00110133CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRP_SS'.
PERMIT NO.
10231 STERN AVENUE
AAAA—'BRAIN PATROL
0011.01.33
OWNER'S NAME: -
APPLICATION SUB DArH
BILL PATERSON
1701 S 7TH ST
31/29/2000
' 111IONIi:
SANITARY NO, CONTHOI. NO.
(408)989-6005
ARCHI'I CCT/ENGINEER:
HUILDING PHRNII IINFO
C
BLDG ELECT PLUM){ MECH
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y
1_I I_-1 1=1 I-1
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1Ob Description
InI?DCONmcdtilORSOECLARAfION
1 he¢ny a1I'C Thar I:nn Ilcenttd nnJer prnvisiom ill Cbapmr, 9(cmnnsncing
with Section 7(XXI)of Division l W he Business and profession, Crdc.aml my license
in Ibr'e Ice
=(�__
Gomrtnn
SEWER LINE REPAIR
OL'CI,A A'nON
/
Kj 1.rAer . sad as public maaNs
/
=hall
7
OW NEH-BUILDIi UF.CLARATION
o License for the
affina Inw 11. cxcmpt ffom the Cosion,
I hree
O
Ca y or
.. and profession, Gde: Any anyor
ing rcavm. (,ninon ]In,3,
O
r, aitesa
,M1 requires a Permit mu nsouca alcor, improve demolish, or repair any structure
o which vet de
n
in.,
he wchlraor`wHvill hri nem
wmy,, li,the
innsed
Sy. FI. Floor Area
Valuation
poo,mr, ofru
kisl Im I -ave
— molheislin,witpurwtion70 epnDi,msn3ol
he usineslandprWwon,Cora
(commmnis Section 7(X10)of Di vision Jt Business Caplet
ewhh imJPal. An v nn
the
or that is cxcmpt there li and Inc basis for the alleged c,empnoo Any
l penaial
io any'applicantforapermit subjects the applicant toacivil Penally
applicant
of Section703than
n
APN Number
Occupancy Type
it
m nm Im,m tnan Eve handr,d dnunr, (..(ro)s
01.mnwnerodthe propety, uo my employees with wase, as their wle compensation.
7 1 -701 171M
Required Inspections
will Ju the work, and Inc. sam,una is in Immndcd in offered fur rule (See. 7194.
I. me, and Professions Cade: The Contractor', License law does can apply to an
property Who Builds, r mpmves Ihere .and who docs such work himself
or Itof
�,ai m. awa ca„ laycc,.',,id,d that,arl, is:prnveterns allot mtetded ar
106 — SEWER & WATER
nQeml for sale. If. howm'er, the building or improvcmcat is .mid within one year of
omplenon, the ow nil-0aader will have the burden of proving that he did not build or
POP — UNDERFLOOR PLUMBING
mpnweforp,l,,,rafall.)
.301 — ROUGH PLUMBING
01, as owner or the totality, all, enclnrivcly coatmcdng will, licensed eammno, to
e Cnatetnra
71. business and Nufe,,into Gde:)'Tbm
consul the project (see.9,
507 '-- FINAL PI_ LIMB I NG
License Law dors not apply to an awnet of property who builds or improves thereon.
,
and who contracts Ino snuh prnjlll, will, a,nann,or(l) licensed pmnanl Ia the
Contrvctor, I,imnsc law.
❑ 1 um emn,pt under Sec. , if & P C for this reason,
Owner Unc
WORKER'S COMPENSN'ION OECLAR6r1ON
1 h achy Sltinn under pe.toy of perjury one of the following declamtiom:
'❑ 1 have and will nsinmin a Certificate of Consent In self -insure lir W'ader's
-
Compensatlon, as provided for by Section 3700 of the laiur Code. for the
,con n once of the work lir which this 'Count Is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the labor Code, for Iha pttlm'tnaneu of that wad fm which his peril is
nn,�/I/ Inw Tone carrqier and policy nu?mnMr arc:
'asued. llyy Worker, ow
�Co
artuC! '/Aa Policy Nn.: /1✓—Q��Y/ 'QV
FHTI FIGAlV of OF E](LMFIION FROM WORKERS'
COM PI!NSA i'ION INSURANCE
-
(This section need not be completed if the pem,it is for Inc hundred dollars
IY I IXII nr Ill,)
-
I cello fy (hit in the performance of the wink far Ishich this semi, is issued. 1
shall all cminy any lcwn, 1. any mmmnar so as on became smbjrcl m the Workers'
Compensation Iawn of Culiramia. Dare
Applicant
NOTICE'II) APPLICAN F: If. cher making this Cctilicam of Eaeminim. You should
became whjeet to the Worker's Compensation provisions of the lmMr Code. you mus,
Innhw il, I. .nFly with such Pr. conn, or plot, permit shall be devoted revoked.
/y CONSTRUCTION LENDING AGENCY
1 hereby anion for there is a construction lunding agency for the Iwrrnrnwnce
tiof the work fill which this permit is issued (Sec. 3V)7, Co. C.)
'] Lcndcr'a Name
Itmdcr'a Address
1 ocnity In, I have read thio application and ,,all theahe ahuve Int on non ii,
correct. 1 agree to comply with all city and county ordinances and slam law, relating
to Wilding construction. and hereby uuthoriee representatives of this city m enter upon
y local .. prefer, f It i
y (W) ifireen, civil. indemnify adkeep 1 l,0b,City 1'Caperton a6airw
n liab II : j Ig u. cost, 1 r,itwesl, which at., In any. say illeme ubmml said
� City sensed o of ll, 6' fob Id��,c t.—�
/ 2-
'� APPLICANT UN F,R' 1T4YIL 'OMPLY WITH ALL NON -POINT
Issued by: DatC
y'
'
Re -roofs
amt npn anocnmmnm Dine
IIA9.AR000S UISCLOSUHH
Will Wildinglodec store or handle hleardoanddmcrily
Type of Roof
Capt
the Cucanlnommrc
m defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Sa@ty
Cndu, Sa'dnn 25532(u)7
O Yes 0 N
All roofs shall be inspected prior to any rooting material being installed.
Will the applicant or ti non, nailJing oocvputu use equipment or devices which
Ifa root IS installed without first obtaining an inspection, I agree tO remove
amagmen,
Quty Me
emit hmardaus cit cumantinem, as detinet by the 11ay Area Ar ali
Di,ti'll
all new materials for inspection. Applicant understands and will comply with
❑YIN ON'
all nun -point source regulations.
I have real ma ha'u'l...., .camiuls requirements under Chapter 6.95 of the
Califomiu aeallh & Sakly Cede. Sections 25505, 25533 and 25534. 1 understand that
if the building Anes not currently have a tenu ll. that it is my respnnsibility to notify the
secupam ofIce ""mol nail, which most be ,an Prior to Issuance of a Caml!"he of
Defapaney`
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner Dme
ormalmli,ed.,car
OFFICE