01020015CITY
ND
CONTRACTOR INFORMATION:
'
lOF
DIVISION PERMIT
BUILDING ADDRESS;
PERMIT NO,
1129 STAFFORD DR
CUPERTINO PLUMBING
01020015
OWNER'S NAME:
APPLICA'ION SUB DAPI(
DAVID W00
10297 S DE ANZA BL
02/05/2001
PHONE:
SANITARY No CONTROL NO.
(408)283-0618
All 'I'IiC1 JENGIN17GIi;
BUILDING FERMI I INTO
•
BLDG ITLEC'IPLUMI{ MECII
J I-1
I.ICI?NSFI) L'ON'I ItAC'I O11'S IIITCI,ARATION
Job Description
1 herehy a0imn the Ium licensed under pm
Profe,i
I is Code9ndulmenense
w lb Semhov elNap l)f Divininn J of the Buainen, unA l'mfexxian. Code. unduly license
is m oral rorce anile eel. L y�
COPPER REPIPE'
S—
Licunsc ClacY '� nisi p
alwo
ELT S F,CLARATI N
ARCIII TII
Da10 — Cna,'tibir
I J r J y11 bull he 1 p ill record,
Licensed Pt:: I
I
OR HUILDER ULC\RATION
I I Iy tf that It I lll t1 C I' 9 I' ba
county follow 8 (al >O31 S B and Pn 1 Gd
nes city
y 'ty my
O/
rnli Ary. tdurc
wn'.hlvyu lucid-uilL t,,,lnat,,li in a. a
he l in,
fIor mailpcnmiuoliteazi
Sq. FL Floor Area
Valuatio
skit awocafcment
Ibnlhe'I,lieenmit pw,,am mtheprov ina,.onbecuntmerm'Sland iatw (cn
Ilial he
Calc)
Code)
11 awild Sccriin701Hgnlhehll'I
ffu
$ 000
flthc9ged letopmar.leaimm
m' Nat he is lie Ibe exemption. Any situation
ill he Ile and the
Iany
o ll) peva subjects the
of tiwlino a the s iv any dred doll fin a permit suhjecrt the applicant to a civil penally
31.5 b
,r not mare edam ni hmmrcd minors (ss(xn.
APN Number
Occupancy Type
32606013. 00
❑ 1......ner of llm,no elty. or to,vinpinyas suit w'agca as tbeir nnle a.. r,nsali..a.
Re tilted Inspections
will do the work, and the ,ducwn is not married ur oferad lin vale (Sees 7044,
Bmincns and laofcssior% Code: The Contrvcmr', Licence Use doe not apply to an
r,f prnpany WI hold,,,h,pmve, me,am, and whoao, such work hi'nwif
202 — UNDERFLOOR PLUMBING
or through his own employees. provided as such improvements am not intended ..r
,Iter"I for nine. It. hew.:ver, the laald ung a iluprove'lanl is sold witmn one year of
301 — ROUGH PLUMBING
nmnplefinn, the owner -builder rexill h❑m burden of pontine that he did not build or
lnp,reve ku",tone m'xala.L
502 — FINAL PLUMBING ENERGY
❑ 1. as allr the pmper , ain exclusikely contracting with licensed c,tamelm, to
507 — FINAL PLUMBING
cl)nanal the project (ties 7(94. Basins,, anti Prom,sions Calc) The Come'r's
Litt a Law doenot apply to am owner of pnmeny who heil,b or imprn m tenon.
and will) contract for such projects with a contracm,O) Iicco,cd puauunl m, the
Contramm's License Law.
01 an exen,l muter Sc:. . 3 Ae PC lin flu. rcasor
Own" Dam
W ORKER'S CO.MPENSATIO,N DELL\RATION
I herehy ahrm under penalty cf perjury lane of the fo kol d.el—bom:
D 1 have and will nainmin It Certificate of Consent to salt -intoe fin Worker',
..
Compenmtin 1, as pnrvlded fur by Section 3710 of the Labor Code, for the
performance of the work for which this pernit is issued.
01 have and will a,ainwin Worker', Cmn,vruauion hnsorancg:n re4tl'Ired by Sacfin I
3700 of the Labor Code, for the performance of the work for which this pculd, i.
'
xuj{(.m/'mc u
issued. My Worker's Con pensatiun uain.a and Policy ether ore:
cmric'.324 sf+tic i tm'S oIR N,.: l�)076�Y I y
s CEwn ICATK N OF EXEM19'ION FROM WORKERS'
it
it
1f COMPIiNSAI' ION INSURANCE
(This necti,o reed ill,[ be atopl"ed it the Iertnit is for one hundred dollars
(51430)... less.) ,
I cl rtify that in We performance if the work file which this permit is issued, I
shill not unfitly any pemmn in any manner so as to biome subject to the Workers'
'
Cr u"oulinn Luwn ,I Caromio. Date
Apd,canl
-
N(yl'ICH 'IUAPPLICANT: II: altar lnnkine lhix Ccniac:ec of lTxmnpJnn. you A Ill
becvme,object h, the Workers Compsnsxtion provisil)m of the Irbor Cafe, you must
it ... lovin comply with such privisionr. or rail panni, ,hall he dcuaal ,—kat,
CONSTRUCTION LENDING AGENCY
1 hereby affirm that them is a construction lending agency file the perfoorarim
il'the work for which Ihlx pcnnit is issued (Sec. 3097, Civ. C.)
Lender', Name
LcnJcr'u Address
I citify that I have rend this.,dication and ,mos the the alsov. illumination is
acct. I agree to cmnPly with all city and county endurances and ,tato laws relating
to buil.ling construction, anti hurchy authorize representatives ofthis city h, comr upm
the aLme,ntentioned property for inspection purpuras.
( Vee) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgn cntx, aos1, and esMnes which nay In any way ,cane aguina ,aid
City in ciroc9 once ..f the ;mining of mix permit
J�V
WILL COMPLY WI of ALL NON POINT'
1.
Issued by: Date
S EG A'RTAlDSAND
V
Signatnc, Applicaut pe Dae
Re -roots
IIALAROO 5 MAI'F.RIALS DISCLOSURE
Wintheapplicantormtulr. Idinx.ee.f.matlm"nanmena,:ndoa,meeap1
TYPe of Roof
its dewed by (he CiTert inn Mudd pal Cade. chapter 9.12, and the Health and Safety
Calc, Swami 25532(11)?
DIf- 1:1 No
All roofs shall be inspected prior to any roofing material being installed.
Will the:amlicm,tor future building tecuf:mt use c,luipment or device, It hich
If a roof is installed without first obtaining an inspection, 1 agree to remove
emit baeadous air cl)aaminnnts as defined by the Buy Area Air Quality Ma lageoanl
District?
all new materials for inspection. Applicant understands and will comply with
°Yen 0 N
all non -point source regulations.
I have rend the hartm,u.s maurii6 va,iruneas ander Chapter 6,93 of the
.
California reallh A Safety Cute. Sections 25505, 25533 and 25534. 1 understand tlml
spaxibilify B, noti fy the
Ift laihlingdocsran c dna fly hills atcnrntlhat it is try rem
xapam 11 e rc rcn m, when must h aet,nor to issuance if a Cenilicafe l)f
o. ,ancy.
*S':� I
Signature of Applicant Date
All roof coverings to be Class `B" or better
Owner oraumorvedageln Date
OFFICE