02070044CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR -INFORMATION:
BUILDING ADDRESS:
0072 AMADOR OAK CT
19ATER HEATERS ONLY
PERMH'070044
OWNER'S NAME:
RED SNIVELY
70 E. MAIN ST, SUITE 200
APPLI 1%"Osii9A�P002
PHONE:
1z,
(415)566-2209 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
a-
C
BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
1z LICENSED CONTRACTOR'S DECLARATION
20 IherebyaFrmthat Iamlicensed under ProvisionaofChapter 9(commencing
JJi�bb p�
-w with Section 70(10)ofD.,ia,m 3 oldie Business and Pmfessionscale, and my license
y
REPLACE WATER HEATEFZscription
is in full farce an ffce3 Lic, p
ucenaeC a< J 4
Dat Cmamnor
ARCHITECT'S UECLARATI
<j 1 under,e nd no, plans shall he used an public records
i O --owd Peresswrad
Hca OWNER -BUILDER DECLARATION
or 1 hereby affirm that 1 am eaempr from the Condee i, License Law for the
a following reason. (Section 7031.5. Business and Professions Code: Any
city or county,
= CO which requirem s a permit consumer, alter, improve, demolish, or repair any Orucmte
$700
Poor tell, .. ante n'4 the ,,,licam, Initiate perm t to rile a signarrivirement
'- part W is lsed jamormtl the;pmsminesIf the C t License Law
(Chapter 9(commencing witht ,n 7000)ofu o 3 of the Bane. dPof zynCdde)Or th
h '
0'oo8rea Valuation
t h
xempr te f add the basis for he allcjpon
,34 - -2.
of Sen ion 703 1. 5 by any nppllcan, fell a permit vuhjn-,, t5, r oPplimal m a civil penalty
If not more than five hundred delta" 5500)
!
502 A-Vf1plyr
PLUMBINGI ENERGY. Occupancy Type
❑I,ow—act of the property, ur my ennployees will, wages as their sale compea,miom,
rill Jo the work. and ',be structure is not intended or offered for .dile (sec.'7nu
- AS TEST
-
Business and Professions Gale: The Conuactor's License Law dden nor apply ,d an
owner of Property Who builds or Impreves thcteom
_
5 0 7 - FINAL PLI � �T&}Inspeetions - - -
and who does such work himself
or Through his own employ«s. provided that such improvements arc nor intended or
r
offered for sale. IL however, rhe building or improvemcni is sold within one' ear o F
y_..
... .. . ". "-_.
op ov ei owner -builder will have the burden of previn6 thio he did not buil) or
.....
for
improve fell Puryna of sale.),
111 f the Property. am enclu, ly i g lh larsuld coal a t n Id
.. .. .. .. ..... -..
ounromartLa p sect (sec ]'Ian Own dProfession,CW JThc [ mrs
I tv d of apply to an own f property h bu p th
��sta � fs�r lq�® .'
Gs.a,
d
arta who rs contracts for sucn.pm3«rs M a contractors) licensed purwam to the
ontr is die
Cnnwcmis Liccns Law.
LLii
..
❑ 1 am esnmpr under Sec. B&PGfor thlsrcannn
Owner �
... .... ... .... .. _.
NOV '0 C 2002
Date
WORKER'S COMPENSATION DECLARATION
I hereby alfitm under penalty of perjury one of the following declarations:-
P G
BUiLDICiLIVtA
❑ 1 have and udI manmain to Cenilieme of Cerium m self-imu , for Worker's
I Cnmprn>mion, as provider) Ru by Section 37W If the Labor
Code, for the
performance of the work for which this permit is issued.
��p(l1 hacc and will triennium Worker's Compensation Insurance, as reymoed by Sccrm
/f 700 of 0e Labor Code, for the perfornwnce of the for
work which his permit is
issued My Worker'C pert , ell c m dP 1
eaa Bran
/6F5 V z.3 ..
EX
CERTIFICATIONCOMPENSATION
s,', " r"r�. h_�ery t !'1'[j y'
'
. _ COUPENSATION INSURANCE � ' � �
INSURANCE
t
-' ' •" r � '
(This s -Lon need nm he compineJ if the permit is for one hundred dollars
131 W)nr less.)
;
I ernify ,bar in the performance of the work for which this permit is iaueJ,
shall nor employ any Person in any manner sn m hcenmc
as subject m rhe Work,
Campom.ni n Lawn Of Cablian in Dnm
'
Applicant
NOTICETOAPPLILANT.If. aper maknng thn Cemficme or Eampridn, you should
bocome su en m ihe Worker's Com
on Provisions of the Layout CoJ<, you thud
fort r
hwith comply wltM1 r:ucM1 pnwiaine,,ns or or l this pennir mall fw deemed revoked.
• ' '
9 CONSTRUCTION LENDING AGENCI'
I hereby affirm thauhem is a constructions lending agency for the performance
of the work for which this ,air is issued (Sec. 3097. Civ. C.)
Lenders Name
Lender's Address
I cemify'b„ I nave read thisapplication and name that the above infurmilum is
1S , dl, II J
county ordinances d sr r I sus relining
I. building
1c ., cion dhe by a nu prenative for tyt cmc upon
the M e t ,, Luc. ay f molter Lion pairs Iry .
ed ri It
c
(W uagreet, t le ri fy m, pfaint .s the Cip fC ycrrino'ug,iI,,
1 which may in
lin 3 Jgmnce cons and
V
'
Ciit ing of nes any way acerae aeainsr said
. '. CityinC consequence of the of t'I Lenoir..
UNDERSTAND
,SOURAPPLICANTEEUV ATIONSN'OS AF 'ILL CO.\I Y R'1TH ALL 6r N -P NT
SUUkC[REGUI„\TIO,NS. -1Issued
)
�r t
by:
O
Date
tiignaturc nr ApplicanUCommn-; ar,
IIA2ARDOUS SIATF.RIALS DISCLOSURE �
j
Re -000f$
ll the applunt future b slain, oecp tI' or. simile luadlonsnamral'
as d 1 Wd by th C p i bl n' 'p I 0 d Lh pr 9.1 nd the Health end Safety
Type of.Roof..
... ..
C adi, Section 25532(m,..•\
Will -
..... - .. .”.
..tin fgI to,
Al] roofs shall be inspected prior to.any.roofing
t future building -which
calandll, allcomminution,
r a nm annasdefincdb) hp BayA-;4P Q rltyMouageme
material being Installed. ._. _
1f a roof Is installed without first obtaining an inspection, I
s. pyu�
agree to remove
all new materials for Inspection, Applicant understands and will comply with
hazardous
all non-pointsource regulations. --ve
rcSJ rhe
mmeriak rtyuirtments un r Chapter 6.95 of the ealth & Safely Code. Sleridns 25505.35533
and 2 531. I undernanJ thioin8 does nor cunenrly save a,nraa,. rhm i, is myresnvihilirymnmifthef
he
rhe rcyulrements which must be me, prior m issu Ice of aCe ifa
.oSignature
of ApplicantDate
°rag"' - a,e•
All roof coverings to be Class "B" or better
.. .. OFFICE