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04040083 CITY OF CUPERTINO wd,,;&' BUILDING DIVISION PE11MIT �CONTRACTOlt INFORMATION BUILDING ADDRESS: GREAT AMERICAN PLUMBING CO PTMN004040083 10060 CRAFT DR 01 NEWS NAME: PERMIT ISSUE DATE CAL—WESTERN PROPERTY MANG. 166 GRAHAM AVE 04/14/2004 ONE: SANITARY NO. CONTROL NO. (408) 995-6400 ARCHITECT/ENGINEER: BUILDING PERMIT INTO BLOCELECT PLUMB MECH 0 0 0 0 Soo LICENSED CONTRACTOR'S DECLARATION e u= 1 hereby arrrm that I am licensed ander provisions of Chapter 9(commencing lob Description 5¢w with Scmiun7000)m Division 3 of me Busi nassanit Pruressions Cndc.and my license is inmBmrceandefressl�. 5r�in4 L PROPERTY LNE C/O 1��1���/�r,5A`II ra�� &✓,, Liccnx Class r—.3U Contractor 990H '�alL ED Eep Dam C-S DECr(RATIOi wvu P211 AwI - �(� 1� ry ARCIall ne semi DECLARATION 1 understand my plans shall W used aspublic records gto at, APR 0 6 2004 c o Licensed rramssmnm S OWNER-BUILDER DECLARATION 1 M1emhy affirm that 1 vin eaanpt from the Cnmmnor's License Law for the w E00 following reason.(Section 7031.5,Business and Professions Code:Any city or county BUILDING U ILDIN � <„� which requires a Permit to construct,alter.improve,demolish,or repair any structure ® M 12 0 °_y prions its issuance,also mrmos the applicant rorsuch permiuu Bleaxignedstaremcnt that he is licensed pursuant to the provisions Of CoreacoOs License Law(Chapter 9 Sq. Ft. Floor Area Valuation at I�-° (commeidng with Section7(XXq of Division 3 of the Buamesx and Professions Code)Or I that he is exempt therefrom and be bais for the alleged exemption.Any violation of Section 7031.5 by any applicaufor a permit objects be applicant o a civil Penalty of 3'A5)R24hk6cr00 Occupancy Type not more than five hundred dollars(M). P Y YP [1 I,as owner orbit property.or my employees with wages as theirsole compensation, will du be work,and be structure is not intended or offered Tamale(Sec.704,Business and Professions Cade:Toe Contractor's License Law does not apply tu an owoel oI 'Required Inspections property who builds or impmvea thereon,and who docs such work bimseUor m dugh his Own employees,provided that such improvements me not intended crefrered for sale.If. however,Use building or improvement is sold within one year of completion,be owner. builder will have the burden of proving that he did not build or improve for purpose of salt.). I] I.asr of me property,am exclusively contracting with licensed convectors to construct the project(Sec.7014.Business and Professions Calc:)The Contractor's Li cense Lsw docs not apply to an owner of property who Wilds or improves thereon,and ,who contracts(a,such projects with a contractor(s)licensed pursuant to be Contractor's Lice am Law. ❑I am exempt under Sec. .B h P C for this reason owner Date WORKER'S COMPENSATION DECLARATION 1 hereby Unionunder Penally of perjury one of the following declarations: 1 have and will maintain a Cenifcam of Consent o self-insure for Workar sComren- sztion,as provided for by Section 37M of the labor Code,for the pcAmmantt of the work for which this permit is issued. t]1 have and will maintain Worker's Compensation Insurance,as required by Section 37W of me labor Calc,for me performance of me work for which this permit is issued. My Worker's Compensation Insurance easier and Policy number art: ^L' Canicr:_57A ._ 9-149M19 Policy No.:-a Q I.35o�'t• CERTIFICATE OF EKEM MON FROM WORKERS' COMPENSATION INSURANCE (Thk xetiou need nm M campleled if the f must is far one hundred dollars(5100) kis) I cent ry that in the rerfnrmanee of the work for which this Permit is issued,l shall not employ any person in any manner an as br become subject to the Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Ccnificam of Exemption,you should become subject to the Worker's Compensation provisions of the Lahor Code,you must .J O forthwith comply with such provisions m this Permit shall M deemed revoked. Z'` CONSTRUCTION LENDING AGENCY l..r Ihereby affirm that there is a construction lending agency Or rimfemanee Lir ame work for which this permit is issued(Sec.3097,Civ.C.) ke A Lender's Name z Lender's Address U O 1 eenify that 1 hat read this application and sit¢mat be salve information is F cone”.1 agree to comply with all city and county aNimmot,and stale laws relining m �U building construction.and hereby authmim representatives of this city to enter upon the W above.mentioned property for inspection purposes. gy (We)agree on save,indemnify and keep har ilcss the City of Cupcninu against rn liabilities.judgments.costs and ex reuses which may in any way sector against mid City U 2, in can qucnccofthc granting of t is rermil. ^ APPLI AhT UNDERST 'D. NO WI HALL NON-POINT Issued by: Date SOUR DREG ATIO Re-roofs Si alit cfA rsicanUCantraclor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof III the applicant Lir future building nacupanl store or handle haumdous material as the sed by the Cupertino Municipal,Code,Chapter 9,12,and the Health and Safety ode.Scnion 25532(a)? ca � All roofs shall be inspected prior to any roofing material being installed. ❑ Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove mil hazardous air contaminants as defined by the Bay Arca Air Quality Management all new aterials for inspection. Diatrlcto �! OYcs P(l 1 vcreadmcharzr nus materials myuircmcnB under Chapter 695 of the CaliforyI (?;2� lJ manes -Safcly Co a.i bits 255115.35533 and 25534.1 understand that if 0.Wilding ,`/_'�/_lJ/ Jces not «cit Y ha c m,Nat it isin pnmlmlay to soul,the lx'cuPan"of the CY rcyu' m mw 'eh " fa GtrllBemmsr hcu ` '- Sig atur o Applicant Date �� o r u orireJagrn" „e All roof coverings to be Class"B".or better ry Community Development r 10300 Torre Avenue r - Cupertino CA 95014 sTelephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: PERMIT# 1©0 _ �� OWNER'S N qt_qre:ri T PHQNE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 21 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing L~biu (�o(p Roofing Septic Tank Sheet Metal Sheet Rock Tile / o tractor Signature Date an CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE a CUPERTINO PERMIT APPLICATION FORM APN # 37S- p Z o�� Date: � Building Address: IODc,cO CRAFT- 00,tve Owner's Name: Phone#: AL- Wesn¢,j o &. Contractor: Phone: License#: 6ReP,TR C0021CM1 (-1KM61Acr z-IOS- Contact:-1�4JAC-- lb Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb (� Job Description: �Rv e�T (-i tis E LC eFln1 v u i Residential 14 Commercial ❑ Cost of Project: I d-ob 6 D • A/Pp . i li a e Fee ID Fee Description Fee Group PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING $ / / 766