00070141 CITY OF CUPERTINO I'
BUILDING DIVISION pER1VIIT'r'. CONTRACTOR LNFORMATION: `
-RUILDING ADDRESS:' - PPRMIT NO'' v
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OWNEWS s NAM` 19160 C07ETTE LANE APPLICATION SUR DAPI. t
? BUDGET PLUMBT'NG' 00070141 •
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n ONE, ' LIIJ " 286 pJ RIJANO�E; rjT ,I .SANS PARY NO. CONTROL NO.
;07/24/2000 '
Z ARCHITECDENGINCCR. -1 " !T' '+A- % _ t HUTLDINC,PERSHI'INFO
C ❑O❑ ('510) J0♦377847' BLDG ELECTI'LU MECII' v
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<y LICENSED CONt'RACTOICS DECLARATION a
O z 4 a 1 h ny « m o d I P fel pt 9 ma,tne ny =y.,' Job Description -I
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Licence Class Lu. M
do ad Date C n, I
ARCHITECTS DECLA WATER 'HEATER , .so1 u derswnd try plan, ll bi r d ap ilil record' -
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Licensed Professional "p. r "
OWNER BUILDER DFCI ARAI'IOY - AL4 , _
1 Ev,, I hereby affirin that hain ounip,front he C t L - the
lzvfall b (S f 703,5 H :rio IP f it.Cad All,city
or
h p q n: p I Icstsitue p d po Y: Iope
ad ai 't,pre t t L. un al y ' the appIe ,t M1p a
re
fileasined,latepead
3 0i.,he I,tire:di normant(,,,hep ions iddeContractors Li,croc L fCha �
,r9 S ,Ft.Floor Area'
(e nen'ng widt Sectio,]INNI)of Dris n3ofthe R,sne nd Professans Crclel 6 „ , ^ "Valuation
nr ibis he is exenPt theaefter,red,tl hanis far the II S J cacnaptiod'Au'r violation
of Section 7031.5 by > PPI I t Painful tabled'th PPI I(' l be Try - _
of"atnanePanlinn if,III,I ($500) a - APNNtimber - '
'Occtipancy•`y e
t - , ' $
,yp,�T
°1 t the p Pent y PI Y lh g.a bedside P :'F ° .. YJYJRf
ill do the k d the I I :act irt,pl in opered lot saleowl-10,14,' - - - - "
Biomass d P t : n Code Thec I I L Lad . t 1 alpfly t3750702r"Rr�ired Inspections
Fp p gWh h ea 1 d eon .ndwboJ h mandator
bw •
n er gh M1'. ply p 'd J thro'a't nprove I. t' t Wedbr
offered f 1 If,If th hiding P nen,i old wah'n ,a,ywrof ' I.
- onddi n the h ld III d burden fpmvng,hat he did not huldor t"
imP tier 'ton"a"n ) 502 ._ FINAL. PLUMBING $NERGY
506r — GAS- TEST
°1 n Ili I p ,y a exclusivelycontracting. Ihlicensed contrnat rs t `
asnotroo the p ] 'I Nice,70418 = dPf- ' nCl )The Ct 507. —
License Law daev aa, pldy, ntow r fp p ty , b ld p tr F,INAL :PL"UMBING�I
a,id whin contracts for such prolces with onandin(')I'en:ed puma m I the -
Contractors L : Law' " . S _ ,q
°1 n scaut under Sec. ,B S.rP C fonhls rearm
if
Ow D.,
WORKERS COMPENSATION DECLARATION - S " 1' 1
I j I t , IWI/I1
I t rory afT m nt Pe 'Iqy f p l Y ent In ll g l P t s �� V e"
' Ih and II I CIf , ICnett II f Wk _
oal
pen , p ided f IrS t 3700 I ,h Labor Code, [ II 11/
crf of the work for hhthis pemt , i d �r� `.
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3]fl f the Lab C l f thef 1(lie k 1 which,h 1 ,is
issuedMy Workers CouBuroation I and Pill a pclivara.
it
Carrier Policy b
iICATION OF EXEMPTION FROM WORKERSO a
COMPENSATION
;f
INSURANCE
(Tti. .et t need ons hccsmplctd if0 prmll isr lone hundred dollars
r r
($lnlp or les'.)
1
I ccrify that't the co ccon ll vo,k'ku hd1
hall tpulpit,
1pl Y' typrcnto tinymine, t be 'objectt the
W k ` f M1tt \
ApplicantII(({qqq rllt1pq/j'
NOTICE TO APPLICAN I if. II nkiyll .Cn'I ale of Exenp,on.you should '� 4
Z bee object ,h W k C .t t p Rh 1 h y mus,
Pooh IM1 ply d h p thispatina doll bad d-Code,d '
CONSTRUCTION LENDING AGENCY
aIh by aft nthat tha I nd'ng age Yf the perfannance -
W
of the
work farwhich11 p i'. ild 30970 C)
Ga
Leader'N II \' ♦U _
Lm e Addtl::
I (hillcertify Ih a leadth: pplc, d.tt iklthe h f I s g '
reel l agree m comply with all city and county ordinances L t t 1 lit g - „ ,
C.I building c n incl n dh by' d pee n vs fth':city uncmcr upon "
theloose" - nlanedp l nyI -peen partm '.ta `
Ft O. Iµ 1 grat 'nl fY dk pl n I , the city fC p , , I
V) Ilab ht es,on,rocn,s. I' d ea se vd Llt may m any yracial.fairs,sold. t" t
City in canseyuena of the Roundup of,Ids Perinid
APPLICANT UNDERSTANDS "
C U ER TANDS AND WILL COMPLY W
C L WITH ALL NON-POINT
ISIS b �
SOURCE REGULATIONS. - - 1 J
Y, 'Date,
Sigi I rnppl WC mart ,Data ..' Re- 'Pfi -
HAZARDOUS MATERIALS DISCLOSURE , '
Will theppr ka, n bu king c p' ,:, r handle hamnl to, 1 'hype O 'Roof '
asdefned by the Cu pent Mlnc Pnl Cvda,Cla pmr9.12 and the Health ands f D;, ^pI
t' Coda Seaton 25592(n)'. " 1
°Yes `❑No' , '
- - _ - - '•All roofs shall be,ins inspected prior to an roofs
p p y , ng material being installed.
Wit to alffi6 , future_ building Pat use dyu'P t di ce'which" If a roof is installed without first obtaining an ins ec'tion, 1 a re'e,to remove',- .
cant bard on, t I a.deotie 1 by the Pay Area A' (Iwl ly Management - - - -g P }�'
7' respa
trict7 ' - all new materials for inspection: Applicani understands and.will comply.with -
°Ye - °N all non-point source,regulations:
1 ba e d the z d a.- I Is rcgmmmenls.I nd Chapterfi 91 f hip, "
if H IIIffiSaflyC 1 S t .25505,25593utd 255341 til wtdlhr r
b'Idngd . n lfyh ale ttht , . yrcp hlty, tfythe _
t it a Rqa re t.which must ba ,P' , i } Cloth nic a( ^upaney ySignature,iof;Apphcant ' Daten r ,b_nmd igen, Da,e •+• ,•
'' All roof coverin s to'be Class `;B':or better '+