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00090036 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PURMI'INO. 90036 OWNHR'S NAME. `r APPLICATION SUIT DNI It 00 IIONIc SUSAN SANITARY No, C'ON'I Rol.NO: cs ARCHITECrn;NGINEER: BUILDING PERMIT INFO O CO BLDG ELI= PLUMB SUCH sufy IJ IJ 1=1 f_I Fa w Lea bort ill C0ccr,d TORunk,S Dki L,al haat Job Description . " I hemny anon))mal ant canned under prnvi.dmts menapmr 9 rea,mmenentg a=_9 with Seninn]q)npd Division]of the Busineu and l'mfewsions Ctde.and my license iin lull face and affvcl. memecla„ _ Lie.4 WATER HEATER ce 0 Date Cnntralun 3 LL ARCHITE:CT•S DECLARATION C LS 1 me ernland my plan,,hull he tv,d us publle records hiccnwd Poor asinnol FINALED F OWNI?R-BUILDER DHCLARATION © 1 hereby dlirtn)bar 1 um victor,from the Contractor's Licente law ha the tZy� following masnn.lSminn](DLS.Hmrcs.irand Pnsksions Csdc:,\ray city nr county MAY 3 1 2001 z F even I. permit i t t alter inn d linh P y xlmunre - i 3 prior tells o alum bey :the applicant h prnut t t l g d state rte n that heis licensed Pursuant tthe invoision,of the c I tor's Licnosct 'IChapter9 Sq. Ft. Floor Area Valuation fcontmca ing with sectio,71NXp of Division 3 of IM1c Ru,inc,a and Pmfvsi ms Critic) nr mat he I,excmpl Ihcrefmut and he bast,for the ulleecd cxemptinn.Any violminn of Section 7031.5 by any applicant for a pernit subjects the applicant m a civil penally of nm mom than five hundred dollars CS50(u. APN Number ccupancy Typc ❑1.as one,of the property,or my employees with wage,as their stile compenvaban, will do the work,and the structure is not intended or offered for sale(See 70.W, .� Interns,unci Pmtceeian,Code:The Contra,aW,IJcen,e Law doe.run apply In an � ECIUIred Inspections owner or pmpeny Who build%of improves thero-m,and who does such work ni owlf or through his own employees.pmv led that such in proncments are not intended or n — oftcoalI Iv.It,ImoeRT.thennudingorimpnten,enri, oldwitbiumucyearof 50e FINAL PLUMBING ENERGY imupledon, he nwmrbuffer will have the louden.1 mvir,Ino he did bol hoild m 506 — GAS TEST mprove for purinse of,ale). 01.as owner ofthe pnoperty.antcaelnsrvwycone ,in,ON,ranMdinm,ael,+m t„ 507 — FINAL PLUMBING consumer the project(Sec.]IW.Ilusiness and Prnfecsionc CW,:)'I he Contractor', License Low does not apply to an owner of property who huids or improves thereon, and wIW aonew,for each prINItn ort,it conu'acmrs)I'aCnnnd pannoto Io,he Conlnctnr'.,License Law. ❑1 am exempt under Sec. .H&P C for this reason Owner Dare WORKER'S COMPENSATION DECLARATION I hereby atom,under penally or perjury one of the following declarations: I I have and will maintain a Cenifican,of Consent m S IFinwre for Worker's mtpvn,anun, os Irovidni to, by Section 370() of the Labor Code, tiro ,ha Performance mpemanerformance of the work for which this permit is issued. ❑I have azul will tnui ntuln Work Ye Comp,n ,ran n,,vncn,-required by S7ection C 37N)of the Labor Code.for e rforce w of the work for hich this pennil is wed.My worker's Compensation Inwmnee carrier and Policy mm�ber are - wnm,,: Pulpy No.: CERI'IFICAr1ON 01:EXEMPTION FROM WORKERS' COMPENSATION INSURANCE _ (This section need not he compined u the Kenn is for one hundred dollars (S 1Nd)ar It,,.) 1 cenify that in the performance of the work for which this permit in issued,l .shall not employ tiny person in any manner so as to beconm subject to the Workers' Contpenrnion Laws of Calif a nla ITnn Applicant N0n'ICE TO APPLICANT:If,afree making this Ccuificate mf Excmprion,you Sheard haaome suhjc,1 m the Wokurs Cntnpcnml ion pnrvisioms 4 the La o,Code,you mux) Q O lonhwoh comply with such provis onw or This Pemut shall he deemed revoked. Z F ry CONSTIr is ON1.ENDINo AGENCY > 1 hereby attic This Ibere is n c..ed(Sec. coding tigsmcy for the perlinmmece _ of the work for which this pennil is iswed(Sec 31197.Co.C) Qleader's Name Lender's+Wdrew., 1 emify that I h:we mad this application and state that the above innnnintion is cored.1 agmc to a,imply wah Ill city and manly onloar,s and are Tawe retuning Q U to building constmclian.and hereby maluoire representatives of this city In enter upon rhe abnvena n coned property for inspection purposes I( y (Wmugrecmrove. andepeand kccphunly in the ChaofCupvnlniagoint C6 liahilili( judgments,costs and expenses which nwy in any way tisane ai U'said V Z City in c oequence of the mmin,of his permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLNONd'OINT Issued Date SOURCE REGULATIONS, Signamm of Apprcnntrcnmroclor to, Re-roofs HAZARDOUS MATERIALS DISCLOSURE Will the applicant mfuture building occupant since mnandlehamrJommaterial Type of Roof is domed by the Cupemmu Municipal Cd,Charter 9.12.and the Health aad Safety . Code,Section 255320)7 ❑Yes 0 N All roofs shall be inspected prior to any roofing material being installed. Will the applieuo nr lot banding accopiell u,equipmem or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit huurdous air contaminants an defined by the Ifay Area Air Quality Management raem'r all new materials for inspection. Applicant understands and will comply with 12Y,' 0 N all non-point source regulations. I have mad he h raldonr materials requirements under Chapter 6.95 of the California Hicahn&Sovly Code,Sections 25505.25533 and 25534,1 understand that It the building does not uurni n i,have a tenant.th,h Is my ev,o ismilhy to nobly(lie occupant of the requirements which most he mel prior m issuance of a Cenifcme of Oecupattcy. Date Signature of Applicant owmermaummia.ed aces,, Dale All roof coverings to be Class `B" or better OFFICE