04120105CITY,OF•CUPERTINO .
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INFORMATION
BUDDING DIVISION : ' . PERMIT
CONTRACTOR
..a<•,..x,_
BUILDING ADDRESS:
CUPERTINO PLUMBING
PEaMITN004120105
19423 CALLE T)E BARCELONA
OWNER'S NAME:
PERMIT ISSUE DATE
hk JAMIE MAY
10297 S DE ANZA BIN
12,11512004
NE:
_
SANITARY NO. --- - -' CONTROL NO.
(408)253-0618
ARCHITEC MNGINEER:.
BUILDING PERMIT INFO
:
BLDG ELECT, PLUMB MECH
•
l� 0 0 0 _
LICENSED CONTRACTOR'S DECLARATION
'
Job Description -
I bcreby affirm am, I am licensed under provisions of Chapter 9 (commencing
- P -. - - -
with Scotian 7IXIU) of Division 3 of the Buvr., and Professions Code. ape my licemc is
in m0 rose and effectG — at qoT
COPPER REPIPE
License Class Lie. g'
Date /�7-/t - Chrcomar v-
-
WATER HEATER. AND WATER SERVICE �7/ - - -
I and V p 1/1¢�-used u public mcomds
2 �1 ECTSDECLARA ON
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Lioensero* awl
NE -BUILDER DECLARATION
0�
I here y affimm Nal 1 am exempt from the Contractors License taw for the
following mason. (Section 703 1.5, Business and Prefesvmu Code: Any city Of County
which mquims a permit in conswm. alter, improve, demolish, or ropy any IWC,..
prior m its issuance, also requires the applicant for such permit to rile a signed eutemenl
that he is licensed pursuant to Line pravisions; of the Conma,mr's License Law (Chapter 9
Sq. Ft. Floor Area
- Valua"000
(commencing with Section 7") of Division 3 of the Business and Professions Code)or
,
does he is exempt thawfrom and the baso for dte shelled exemption. My violation or
APN Number
Occupancy Type -
Section 7031.5 by any applicant for a permit subjcm lM applicant Re a civil penalty of
not mom than five bandied dollen (5500).
37504014.00
the pmpersyar withwagessstheirole eompenaadon.
❑iashe
Required Inspections-
whist isemntende
will dod.wart, and destruction for and, (SxJOaI,Bmear
tsme.net Licam,
ao,dosactaffered
and Co rs Liaaho Las does wt apply ff m owner of
Cam: The C
-
0,whons
himselfor Wo ugh his
sthere is
Warimproveschimprovndwho
'
aressuWwork
ownenywyceii, that such improvements are oraffimpletired for Cole. If.
awn a
uilding
the m year 1c
however. theavethe or improvement is sat
however. or I
not year or completion, Ihe framer,
heur,comf
builder will have the burden of proving dos M did not Wild or Improve for purysse of
salt.).
❑ 1, as owner of Jae propcny. am awknOwly Concocting with licensed conuacturs to
.. ,
ceramic, the Project (Sec. 7044. Business and Profusions Codes:) The Cim rumri Li
coves law does not apply M in owner of progeny who Wilds or improves themon, and-
whoconuacufor such projects with a contractor(s) licensed purawnt in the Conuattofs
License law.
❑ 1 am asempt under Sec. . B k P C far any reason
Owner - Das
WORKERS COMPENSATION DECLARATION-'
1 hereby arfimm under pcndty of pcmjury om or ds following mclmadoss,
aJ l hamand will maimmina Cenificasof Consentloulf-insumfw Worker's Compcn-
-- - - _ -
mian, provided far by S3700 or Ne IaWr Code, far the perlormena of the
forrwhich Nis permit isissued.
I issued.
have and will mainland Worker's Compensation Insurance, as m,iisd by Section-
OOof the labor Com. for the performance of the work for which dais pecoit is issued.
- .... -
My WorCke�(. Cn pensatio�n /sunnce carrier and Polity number an:
��
Cartier: r `' Policy No.
CERTIFICATE OF E)CEMPDON FROM WORKERS'
COMPENSATION INSURANCE
pits section need not W completed if the permit is fusion hundred dollars ($100)
.-
orlcss.)
1 unify that in the performance of the work for which dais Permit is issued, 1 aball not
employ any person in any manacrsn as to become subject to the Workms'Compensation
_ -
LawsofCalifomia.Date
Applicant
- -
NOTICE TO APPLICANT: IL after making this Certificate of Exemption. you should
become subject in (be Worker'a confirmation provitiom of the labor Code, you most
-
foMwith comply with such provisions or Nis Permit shall m deemed revoked.
CONMUCnON LENDING AGENCY
I hereby affirm Vest Vert is a Construction lending agency lot in, performance of
the work far which dao permit is issued (See. 3097. Civ. C.)
LenmYI Name
Lender's Address
I cegree that 1 Max this dune Ian is
above iws
correct I agree m comply with all city and mlatiun
with and sole laws slating
city omi and
had coon ty o
e
construction, oil hereby euthoria<rtners. ies of this city winter upon the
mpress vas of
abovingcotioned
above -motioned es.
ctl ertyarm for on partl
(Wes) agree m Cove, indemnify and kith
a I. dcrunify Imcp hathe City of Cupertino against
m
� IiObilides.ju/dgexpensess. casts and expenses which mayy in in any way accrue against said City
//////�����1 \yam
Co1L5ajAl"Ce f ting
/
APPJ.HCA D RSTANDS AND WILL COMPLY WITH ALL NON -POINT
SA DWI
Issued by: Dae -\J
/
Re -roofs
Type of Roof
L
gig uurC plicanUConuaclor Da
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding occupant mom or handle hazardous martial
as defined by the Cupenino Municipal Code, Chapter 9.13, and the Health and Safety
Code,
All roofs shall be inspected prior to any roofing material being installed.
0y35332(a)?
.
If a roof is installed without first obtaining an inspection, I agree to remove -
Will the applicant or raw. banding oa:upant use equipment or devices which
.mit hazardous air contaminants u defined by the Bay Arca Air Quality Management
all new materials for inspection.
District? ��
❑Yid tLd^a'
Ih Ne havarda smalcrialssquismcnls under CaaPlcrb.YS of the Glifor
ma HC.9I @S c,jC ,Sccduns25505. 25533 and 25534.1 understand the iflhe Wilding
does ten hd a art
n Nm is ts my rtaponsihility m notify lac axuPant of the
mq semen -h t prior to issuance ofa�G[OjfiC<ICo capanC
Signature of Applicant Date
/I\ 1f /// UU
All roof coverings to be Class "B" or better
o
ad am Date
cr a il ca