01050181 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT No.
18880 TUSSLE RVE. SPECTRUM LEAK LOCK ORS INCO1050181
OWNER'S NAME: APPLICATION SUR DATE
. KENT MARSHaLL 17835 ELAINE CT /
PHONE: SANITARY NO. CON'BOLNO.
❑z Z ARCHITEC MNGINEER: - BUILDING PERMIT INFO
O C BLDG Ii1.liCf PLUMB MECH
�a
m❑Es Lrm;IndIIDCONTRd rude,
DECLARAnoN Job Description
1 hereby 0f tba I an,IicxnwA under Pnrciainns nl Chapaer9(ttnnmencing
H=^rC• wit 'caion]OW)ot Uiviy:r3of the Business and ProfessionsCNe.and mylimnse
a m - ,full fnmca
w cell' cuss' Lie.x 3 SEWER LRTERALe..REPLRCEMENT.
P's d Cummer
A o dmi1'Ik-me to lfablic e,ON
C I unJcramnJ my plant.mall he mad ua puM1lic rearm.
ce a Licensed l'rvfosaional
c.ce0
%ca
OWNER-BUILDERexca,un DECLARATION
I naso .IRrm.Lint I nmBUnIr from the G,mrue Cotur,LiAnyc Law cu the
C%w fidluxir reason.($,c m 7031-,M alw, ,. .'.,fids ,Culla'.Any can or county
FO which1 : P 11 t Ilcr ' J dl.d p'' any anvwrc
pro t r 1. y m ppli tf - hpe min fl -b Jammmum
that he is Licensed pun a Ir tilep Int of C I mal L L 'IChapter9 Sq. Ft. Floor Area Valuation
(cram nsncins is ith SW im 70001 of Division 34 the E mineseand Pmfeasinns Core)
or that he is exempt merefrmn and the basis twine alleged exemption.Any violation
of Section 7031.5 by it":Ppreant for a permit subjects the applicant or a civil penalty
A olu nn,m man Ew ha.Nred do0ar(8sn01, APN Number Occupancyype
0 ftsoneaul the prxls,0,.n In,cmpluyec will wages m their sdeconrpcnsation. 375208A 00
will do the work,and the avuemK is Dol mumakd or offered for sale(Sec.]OH,
Br%iocss anal Professions Cade:The Contractors License Law doses not apply to an Required Inspections
of progeny Who builds nal improves Thereon,and who d«s such stock himself
mx mmnglr his awn employees,pma,dm mal rich impnwe,aair,,an,nm intended nal 106 — SEWER & WR TER
o@red lot a:r,11.however,the building(,I'improvemmnu is sold statin neo year of
iopinou.meownmr-hrdmer will nae::me hmnear or proving tire,he did sari Isidd m � — UNDERFLOOR PLUMBING
mmprove for purpose nal awe.).
❑l.as ownernnhepraised,amexcwahelycontracting tithlicensed contmeorsto 301 — ROUGH PLUMBING
consumer the project(Sec.70-14.Budnoa and Profexsinm..le)The Contmrmrs 507 — FINAL PLUMBING
Liccnae I.a.does inn apply to u,,owncnn pnq,any who builds or impnxes therein.
mull who contraen Ibr such pmjcer will, a u.d,aOrn,) Ikcmal pm,,r I ,,the
Conrado,,Liesure L.I.
❑1 an,exempt unit,,Sec. .E K P C for This myon
Owner Dare
WORKER'S COMPENSATION DECLARATION
hereby alEmr undtt penalty n1'iwrlul'y rare or the b llowing decamaliams:
❑ 1 base and will maintain Is CeniBcme of Comem In sell:urme for R'ocker's
Compertsation, as provided for by Sermon 37W of the Labor Code, for the
performance of the work aim which this permit is issued.
Cl I haw z I rill m untwn Worker'.Coanpensation Io.n,rare.as required by Section
3700 of the Labor Curie,,nal The pe hoolAnee of tire work for which this p, rill is FINALE D
cd.My Workers Cnanpemn,ion Insurance carriermd Policy?lumberer arc.
Cmicr,V 19j> PIIQ/I(MolicyNo. LW { 1 /beO t -
1CERTJUN Q 4 200
IPICAON orESEMmN FROM WORKERS'
COMPENSATION INSURANCI!
1'Thls ,Guinn Dual naT be e.... 1,ed it the pem,i,Is Tor one hued—I dollar,
lMW1m R.vr1 BUILDING
1 trimly that in the performance of the work for which this permit is moral.1
shall not employ any ,in in any mannrr 19 us m become subject m the W'(ulk""
Compensation laws of Carib....ia.Dam
Applicant -
NO] CH 1'0 APPLICANT:It,arm,making Thi.Credieae of i?acmption,you should
beconm no subjecthe Wnder'.v Comismotion provisions of the Labor Code.you mus,
Q Q fedhwith comply with such prmixmo,oT alai,permit shall he deemed revoked.
CONSTRUCT[ONLENDING AGENCY
a 7 I hcwhy affirm that there is a construction lending agency for the mdomunee
I The wink rnr which'at'l,cnnn I,,xsu,A(See 3097,Ci,C.)
1 Q Lentle,,Name
Z Lender',Address
U Q 1cenif5'that l have Krol this application and stale that the above information is
Is p correct.1 agree to comply with all city and county ordinance%and state law%Klaring
Q O Tnb IJ' br' lir It by and 'he
hhorite I'rie.- tin:city to nn pan
F, p, tw) g 1, indication, o rI l.aaCiTy f C-pead ,n atnat •
y liable IJ m. 1 d jute i' h may in ) coveagainst said
f) Z City m n s ee the granting of Ih s rat t.
`PPI A O t�UWDS AND W'll. WITH ALL NON-POINTIssued by: Date
Sillatio e nl AppliemMConone(or Dom Re-roofs
IMARDOUS MATERIALS DISCLOSURE
Will the ap,licaut or future building occupant sort or handle hmallous marml Type of
as defined by the CuNnuir Municipal Code.Chapter 9.17.and the Health and Safety
Crile,Section 255321x)?
❑Yes 17 No All roofs shall be inspected prior to any roofing material being installed.
Will fire appli,moa„"i cbuddinga-le,un axe erpdp,mvn m devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
sari,hn,ardous air comamimmol,as defined by the IL,Area Air Quality Management
ui,uncr all new materials for inspection. Applicant understands and will comply with
ore, 0N all non-point source regulations.
I have read The It :mons it., reymmmena under Charter 6.95 of the
Callfun.ie Health&S;J' CnJe.Seeiun'25505,25533 u,w 25594.1 understand End
'ndmbuildn" rcmlyhuvwaucamnu.,hmaislny...pm...f iliryt"a ty The
wcupma r emu which mmT M met ,c 10 Issuance al a Candida,of
°i a Signature of Applicant Date
s'.'ti/•o f
owe• alar armed agaW - hate All roof coverings to be Class"R” or better
OFFICE