309 — EXTERIOR LATH
z v
CONSTRUC`HON LENDING AGENCY 310 — INTERIOR LATH
herehy allinn thin them is a canametion lending agency fm the performance — -
m ,tilhewn,ktoo bidsthi,pror,,I,',,.ad(See.3an.ON.C.) 311
SCRATCH COAT
y p Lund,,,Nauru '.
a z 'LemicrxAddre.,c 31.3 — ROOF NAIL.
U O 1ocoltylInd Iholy,malthis amonealimllln,IoaOuflatnknhoCcnif...o'ho.i, 501 — FINAL ELECTRICAL ENERGY
W �r e weer.I.gree to comply with Ill ally and cooly onllnanca,and nate Iaw..ekaing
O r, ml,Iludn"cm,Nmaralaand hereby aad,orsenTrcmamivesofhas city Inenter upan 502 — FINAL PLUMBING ENERGY
the uhu(We).,ioned propend fur ify andinn purpose,.
F a es.j.dgrcca„ave inedastlanse, hut,natyintanCay a,.aNnnag a+t 503 — FINAL MECHANICAL ENERGY
N City in neltermtc.cosec and capen,e+wh¢h any in any way aamc against sail 504 I N L BLI I LD I NG ENERGY '1
U i APPLI comequ NDER TANDS ng of thin permit. `
AYYf.ICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT' Issued by: SSS FI FP'TRTCALDate —2' J �V
SOURCE REGULATIONS.
Signature of ApprcantlContmnor DmC Re-roofs 506 — GAS TEST
HAZXRDOUS MATRRIAIS DISCLOSURE507 — FINAL PLUMBING '
Will the li'licam or future huild;ngm'cupant saacar handle hza
adou+mammal Type of Roof
as defined by the Cupertino Municipal Code,Chapter Q.12,and the Health and Safety 508 — FINAL MECHANICAL
Code. CCYce 25532(al” C No
All roofs shall Ildl postefirgipl(gLo k+11Ftmnft material being installed.
Will Nea"'I....I or mann htmdi...ncettpalll use apl'Iptacnt n,it....a,wldei, Ifa roofis insl• ltho )bt• t t tion, I agree to remove
Ildlha,mdnus sirmnlDarn:nusis JClinel11,the Holy Area til,curdy Managcme„a f1 P;fRfiAl_ ��P�41t1I YSI b
,f+ria,? all new materiaMi'4 Utspgt:f'ilgA& ''Ef Int. -,Rgd will comply with
El ye, 0 No all non-point source regulations.
1 have read the M1avatJaus mmcrial,tequiten,ars Wer Ch far 6.95 of the
,lista Icahh G Safety GWe,Scmiuns25585, 553 ,nd 25534. undersand(bar
s ifthc wilding Jas not currently have a to an,,th it n, c+I,mi .hay to no'fy the
neca m of the reyuir entn which mu be t t par r if icmane of o Celli can,of
Ocety. Q Signature of Applicant Date
Owe a,or.athmiredagcat 17U Dare All roof coverings to be C •s. 'B”or better