05110134CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMT"ION:�'�'
BUILDINGADDRM:
CUPERTINO PLUMBING
PERMrrN0.05110134
18969 BARNHART AVE
:R'S NAME:
PERMIT L4UE DATE
ZHIHONG LIU
1300 DELL AVE STE C
02/07/2006
NE:
SAND'ARY NO. CONTROL NO,
(408)253-0618
ARCHIIECT/FNCINEER:
BUILDING PPA O
BLDG ELECT PLUMBPLUMB MECH
0 0 0 0
LICENSED CONTRACTORS DECLARArION
Job Description
P
I b)cby a1Nm thu I am keened uMv pnoritio is a Chaps 9 (mmmmring
veith Stenon 70It1)or Dlrlalon 3orcc Bu4raa am Fmicts i. Cock.am mylice—u
In full Iona and ural.
DEMO (E) HOUSE
IJccnse Claa IJc.Y
D. conlacm
ARCHrITCrS DECLARATION
1 umeaaam my p Wu shall he umd as public mcmds
Liccucd PrttfatlobW
OW NEA -BUIL DER DECLARADON
I hereby affirm Nu 1 am Wmpl rrum We Conuulo"LIrco¢ law for de
following mann. (Scrum 70313, Busimas and Pmfeaaloiu code: Any city ac caumy
rht:h rcyuw . Nn'th to cra, c a1R.. mrpm.c, dcmttl N a mPar any anemm
$10000
prior W iu iawnce. alw rryuhn the applicant for such ramlt w file a til amemrni
cnm,amm:a uanac Law/chal.tt 9
Sq. Ft. Floor Area
Valuation
Wn be is bcc mp.maam In we f•o,ieans a we
(cum.ncing rlW Scctim 7000 a Division 3 of ibc Baa, and Pmfcatiou Codc) or
cat b, b ucoN itcerrom and the Was for de Wcpd tampion. Any vloladm or
Occupancy Type
Section 7031.5 by any applicant fora pvmit ahjau Ne applicant W anvil perolty of-5ARMrMer'ju
cot mom that., Bw Wmdmd dolhn ISM
❑ Luowma orbh plopenY•amy vmpbYw rhh vagnucetr nolo comprnumn,
Required Inspections
«IO m th vork, sod de mu)me b mot WbcmN noRam raraalo (Sec. 70/4. Burineu
and Rvresuma Cmc: Th Contr.)afa Littre law data not apply In an awter a
properlyrbcs,Odsaim Ihjnnpr aiodrcsu Els
imwvtAimauf)tforad
tba, ow carol a for o�B,
pre employm,provideddubarch imprm
We dart
withinarc Kar a mmpiniore dx ow,v.
IMM
or ilctof
bditdcr
IIbtuMW{ Mvuuadd
duMa r01 lone the Eurtrn a ports{ that h did Its bWM or impmw for pwpaae of
tS],1, u tmm a th popeaY. am uekvady eon w4h :)-nit cmaatvs b
"Sinn[
cora, La d projen (See o in Bulrcn am Pofetuian Cone:)r,m Cmuauor's nd
mut law does eat ahp jt an owxr Ia tsd or Impoba cancan. and.
o m.,(.)«ht
who mnuanafcar wch pmJecu NWaconuacWr(a)Bcrosed pvaumb We Cmitmala
r P
�\ '
\
Isla law.
J
❑iw eaemp uMes See .Bk PC for thu woe
aj4lapfij J f/,( IN 7
WORKERS COMPENSAnON DECLARAntJN
EurDy a/14m vMcr pv ,y apmj.Y arc or the rolb zdeclantiwc
.
Ibaw. M maIllWeaCWfevkarM•^•malt-IuumfmWataYCmtpen-
=MEW
sW on, ptwldm far by Sation I'R10 a the labs Code, ra We p)farwax a We
rick wbkh wa pttmit is i>mm.
for r
❑ I bow uM will mulnuin Water's Compri Won Inauantc. n mored by Section
37fI0ar th labor Code, for dc pafomwxeof th w for chid this—it Y laud.
MY Warkcla C.,.Jm 1 --ca. coria and Policy mumbo arc:
Carkr. Policy No:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section IeN ant bemnpkzt! tithe parrE liforme huvmeC del Wa (5100)
m leu)
I mtifv dub in the ps orm. of Wt .art for which this .it a laud. l shall not
trn
anploy an)' pvmn in a y mamcr w u n becalm aubkcl to tie War' Canp.0on
Iof Cdffo a. Dox )/ / o
on
Applba/ /
NOTICE TO APPLICANT: IL afer mating this CcniOox a Eaanpim. You sbmM
become auhfat W ce Watt's Compensation "isiom of th tabor Code, yon mtw
fwhwiW comply W Wt such povidone or this permit shall h deemed tnotcd.
CONSTRUCITON,,unin NG AGENCY
I homily cinam ihu Ihem fm the pafmmaes a
rmurvc.
t•
' 3 . Cin{.{)try
work r) which wa pt V inuW (Sic. 7097, Civ. C.)
Lc
ladcr'a Nuoc
faMer'sAmraa
1 certify dot I bate mad aria .pplicaron am aux tiw We show Inromatiun u
' conbcrt 1 spa m comply wild all cry am camty ordioatces and a.k Ion rtWn< to
EviMin[[ovarxtim, are hmby authorim mpca,o a of W4 city n rnW upon We
0 above mmoom,clpropcny for inspection pnryosea
'AC
(We) agmt W saw, indemrify and trop humka the City of Cupenim again,
q liabilities, judgmmu.ewu trod rtpelu) which may in any way acme agalnasaid City
i mcon¢yurnce of WcgMbng of Wu(ermib.
- APPLICANT UNDERSTANDS AND WILL COMPLY Wrnl ALL NON -POINT
Issued by: Date
SOURCE REGULATION
A �-
RC -roofs /
Type of Roof
v�v71O �j
si{natwe a AppliunVConuacxr D.x
HAZARDOUS MAlER1AIS DISCLOSURE
ME tieapplicant)futort Wilding mcvpni am or barMlc havfmus ma iai
dcBnm by We CupeNm Municipal Code. CEapty 9.12. am th Ha1W am Way
k.sectlom255J2(a)7
All roofs shall be inspected prior to any roofing material being installed.
0Yes $Nu
If a roof is installed without first obtaining an inspection, I agree to remove
Will de.pplkml or rI! building occupant sic equipment sir &c cca «bich
emit buardmu air pooumimnu n Jcfutrd by We Bay Arra AIr QtWiiy Management
all new materials for inspection.
O u 7 y
❑Yes ,C-aN.
Inutcrinls
I how orad ce hvaNau mquvemena mdr Claps 695 cath Glifar
mile Ha1W d: S.fttYCodc, Satioa 255(15.25517 w12I531.1 undcrasd Wa I(Nc ddMm{
Joey cot eurtemlY haw • tvvne Wa it u mY ropwwbiEtY b codify We artu0am N do
q m nHwhMnm ahmap a m aan�a.�nre,epr
Signature of Applicant Date
y i�e
All roof coverings to be Class "B" or better
Owns) aatna;xd.gcn D.x