00070143 CITY OF CUPERTINO - `a., -' t c
BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION. ;
EUILIIING ADDRESS: PERMIT NO.'^ '� '`;, " f' � - 4
OWNER ASN r.''x S i APPI.[CAT]
111321` CL'IFDEN WY WATER HEATERS ONLY ' � 143
ONG - SANITARY 0 ' Cp NO.
ALTMAN 'IRV'ING AND JULIA' 500 ATHPORT BLV. X17•/24/Gdll&�f
s Z ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
'_(415)3 ELDc el.ecr ,P.L MUCH
�z�
Z8' .K - dICENSED CONTRACTORS DECLARATION * . Job Description
O Z p 1 h by Mon that I'o licensed Je p f Cheaper 9( g - ,
F, F•ulvolhSection 700(1) f Division3 of the Business addP 1 Code.,armary e
.lfllf i Rel
ry e' "Li serClash L' M
XXOy -Date Cotionantar _ P -
N a w iFit ARCHITECTS DECLARATION
Vin° I naersh ldy plan,'heir b do Public WATER HEATER (\.
w_pp L i Prefic,,ound
OWNER BUILDER DECLARATION s t V
s ou=v, I hereby affirm that Larrat exempt from the Contractor's Incence Law for the -
-k�y¢ )llmovid ra,sn (Seat 7031.5. adP fic,,ionsed Ary'nlyor county v
E S O when requires n perm,,to construct.ate,improve Jen il'dto,apo r any arunure '
a3
prin to itsa also yu the applicant f " npmat n .'g d:namcnn _ n
man :rep tt n p : : fm c t t r U Lw(cbayrr9 `Sq. Ft. FloorArea,.' ( Valuation
(eotnme...ng with Section 70XX))at Divisor 3 of the Easiness and Prof iansCode)
armed he is rxeinpt therefrom and the nnsis frothe alleged exemption.Any violation
of Seaton 70315 by a,applicantfor,, aboar,- gea,the a,hearim.civil peachy
of mi osis than fsehundred dollar,(s500). - _ APN�Number : ' Occupanncy�'Ibpe
°1.as e f m'p Perry, Y apl yt : 0 g th np t ! 00
will do the k d Oa7 structurenot I dw!or offered for sal (Sec 7044,
.
en m P rasa c d Th Contra Ur L d t .ply quired inspections .
wnr A propettr Whohold,ori npnwes th...,a,and whoi such wrnk ntmaelf � � 3693700Q�' "
or through his own empluY,c, presided that such improvements are not I ti nded or
offered for sale If,however,the Building or improvement is sold within no year of ' "x
completion.throw terbmav
lderxll heth b d r provlgtim he did not buldor
mprove for purpose sisals): 1502 — FINAL—PLUMBING ENERGY
506 — GAS TEST
'
❑1 fthe pry 1 lar contracting nl licensedcntmrtnl
rrLt tory j
(See.7044 E .- wPrr '.I rem)Tore t , .507 '— FINAL PLUMBING
Cirrose Lnw Jnes n tn apply t n weep rf pmperfy who ht 11'o mprove,th abs, '
- and who compacts for.such pritjects with a contractors)lieciewd,pursurni-to tiro
Combecml's License Law:' t ' s "
°I am exempt under See ,E&PCfar this.,on
.Owier .. Data -
WORKERSCOSIPENSATIONDECLARATION -" a
I hereby gffiml under penally or peJury aneof the following declznnians. - „ s '
1 I mr, ad will"maiintin .Certificate t C ni to If' .Ire for W k r,
pe n, us D 'I d f by 5 ti - 3700'of Ib L h Code, for he
,_Perfnrmanw of the work for which this perms is isarut. - -
I
°I Inildhe Lab..Core, Winter's Compensationto: i ed by Section
3370D714 M toWLabprC de f (heo f ofthetf h hra permit s a i -
is.uled,�My Workers Counters ar n Incur v and Pal'y number ert. '
it r
' Cornea Policy No..
CERTIFICATION OF EXEMPTION FROM WORKERS' - - a' Is ,
COMPENSATION INSURANCE _
(This e,d nn J robe complded if the permit la formehp ndmd dollun r � '
I candy that in pc work vshirth this 'is issued I
II nt cou,nny Yc Y t ,x as h boa ooged to the Work,,,'
Co Pena do r haws fcal ro in Date
..
' I
NOTICE TO APPLICANT ll;zlbarmaking this Cerlificale of Exemption,you should
became untal tolmWorket,Cramparro,ofi,sePn neof,he Lbop Code,you must '
'Q
forthwith tplywithsuch provisions othis parmit.hall be deomed revokaJ
CONSTRUCTION LENDING AGENCY J •^! - '4'
i h by w Ir tl r d t i I d ng reg n}1 thegrr sec
okf 1' htl pain t'stss cd jSc11N7,CIv.C7 -a '.1 - -
''eQWi Q. Lender's Nan • r ,
Le :A IJ ess
'V 1 acarry that II vereedths dichdon card lan,dau'lad choseinformation' - -
W1Hamacer.I agree t,conciply.with all city and county'ordinances and.pl I' Itng' - - -
Q'V
in building coneirectimand lmreby mriodanpresente(ves drift, ty mentor open
the b mentioned property k inspection .n P rp _
F'GI (W)agree t.'ove.indemnify and kep lanno6esta,CtY(if C p Imo against
UVi .Ilablf julgmet. :ts and e sparoes1 'h may inaty evey ace'[ad against said _
Z City in a aegne,ce of thEartian,ofth Prot s _ s ^ ��
r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE n80ULAT1oNs Issued by. •�� J Date
'Sig t 1 Applirant/C t aeon' - y Date
i ' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
wn th-pylic t f t buildingatsondl 1 m t al val Type Of Roof'oof
as defined by the Cupertino Municipal Code,Chapter 9 12, 1 the Health ad -
Sdfieay - • .
'r
Code,Section 255120.
❑Y °N All roofs shall be Inspected prior to any roofing material being Installed ,
wit In ppf t future n li g p ,i nae eq 1 t d - a Inch ''If'a root Is'mstalled without first obtaining'an inspection, I agree to remove.
chair h d s c I t,as deftndby theEryArea A p Managementlty' : -
DI t etoYr_- a °No
all new materials for Inspection. Applicant understands and will comply with :,
lei all non-point source._regulations.
1 have read Ins huzardmi,materials q it r spol,ru ler Chapter 6.95 of the
California Health&Sandy Codc Sections 2550525533 and 255941 taiderstand that
iftire building d t correctlyh d tenant,that its myresponsibility t tf5m s '
-
occupant'or th 9 t h h r oat he t p a m u 1 Certificate .,p f :1 E ', -
Occupancy. - - - Signature of Apphcanh i 'Date `
ownin umhop-d reg nl _;'Dare s. .i,' All roof coverings to be Class B"or better, '
t , .. OFFICE