02090152 OF
CI BUILDING DI ESIOON PERMIT CONTRACTOR INFORMATION:
"P6"MArRUVEMBER DR ABLE EXTERMINTATORS INC PER),l090152
9MTLNAAGPAWAL 68 SUNSET AVE APPLIC619NfS U)n002
( PHONE: (408) 251-6500 SANITARY NO.L // LL CONTROL NO.
�a ARCHITECT/ENGINEER: a BUILDING PERMIT INFO
w— BLDG ELECT PLUMB MECH
y= LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l an licensed under provi.eions of Chapter 9(commencing STALL SHOWER/TI 29b �PtATIEMENT
F:tto with Section7000 fDlvision 3 of the flacar J Professions CodeanJmy license
or i5 ierr,e ��W4ALEO
co a License erose - r _ Luc. ;_ 71 3
a 0 a 0 Dm u L Conmector �r !XT ddu A?
a w0ARCHITECTS DE ATION
Y 1 understand in plans shall be used as a tic«cords
z L 2002 w p O Licensed Professional L
co_ OWNER-BUILDER DECLARATION
I hereby affirm that I am esemps from she Commcmr's License Law for the $1355
I: a following person.Section 7031.5.Business and Professions Code:Any city or county BUILDINGE xF o which«quires a permit m construct.aloo.improve.demolish,or repair any structure
ca 3�' prowl issuance,also req thef m
such fl statement
ement
that be isl a dpdip aM to thn provisions (rhe Contractors License La (Chapter 9 f 7. O ea-, s1 ,. Valuation
(co etc npwth Se.Y nt7W0)ofDvif 3 fin B 'ne. ,d Proftesons Code) �(b,w IL.r ._fit r.I lS !"'S 5't}IS Iy TA\8.1'D al
or that he Is exempt therefrom and the basis for the allegeii akempim.Any violation
of Section 703E5 by any.,heads for a pemnh subj«m she.p,fc......dvil prnahy
.of nor mom than nee hundred dogarwa5wl. 1 U iAPN4Q9NPA Occupancy Type
01,as owner orthe ndthe sLirmy is of nwishwagesfe thei rsolearmpen710,14,
102 - PIERS
-,wimeo mewurk,-and'. structure Ciaorlmens Li or a Low for:,orasply toa n — Required Ins ectiorl- •'I E
•ownmas aropsoy Whon,ewe:The Comrocmfs Lime Law a«5 nw apply re an 10 4 - REBAR 9 P
owner of pmpeny who Wilds or improves thereon,and who driver such work himretf ,
or through h. n pl yee. provided that such t intended or 105 -ANCHOR--BOLTS
- Irna the in ming p mm, -old rhi,one yeor .__._...._
.offered fictrisale. _ ._._....
completion.be owner,builder will have the burden of proving the he did nor bold or 106 - SEWER & WATER �� I• ��
improve for protons,of sale.).
--- . ...---__-._. __._.__-_-------..__...--- ---_._--._.2.02_-=-. .UNDERFLOOR_PLUMBING_____.—._--
❑L a;owner of the p(Sec.7,am<usin iss a d Professions licen.m he C.nlots m : .i 0:'% G..,`:I'"
License
stheaw oes n(Sec.70aa,owner o and Professions Cwe:)Thever tmeree'S 203 - UNDERFLOOR MECHANICAL ,nT
Liccnu law dam not apply an owner of ProPerY Proves mcrcon, I .• -
- cenawudsaeim 4 - UNDERFLOOR FRAME
..and ho o r u.for Lich Protects witha comrar rtsl.l d purs s to me. ._
20
Contractor'sl < pt s Law tl" a&Per m:.«son 205 - UNDERFLOOR „INS LAT,ION
own " Dole301 - ROUGH PLUMBING
WORKERS COMPENSATION DECLARATION 302 — TUB & OR SHOWER
T;:'.'Ihe'«bYalrirmunde.analtynrarrvryJ4scdtlefruawiageecla�ei„a,: 303 - ROUGH MECHANICAL
3� _ ❑ Ina.e`Lina'wiilmaimin3'crifieatebi"cdn,ht B-reit for Worker's 304 _ ROUGH ELECTRICAL
Compensation, as,pmvided-for by section 3700 or he Labrr Cwe, for he
305 FRAME
se,forio n,e onhe work for which Ito primp is�...ed;ret, 306 - HOEDOWNS
❑IlaveandwiB'mimalb�Wnfkrr:caml,< n1mic,�rmw2,ase,uireby3kddn 307 - INSULATION
3700 of the Labor'Cr,de f thednpeuance of the work'for which this permit m
issued,MyWorker's cmpeniarban Insurance earricr andPoly _308, .—
Policy
08 SHE$TROCK__, _
(f„ ERTIFICATION'OF LKE — - .a...,.�e..^•w—
'STn fC FONOFEP M” ! '7`llyg ov 30.9' EXTERIOR, LATH
MPr FANCE" RKBR$
COMPEN9ATIO AYcc INTERIOR�_Ll1TH
` I' (Th„utio ,ma rth,rat;,plc«wif mePcomtisrrtreehundreddollars' 311 :SCRATCH COAT ,icerq,,rl: `y Lir
alool n _.1 _ 313 - ROOF NAIL _
.-.,y Ic tgmrnm pe Tom - fm k( h hm perm .- .. .. . .._. .--.. -._..--, ........ ............... ........ - - -.
J 1 501 - FINAL ELECT'R•ICALA_ENERGY T._.- -
'�nH t plyyp yp - 'mbecon, bfemt me woken 502 - FINAL PLUMBING ENERGY
Come t C
Applicant. tl.
E
NOCertificate
rTICE TOAPPLICANT 1f rte aki gm Certir t r Essunprom., _503__=--FINAL; MECHANICAL"-"ENERGY'-- - -�
u should
become
-,hlcn so she Weke(.C npcn,at p -ons of the Labor Cal you must
z 504 - FINAL BUILDING ENERGY
0 O forth roti comply .. ubhp '. ns or shall bed< J revoked.
_ . 505- --FINAL- ELECTRICAL _ .. .. _ _..
^ V, .tl ' ' CONSTRUCTION LENDING AGENCY
E. r oO thereby R"rm th tm r.0 'nstroci nn lane nS as<df me pdoisoariic 506 - GAS TEST
of N work farwhich thispermit issued A 'L . Se. 3.0.7.C._C)
ed Ne ,_
_ 507 -- FINAL--PLUMBING. — --- -- —'
Z Lend« Adg,6:,. 508 - FINAL MECHANICAL`I(' ',
✓U0 p., I ri fYm tlh dm.appli mmol the bo<in(ummtion is 50e" INAL GRADE
E., cors« Iagreet comply 'm II. ity a d ,Y ordinances J tam laws relating
+=0;[;1 nr bwlJmg cm,.stmciinn;unit hereny:imtioriro«pmsemxrives ofmis ci,ymen¢r upon 5 0 - INAL P ING
�,:w me abve.mrwmmp,pnpnyJprinip<nrgp m a. ... -. 5 4 - INAL BLI OAKS
(wet dg«em saga indemnify and keep harmless the Cit,'of Cupertino against
-_ Vi liabilities,judgments,costs and expenses which may in any way acntie a,.mo.said
U;ZZ Citymormserorraeofinegramin n't, .
AP LIC, ,."D .STANDS D �COMPLY'WITH'ALLNON-POINT” Issued by, Dale
SOUR RE IO,ISa; ',�•
Z
igna o ApplicanVCourractor -viteure. Re-roofs
i HAZARDOUS MATERIALS DISCLOSURE,.
will mea ppl'caw future building acupa t t more
1 „Type of ROOFZed
r h n 11 harard mdfned bysb CupeninoM cipal Cad Chp¢ 912.aad'hH lth d5fty a , t.551 O .J�� e - ' ., ss. ' . Ilan{ 4l f l ,i t .Y Mror OM1m ? f - - All roofs shall beinspected prior.toany.roofing material being-inst ,-._.__.�._-
WiH the applicant,or f buildingoer p 1use equipment d est itch If a roof is installed'without first obtaining an'inspecno`n_ fYagree toiremove
em t M1 rd cepor
cm t.a.dcfned by the Ray Area Air Quality M nag ment
District? G(/ all new materials for inspection Applicant understands and will comply with
0Ycs • " - - - all-non= oint source re ulat2ons "
I.have reed the hazardous materials ,,u rementr u der.Chap ei 695 of she
CaliforniaHealth&Safety Code.Sections 25505.25533 and 25534.1 understand that
bec.,arr,f Bdoes not cunendy ha,xasn,ami met it is my re,ponsibility to notify she
«cupam pr a«qui«mcnm w ch'List Fe ren Onor m issuance olb CemOcae of
i
., Dceupa g Applicant. Date
s
'� ' .`, -.-Signature of A li
& 41 .. - '„e All roof coverings to be Class"B5'or better'
0 or m orard agem g ,
- . .., .r.: ._ . OFFICE. -.. ....... - . .,._... . .._. .........