00120076 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: _
BUILDING ALPfIry;y��( .> I'IiNMIT NO 2_ r
3.Y-'�J I_ WHITE FIR CT CUPERTINO PLUMBING 001 c0076
OWNER'S NAT
YETA RUTH F 1.0297 S UE ANZA BLV 0 APPLICST1OyN ItllDvrLJ/201210
ZONE SANITARY NO. Dr
CONIAOI.NO,
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ClY'1_ AItCfI1TEC1/IiNGINIJiH: BUILDING PERMIT INFO
❑LIA1 ELECT PLUMB MECII
a7 1=J u —I -1
8nad
y T fiLICENSEDICON'TRACTOR'S DECLARATION lob Description
o%=0 1 nr�<ny nlEnsrr,l Ira
lnat 1 nm Gcroerd L1111111,110111110111 t cnnmer h mn,mcueing
W wimsecrnn]INnnn ,ine.. nevy}•9 nJe.andmyiicen.e BASIC BATH REMODEL W/WHIRLPOOL
a m S J
is In fall force an
d 0 d U License Clay._ eyT Lic.p
'yj 3 u Dnlc Cummmor
e AI<CHrlEC'1"S DECLARATION
t 1�O< I nnderxmnd my plan.shall M used u.public records
6 p LiccnscA l'rotcnsinnal /
UatNG id Uan",It of the RAr ON
coo
I mete (Sect on 11. escape hum the Contractor's License law for the
2
following resdreS a(Nation construct.alter,
and Ive.denioli Code:Any city onownty
F O which Ieyuiree a pnmit m conwrvet,ahev improve,demolish,or repair any vlrvaurt
Ccep'on I I. y II ... e t a A t e nc 9
s� (arta licensedpartner,n n 1 fn L t Y v, 1 ten ode) Sq. Ft Floor Arca Valua[p�,,DO❑❑
(Nnnincencing,hes a with healon ant and
he WA n J,f the lege acs:and profession,Code)
9:lVJ1UQ1
nr thatis exempt(any applicant
ant the aper,for the subjects
the
exemption.Any l per lly
of Section,.I ,I98.11.5 byany upplicwll r,r"pennil subjects the applicant m°civil pen:dly
Drum l„are man livebumo-m noullrs lsSlrol. APN N)1Z`rV�ra7. V1 hJ Occupancy Type
3..
01,mownerork, progeny,ru lhyemployeeswith wages e their vole lc(Se.70,1n.
will Jo the work,and the structure LS not imcnJN or aIRmJ for,vk(Sec.9M0.
Bgeincsv and Prnfessinn,Cu 1, 1h Cnmracmr'r License I.aw Joe,not agply to m, qULra ❑❑s}p a•LLions
r of p,,,,,Iy Who build,n,lltlprose,thereon,and wbo does sed,wore,bllnsclf 106 — SEWER
R� H f E�d
o,r through his own employees.provided that such impnwements are not intended or
pened for sale.If,hmcver.the(wilding or i,nprovemmnl is sold within one year of 202 — UNDERFLOOR PLUMBING
ompletion.the owner-builder will have the burden of proving that he did not blildor '01 — ROUGH PLUMBING
i o,n e tar nurnore��frl,L). .�
01,asownc,uf the pn,,n,.atnrsca:ively contownnb with licensed conttaroteln 302 — TUB & OR SH014ER
construct the project(Sec.7494,Business and Proficowns Ccdc:)'fhe Contractor's:am
er Law dons nor apply to an owner orprolzny who builds or improver lhcrcon. 502 — FINAL PLUMBING ENERGY
and wan conlma5 It,, .,It nojed,with .o.nrvamtnl ncen,ee nm,runa In the ISO,f — GAS TEST
Contncmr's Livers,Inas.
O l am escort under Sec. .BR PC I.,tai,«a'”" 507 — FINAL PLUMBING
Owner Date
WOR KER'S COMITNSN ION DECLARATION
I hereby alBnn under penalty of M,.,one of the following declaration.:
401] 1 have and will inanition n Ccnitwric of Consent m,self-imine for Workors
Coforset dun, he provided fnr by Section AW nl'the Labor Cute, fur tar
performance of IM.,,,it for xhich this pcnnit is issues.
D I have pad will nwinlnin Worker's Cn..I,a,nian Insurance,vs requited by Section
3700 111h"Labor Cotler for the pen),w,r a of the work to which this peon(is
issuedCwr, tork,ane:
v �ie C, plipn ll. �.yF•y epN cr'�ndl'ol0��-3
CEMIIICAHONOPL%I;MI1110 FROOMWORKIIIIS'
COMPENSATION INSURANCE
ITLis section need not be con,placd if the peril i,for one hundred dollars
15100)"1 len,.)
1 certify Ilett in the perfnrncove of the work fnr which this permit is i,eued.1
shall not ernploy any person in zany manner so as",bearmc subject to the Workers'
Compenairnn Laws of California.Date
Ap,CEc l
N conic s lb)subject
to.he AN Work 11:ahcr making thin o of Ladwr io d you should
hceonm.sa nr,pmt it ashes Cisions or
provisions shof deabv Code.you mon
� 0 fnnhwith vomply with such provisions ver Ihir permit shall be Jttmcd revoked.
.
ti
F ^ CONS here C Ii...ca,1.ENDI NG lending
age Y
a ' 1heteby°Binh that mereliv conarvanw IvnJingagency lin the perfnrmence
W of ad work for which this psmm is issued(Sec.3097,Civ,CJ
IY Q hcnJer'e Nunm
7 Lenders AJJlees
U Q I venify mat 1 have re:ul dr,application ant amt,mm the above infunnmion is
correct,I agree to comply with all city and county ordinances and orate laws relating
U Ill binding.o...rononral hcmbyenthorlre mpresemaloc%of this city u,rater upon
y r� lac flu ve-ni,alin I,d rouwny n,r impeaiou pu,pnecs.
L li (W'e)agme mmm.indemndy and keep handless the Cityof Cupcnino against
Z habiloic,judgments,costs and expenses which may in any way accrue against said
U ti
City In comequence it the grading of this Ixrmil. /n` _rJ`
APPLICANT UNDERS'T'ANDS AND WILI,COMPLY WI'I'HALL NON POINT Issued by: �� Date C//� B
SOURCE REGULATIONS. Y'
Signature of ApplicanUConlmcmr Dale Re-roofs .
HAZARDOUS MA'I'FRIALS DISCLOSURI! -
WinthevpPliealor fmury binding occupant pal c or handle ligeurdou,ociatial 'Type of Root'
as defined by the Cupemact Municipal Code.Chapter 9.12,and the Health and Salley,
Code,Section 255320)]
Dyes 0N" All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or mouse wilding txcupa,t use cluipmenlor device,which If a roof is installed without first obtaining an inspection, 1 agree to remove
emit hvatdous air conmminam,as dunned by the Bay Area Air Quality Momgancm
)i.triaP all new materials for inspection. Applicant understands and will comply with
oven 0N all non-point source regulations.
1 have read the np InlI I materials re m nl.r undo Chapter hJ5 or the /
California lleahh k Safe,,Code,Sections 255 '2. JJ and 255311 understand that �^'
1flhebui A i,ne"nhle Ily havca'lane get i,l yrespntrriII ity get I (enc
cc upas of doe ragnil'• ¢ u wli , M he s r ur u�ispewe°nl'n Cenllienm of
°""p°"�'' l�pt/at//// t2- Signature of Applicant Date
Ower—,anmorimt agent Date All roof coverings to be Class`•B" or better
OFFICE