04120104.. . CITY OF CUPERTINO
. .�.C� TFa�QpE INI�O_R;_ M.mg.rA"^�ION
BUILDING DIVISIONCOLM
r•,,.
BUILDING ADDRESS: WATER CLARITY PLUMBINGPERMIT N'64120104
0620 GLENVIEW AV
' OWNER'SNAME: PERMIT ISSUE DATE
BONZELL FRANK E AND CAROL A 1872 STONE AVENUE 12 /lc;/2004
NE:
--- -- SANITARY NO. - '- CONTROL NO.
(408) 275-9300
ARCHITEC(ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT IT
MECH
L Op LICENSED CONTRACTOR'S DECLARATION ,
mi F Muhy B that I am licenced under w slams of Chapter 9(commencing - Job Description
n< wim Sce 7 )of Division 3 ofibc Mrazv fcssinns Cod,and my Been.is
-tete In full force deffec t•
y,z LiCrimet - t�✓js` Lie.g. C✓33 COPPER REPIPE AND
=mac Da I Can r / INSTALL' NEW- WATER HEATER - -- —
ARCHOECLA
I understand my plans sr1EC1'Shall W mad as
puM1lia nNs 11•;� B n
mo Licensed Professor onal 1(j,-' L
atIancu OWNER-BUILDER DECLARATION I
+� I masa alarm Nat 1 1. uusin from the Cosion C s :Any Cense Law for my
x 00 following mama.(Section NO1.3,Business and improve.
de inoli Code:Any City or county
K$ which rcyuires a permit m cnnnrucl elmq impmvc,dcmnlish,or repair any suucwte - )(tnt. -
w-'^ prior m is issuance,also requires the applicant for such permit to Glc a signed statement ..�
Rn Bear he is licensed puremn,1.me provism.¢of the Cosuamoh U-me law(Chapmr 9 Sq.Ft. Floor Area — .' -' ValuaOw 80
FFG (Commencing with Section7000)of Division 3 of the Business and prefectures CMC)or f� -
'a", mat he u exempt therefrom and the basis for the alleged Crompton.Any violation of , " It tit 1 iI I '' I
Section 7031.5 by any applicant for a prienit subjects me applicant to a civil penalty of APN Number �`j� � l "'Occupancy Type
no mate than,hundred dollars($500). 36925003 . 00 "
❑I,uownerofinepmpeny,ormycmployceswithwagnwd irmlecompmdon.
will do the Work.and the structure Is not intended orofremd for We(See1064.Buurcv ns Required Inspections
and Professions Code:The Contractor's License law does tot appy to an owner or —'- q p r
Property who Wildsmins,cwts therc.n.and who,doessuch work himself.,Omagh his --- _ -
own employees,provided mat such improvements are not intended at offered for sale.If.
however.the building or impmvxment is sold within one year of completion.me owner- _„-
Wilder will have the burden of proving mat he did not Wild or morrow for putpme,of -
sale.).
Q 1,as owner of this progeny am exclusively contracting with licensed Customers to
Conswm Use projcm(Sec.7164,Business and Professions Code:)The Comssckos Li.
ccsse law does not apply an an owner of pmpcny who Wilds or improves thcmon,and -
whoconoacofor such projects with a contractor(s)licensed ponuant in the Comrumrs ,
LKCRQ La-
C3
'
I.exempt under See. .B&P C for this mason -
Owner Date -- _
WORKER'S COMPENSATTONOECLARATION . ..-
I hereby affirm under potty of perjury arc of me following declarations: _ - -
L]Ihmea.d will meinuina Cenifinte.f Conuntmulf-insure for Worker's Compen- _ -
sation,as provided for by Section 37p of me labor Code,for me perfamance of the
work for which this permit is issued.
O 1 love and will maintain Wortrr's Compewtion Insuranm,as required by Scedca - - -
370(10.Labor Code.for me performance Orion,work for which this permit is issued.
y Workers Compensaion Inwnnce canter and Policy tuber
C 'a, lit' polity
C IP1C TE OF EXFMPIIQN WORKERS'
COMPENSATION 1 .NCE
(Thissatiomwednof be,completed if the permit is for one hundred dollars(SIM)
or Icsa.)
I ceNfv Our in the performance of the work for which this permit is issued.I shall not
employ any person many menrcrso a to become subject to this W.rk<ri Comp.nfatim
Laws of California.Date -- - '- - — --
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you shouW
become subjcm m the Workers Compensation provisions of me tabor Cnae,you muss
.,O foMwith comply With such provisions or this permit shall be dcemcd mvnked.
zN CONSTRUCTION LENDING AGENCY
[-s Ihereby affirm 2. m is a coasunmioa lending agency for me Pcrfumaaec of
C'> me work fur which this Permit is issued(Sec.3091,Civ,C.)
t[1 0 lenders Namc
ns lender's Address
U 0 1 certify mat 1 have mad this application and sate mu the above intonation is �_--
,� conn.I agree 10 comply with all city and county ordinances and state laws relating to \
0 U building consumers.,and hereby authorire rcpresentativu or this city to enter upon the
Lu ahovc-mcmioncd pmNrty for inspection PurPOWS.
f-'CL (We)agile or savC,indemnify and keep harmless tW City of Caissons.against
h liabilities,pilgmcns.costs and e.,.which may in any Way same against said City
(„)z in consequence of me granting of this Permit.
APPLICANT ERSTANDS AND WI -PLY WITH ALL NON-POINT Issued by: Date
— _V
E TI NS.
Re-roofs
Si ef. pp is H nRDOUs M ERIAIS DISCLOSURE D Type of Roof
Will the applicant or Nrmebulf ung mapao pore or handle harardous material
a defined by the CupeninoMumm al Code,Chapter 9.11,and the Hcalm and Safety
Code.Section 15532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes Nu
Will mea applicant or future building equipment t use e ui ma ment ter dcviwhich If a roof is installed without first obtaining an inspection,I agree to remove
rap
mit M1arardnus so-commmonams as defined by me Bay Arca Air Quaky Managcmcm all new materials for inspection.
Disuin? \'
0y. on
I he.mad van aterials mquimm y n@rChapter695olmcCalifor-
miaHCaldt&Safciodc, cross]5505.25533 16534.1 undcnmad in.ifmc Wilding
dors not cum It hp,Ona fir' m� o' ility m testily the cecupom nithe
,Cyui m It
7th sr W tpo a sofa 'finte.raf p :r' Signattire of Applicant Date
�5cr tar au ata am DaAll roof coverings to be Class"B"or better
' m
CITY OF CUPERTINO nll
'alla REPIPE/SEiWERS/MAIN SERVICE % V "C�) ��
CUPEkTINO PERMIT APPLICATION FORM
APN ' �# Date:
a - l y -o`f
Building Address:
6o20 G lem U i eco Ave-
Owner's Name: Phone#:
F2ANK I30NZ—ri L yo8- 2-5, z- 350
Contractor: License#:
N AT'P--� LLAP ITI PLI.I rYt e N b I rJ C- —1-50533
Contact: Cupertino Business License #:
NILK S71TAL ;No
Building Permit Info:
Bldg ❑ Elect ❑ Plumb L
Job Description:
12G- Pipe Ccoppap)
Residential Commercial ❑
Cost of Project: uo
t able Fee ID Fee Description Fee Group
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Repipe of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
ByLIC Business License BUILDING