03060162 i
r CITY OF CUPEIMNO
BUILDING DIVISION PERMIT GQNTRACTnR INFORMATION ,.;
i Bu1LDp"cnoDRFss: ALLSTAR PLUMBING PERMITNo.03060162
32 TTRRRT:4 CT
OWNER'S NAME: 656 N KING RD PERMIT ISSUE DATE
NE: SANITARY NO. CONTROL NO.
(408) 251-6040
ARCHITECT'/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+oo LICENSED CONTRACTOR'S DECLARATION Job Description
F I hcrchyef0rm that 1 am licenud under prmvixinns of Ch.pmr J(nammcncing - P
y`S wi.Sccsiun]BgBuf DiviaionJaflLe Busincs�and Prufcssions Codc,endm licensele
^ � Inm..Cleanderr `' 2 REPLACE WATER LINE
p rt Z Liccnu Clppsse Lin.r
�m Oath Contractor
eq ARCHITECTS OECL RR Oor 0/
e I undcrsunJ my plain shall he recd ea public.,.,or
k 0 Licensed Promotional
cg N 3 OWNER-BUILDER DECLARATION
E n O 1 hereby.(firm thin 1 am,Bumps from the GmslraclCo License Law for the
p o followingreason.a (sails.]onstr Business and improve,
do ins Code:Any city for musty
5$ which requires a pemtit m ennsvucL alleq improve,Jemnlmh,or repair any swnumrno
-Z<
that he
its licensed
pursuant
rsamyuires provisions
for"chpmum's License
ave Chex mens
£ mmormarceinnwit pumile.7 the prov0isio of the Conmnessa Littnselaons Co arY Sq. Fl. Floor Area Valuation
Y�S (cat he I& seem withNSereiore and of Divieionrn(feeged Business ptond n.fAny vi Com)or
Net he B exempt Cemfrom end the bre for the alleged exemption.Any violation of 3 5611067 . 0
Section 7031,5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
Out moa than Bro hundred della.($5881
❑Lu ownerkf the property, re is employees withweanu Nei(sole um.Business ��7��P
will Pr la canes endo: OO Cone etol,Lbaced,Law
donal snot apply 70dd,wner of — WER I� tr ect)ons
and Professions Code:TOO Conlremen, nd who Law docs ors apply lf an owner is g
property who hoods orimproves fere..,and whodusauchwork himulfmrshroughhls 202 — UNDERFLOOR PL BING
own employee&,provided that such improvements ere not intended or oRemd formla.If. 301 — ROUGH PLUMBING
however,the building or improvement Is sold within one your of compleron.the owner.
builder will have the burden of proving that he did not build or improve for purpose of 3 02 — TUB & OR SHOWER
"m.).
I.a owner of the 502 — FINAL PLUMBING ENERGY
❑ property,am exclusively contacting with to
aoatmntthe
oes notpply to an ownefousmdrty who Wilds or:lTue aconstrenmriu. 506 — GAS TEST
come Law does not apply je an owner of property who builds or improves Centra,and 507 — FINAL PLUMBING
who ns Uo,. (..telt Projects wiNacomrutor(s)liunxd pursuant to the Conoadoh
License Law.
❑lcon exempt antler See. ,B&PCfor this reason
Owner Dam
WORKER'S COMPENSATION DCCLARATION
1 hereby affirm under pearly of perjury ote of the following decicomimm: -
IhereandwillmaimainaCeniecsle of Continuo at 0insu a for Worker's Cont
"tion,or provided for by Section 37M of the Labor Code.for on perfotmanne of IIx
work for which this permit is iscat
❑1 have and will maintain Worker's Compensation Insurance,a tequircd by Section
3788 of the Labor Cote,for the performance of the work for which this permit is issued.
My Workers Quiptendion lnnm=emir and Policy num rem:
Cartier. \ Policy No.:
CERTIFICATEFEXEMPnON FROM WORKERS'
COMPENSATION INSURANCE -
(This secsinn need not he completed If the permit Is forms,hundmddullos($101)
or Ica.)
I certify Cat in the performance of Be work for which this Permit u found.l shell not
employ any Nixon in any matter an as In become subject to the Workc(i Compensation -
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If.after making fu Certificate of Exemption,you should - -
become subject to the Worker's Compensation previsions of the LaWr Cntle,you mum
.J O forthwith comply with such provisions Or this Permit shall be deemed mvided.
'Z "•' CONSTRUCTION LENDING AGENCY
I hereby afflict Cal there is a construction lending agency for Performance of
C' the.,it far which fix permit is itsted(Sm.3097.Civ.C.)
0.1 QUnder.pL1 nders Name
Lender's Address
V Q I minify Cal l have read this application and sem that Ce above information Is
ly Ftorten.I agree to comply with all city and county ordinances and sum laws relating to
O building cmisconstrue,and hereby submarine mprraentalives of fix city to order upon the0
0 W above-mentioned properly for inspection purposes.
(We)agree to save,indemnify and keep hurdle"the City of Cupertino against
ray fA Iiabilitlea,Judgments,casts end expertxs which they in any way accrue against"id City
V 7 in consequence offe granting of this permit.
�7
APPIICA U STANDS:AJWD COMPLY WITH ALL NON-POINT Issued by: Date
soURCER L N .
UiG5�3 Re-roofs
igna(ur,of ApplicaHADem
HAZARDOUS
Type of Roof
US MATERIALS DISCLOSURE
Will Be applicant or future building ucupanatorc or handle hrartmas material
as defined by the Cupertino Municipal Code.Chapter 9.17.and the HaIC and Safety
Cade,section 75537(e)?
E]Ya z</ 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
it hanalous air cmntamii amu u dpfncd by fc Bay Arta Air Quality Management all new materials for inspection.
isvictl r`-Vin//
❑Ya
I have mad the haraNnusmaarials requirements under ChaPar6.95 of the Caffor
nu Health k Saml,Cotic.Secuma 25515,75533 and 25534,1 undersell that irthe building
does a., umW1,have a ham"fat it is an,rcapoaibility an mury the..am,of the
reyuirem Amustbc npdor tai,euance for a Cenircam for Occupancy. Signature of Applicant Date
O�ncr orvulhomcd
-egcm Dilaam"' jj•Zt All roof coverings to be Class"B"or better
�
CITY OF CUPERTINO o3 v 6 0/6 Z
REPIPE/SEWERS/MAIN SERVICE
CUPERTINO PERMIT APPLICATION FORM
APN# f Y l Date:
Building Address: C/
g
Owner's Name: ��1 Phone#:
Co tractor: Phone: License#:
7 2,77L -2100
Contact: Phone: Cupertino Business License#:
2,77z b
Building Perrrut Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
/ ,
Residential Commercial ❑
Cost of Project:
L4=•
Qty. if
A li le Fee ID Fee Description Fee Group
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFDCTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
2 Z27Z)