01010040 CITY OF CUPERTINO' _
nUILDINs utvtsioN ',PERMIT• CONI RACTOR.INFORMATION 'E
..
BUILDING ADDRESS: PERMITNO
- � � �
18435 CHELMSFORD DR BUDGET PLUMBING 0 1 0 1 01214 0' ',
OWNER'S'NAME: - '*.., APPLICA'I'IONSUIIDATE
LYMAN MAR 28695 ROANOKE Sl 01/09/2001
PHONE, =r SANITARY NO. CONTROL NO, r .
.(510)303-7847 ,
G C Z ARCH]I'EC'UENGIN ER: • BUILDING PERMIT INFO
m UO❑ 'BLDG ELHC'1' .PLUMB MUCH
m=n LICI NSI D CONTRACTORS DECLARAI ION S
_S.o Inegbraffrmmtl r . d d p' Ic1.Iptarnde;tn as .+ ,. .. . Job Description . .
F Cpl wah4t 700fBdD - n3urmeR dProfcslowCndeandc
nyleen.
g '
in all force deflel _ - T ..a
z'Wa License Class •Lie.« WATER HEATER REPLACEMENT- -.+ -
O O Date- - - = Conacror
a0 - ARaci 'EC'I"S DF.CLARA'f1ON
Ilinion,... d yplin,,dall teased aptblcoco.1,
py�Q _
u,�p�0 Licensed 1dfeasu al . - ,
OWNER BUILDER DECLARATION
L naso fl en that 11. exempt fr., me Goornas C s e Anyo Law far me - +
fell a (Second 70115 B dP f Code A'Y d ,county - -
�5F O w N h q � 1 't( , I R P d I'I p. _ y:I- , « a,
i3� p' t t.': I 1 '.m pll II nP It fl 'b J:nm cn
that he r dpursuant I m provisions fm c I L I (Chapter9 Sq.-Ft. FloorArea Valuation
be g mS ,' 7WO) fD" A f[h B : dP r:. '.Cale)- - '
orn-,lie I,oven Ih bot and me b:.unable dleged xempno Any veLfen ;i $750
r oI Section 70315 load,a,licautroeap 't. hive,the apptla,ntmI...lp nmdy -
of 'than frehundred e llars($500). APN;Number- _ -Occupancy Type
❑Lw iwneroflhepropnny,urmyempinyeew with watt lheiraole cempnwaiion, ^ 3752212144. 00
"
will do the k d the:I t do,intended or offered fir vale(Sm 7(113, _ ..
Business d P r.: cod n C t t ,E n L d l p'Iy t an - "r, ' : '.Required Inspections -
er f p p rty WhoF Id: Ip th and h d t
k n ,,if
awrm nchnisownempi,ya.. prea
eedbar. ch'mprovc Is are not inted lo, 502 —' FINAL PLUMBING ''ENERGY
l offered for sale.E,however,ale handing or lotprovement Is.sold within ode year or .-
�otnpution,ale owner-baimerevill have ntebarden ofprotill bat nonninal mdldor 506 —`G,AS. TEST -
,tprevamrpnrpe�cofs,na.). ° - 507 . FINAL PLUMBING - i'
❑I,as owner of the p pent i ly contracting with I' d anewlers to
onstrct(lie project(See 7034,Business and Prafeasrns Cale) fhe Contractor.
'License Law does not apply to an owner of property who builds orimproJes thereon;
P' and who cuslool, for sa,hprojeca with n uh,O,ao)licensed pursuant m the
O luda -
oris I:iccn.e Luw. - - -
hmexemptunderSeo. .E&PCfer his reason
Dwner'. • •,Date PINA .E.Cf
WORKER'S CQMI ENSATION DECLARATION
I hereby fill norder Oil p fury one of the 41h wing deelurafon': (` - 1 - p
❑ have will d C YI ate or Consent to w If' f W k 'v ( OCT " 0 2001x, -
Cr Petsatio, es prevnpd for by Sectio;3700 of Ine�Ltndr C,le,far me � '
performance none work for which this permit is issued. -
❑I have and will maid aid Worker's Compensation Insurance as required by section BUILDING
3100 of the Larde Code,lth
iar e performance of the work for which this permit Is •-
sued.My Workers Cmnpensation Insurance carrier and Policy number arc: ` 4."
. . -
Carrier: .. Policy No.: t. It•.
CERTIP'I-CAPNWORKERS.
COMPENSATION INSURANCE
"
(This ceirat need (n'be rom0lo d d liepemdr is fin one hd adred dollars -
BIW) ,less.)
1 certify mw in rhe performnnce of the work for which this permit iA issued;1
shall not emplay any person in any drainer so u.In avenue subject to the Workers
Cn 1pensaiien Laws of California.Ilam - '
Applicant
NOTICETOAPPLICANT:If,:tial,making this Cenilicme of Exemption,yiiush dd -
becanesubjeettotheWorkersCompemntienprevisionsoftheLaborCale,you must
Q fonhwim comply with sucll provisions o finis Penn shall be downed revoked'
Z
^F CONSTRUCTION LENDING AGENCY .,
Ih by ciffich dor there is.voriscructi lead g seeiav fonhc perfordiscric, ,
of the work for which t pealt's scored(See 3097.Cnr C.) _
.,CtitQ .Led al
Nat -
.d V Z Leader',rAAddress
leemifyihaalh react this applueetwn and state that the h infatuation i.
W try &II haar l r,rod t cly with o u iy unit vin tty d r Inure. d iche law,ider., ^ -
V robuilding cnstructio,and hereby relic ce representatives Oftliscty diener upon f• II
r� the taxwo-duarriOnedpropcotyf :p t
pr
(We)a,cc to d fyand keepl I ..tleCay atC pn 6ainst '
$ r.I Z liabilities,judginions,cusk and expenses MuchaY inany wayectruo agvnst si iA
APPLICANT NDS AND WILL COMP LY WITH ALL NUN-POINT
'SOURCE REGULATIONS.
Issued by,: Date ..
Signature ofnpplicanec t t -Dare .Re roofs - -
HAZARDOUS MATERIALS DISCLOSURE i
h' w n be epCop t future 6 11 6 pov sm.12, the Health a Sudety .,Type of Roof _ -
Cdel Sed by me Cupenlno Mu Impel Calc Chvpwr9 12, ad the Hmlm and Safcry - -
Codc,Secdion255]2(a)7•
Dyes - o No =. All to shall be/inspected prior to any-roofing material being installed.
Will he ppl' future liculdid,occupan use equiparder or devices which If a roof is installed without first obtaining an inspection, I agree to remove
con,n da.areas d. asdefned h)Ihe Bay ArcaA Qm1,ty Manug neat
Fis t all new materials for inspection. Applicant under'stands'and will comply with.
El Yes 0 N' .. - S' x
all,non-point source regulations.'
_ I has, ,ad the tr d ad el. quire t, t It,Chapter 6.95 of the
CSI[n H Ith&SLftyCd S d 0.2550525555 d255341 d :t Idthat w
Ifni g
build dlcsnet renayhwnl
uvc umlhltt sny to.O.dlit,
h ,,calory the '
ecapam if the regmrmmmet to
eonts which coast be aid, lssnanco ora Cenirrcae or -
OeaupaneY
. . Signature_of Applicant Daie' " -
owneroreumoricaed.goal - 1 Dale A !All roof coverings to be Class"B" or better -
OFFICE.