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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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1£ J`i '4L'"�':'j,.Y�^.(lNi'u, M.eC
BUILDINO ADDRESS:
GREEN FIELD PLUMBING
PERMrr NO.
OINEWSNAME:
3513 MADRID DR
Q A
LEE C
R'
(408) 946-5150
SANRARYN 0 OL NO.
ARCHITSICTAINOINEER:
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BUILDING PERMIT INFO
ALDO ELECT PLUMB MECH
0 0
LICENSED CONTRACTOR'S DECLARATION
lb Description
o P
1 hereby afNm that I xm licensed under provisions of Chapter 9 (commencing
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with Section 7000) afDivldon 3 of the Businesx and ProRNme Code. And my license i+
In full fame
F I N A I..E D
and a ea
ueeataw_j tae.«?T f-
REPIPE 2 FULL BATHS.
Dam ARCHITECTS DECLARATION
MAR O 2003
wu
1 understand my plana "I be ed public mcnrds
1"Q' :
-
- BUILDING
Uc%mmd Pmf ngirmal
1 hereby AM= th IN+m exempetmm theontnOoe. License Law for the
following moon. (Sudan 7031.4 Business and ProfeWau Cale: Any city Or county
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which requires a permit b construct, alcor, improve, demalbh, lir Pepair any nrucmrc
prior W its issuance, also requires the applic rm for such permil to Ole asigned memenl
that he is licensed to Na previsions of the Contracmra License Law (Chapter 9
Sq. Ft. Floor Area
h�✓�1 100 -
punuatn
(commcaing with Scetlon7000) of Division 3 of the Busineuand Pfafeuiow Code) or
Y,
that he b exempt therefrom and the bub for, the alleged exemption. MY vlDladon of
E�,,i, wwiir7+�s{.��
3AM V 94LVK 0 0
Occupancy Type
Semlon 7031.5 by any Applicants for a permit wbjects the applicant W a civil penalty Of
not mart Nu ire hundred doldn ($500).
❑ I. as owger or" property. army employees with mages u Nei wkCompeglatnn,
��Trrr777kkAaaa ��T
_ t]]\jl]ER4&()Rd E RJVG
willdo the work, and theawmurtbtwtinsended moRemd foraaW(Sec. 7044, Business
and Prefeusimu Cade: The Camedors Liaise Law does not apply W u owner of
though his
`97LL`s`+`s�"`' I pNjA1r°
301 - ROUGH P UMIG
present, who Wilds or Wprevva therton. and who does work himselfas
own employen, provided that each Improvements am runs mmnded or offered for sale. If.
502 — FINAL PLUMBING ENERGY
seld within am year of completion, the own-
Improveent b er
however, the buildings m
_
builder will he" the burden of proving that be did not Wild or Improve for purpose or
507 - FINAL PLUMBING
tale.).
❑ 1, as answer of the Property, am exclusively contracting with licensed eonuacurt W
romllYen the From (See. 7044. Business and Professions Cade:) The CentnaoM1 Ll-
.. .
cense law does not apply W an owner of property who Wilds or Improves demon. And.
,
who contracts for such projects with a contracerp) Accrued pursuant W to Conuamora
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Lkense Law.
I am exempt under Sec — . B At P C fm this mason
Dau
ORI •R9 COMPENSATIOlD RATIO
I hereby ailing under penalty of perjury one of the following decimations:
haw and will maintain a Ceniftcace of Cotuent W self -Imam for WshM1 Compun-
aaton, As provided for by Section 3700 of the latter Code, for the performance of the
wok far which this permit is load.
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O 1 have and will maintain Workers Compensation Inaursnm, As required by Section
3700 of the labor Code, for Ne performance of the work for which this permit is iswed.
'
My Workers Compensation Insurance carrier and Policy number art:
Carrier. Policy No.:
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CERTIFICATE OF RKEMPIION FROM WORKERS'
COMPENSATIONINSURANCE
(ITis secden shad not k cc mpleed if the permit b for anc hundmd dollen (S I OD)
or La.)
1 aNfy till the pert rmance of the work for which thi+lennit b luwA. I shall not
cmployanypemnu yroenncrs Wkc cube tock Warkcrs'Compenution
Lavas of Dallr ria.
A Iic
N LICA :" , making this CcAOcaor odyoushould
the Lobar
subject Workers Compensation previsions of Ne lames Cede, you menu
mi uomp W o
forthwith romp1Y with such pmvisiaw or this Pewmit shall W domed ranked.
it
I
CONSTRUCTION LENDING AGENCY
I hereby affirm that Nene Is a cowimctlon lending agency for the performance of
' the work for which this permit Is Issued (Sec. 3097• CIV. C.)
Landers Name
Lender'sAddmas
i I agify that 1 have reW this application and stsW that the shout Information Is
' torten. I Agee to comply with all city and county ordiwnaa and ane laws mining W
Wlldingcanswction, and hereby authorim representatives of this city m en cr upon No
( shove-mendaned property for Impecdon purposes.
(Na) agree W save. Indemnify and kap harmless the City or Cupertino agalut
i liabilities, judgmenu. Casts And expenses which may In any my accrue against said City
In 1 APPPLICANT UNDERSTANDSmunce or Am snarti.1 of tANhisD WILL COMP Y WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
/1�� I• �Da• �;
SlgSignature:Signature:of Appliw++pp r Dae
HAZARDOUS MATERIALS DISCLOSURE
HAZAR
WIIl da tuni Wal ingCo e. nom material
, gotthandle Heamow
Chane
As damned by the Cupertino Municipal Code. Chapter 9. U, aM to Health and Safety
by theapple=,rtino
de. Sedan 25531(a)7
All roofs shall be inspected prior to any roofing material being installed.pro+
lNo
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant w future Wilding occupant use equipment or devices which
it hazardous air contaminants u dcMcd by the Bay Arta Air Quality Management
all new materials for inspection.
let?
❑Yes No
I have mad the hnardeas materials requirements underChap ct6.95of the Califor.
nbHcalN@SatetyCode.Scetions13YJ5,15533 and 25534.1 undernend that lffirs, WlWing
dm Iui currently Mm • teenE.011110 m notfye tof the
mibility
mluhcmcnu which must be 1priorcaul arce«;naW
Signature of Applicant Date
All roof coverings to be Class "B" or better
oens w.athad Da