00110056 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22484 RIVERSIDE DR # 3 THE SEWER DOCTORS 00110056
OWNIiR'S NAME: AI'I'IJCAI'ION SUB OA'TI!
WANG FRANNY T AND STANLEY TRIES 1743 ROGERS AVE 11!13/2000
PHONE SANn'ARY NO. CONTROL NO.
(408) 452-0669
BUILDING 1'IiRMIT I ')
0'/O ARCIII'1'IiC'I'IIiNGINIiIiN: HLDG ELECT 1'LU\ MCCII
Z O oai LICENSED C(l51'RACTOICS DECLARATION Job Description
o� e I ny Brat thtl dud p : fare sle. nmm�cceng
f, Cm tb l 91NX11 afD ': '1 I'tl It ices, 1Prot '.' ,Godo.¢I ny license
X18 ln _ XJ �( REF'I_ACE WATER HEATER, REPIF'E HOT R• COLD I
ui3 u lz —11—v—� ARCHI'I CCT:S DECIAR,n(
Hol ON g 1 understand my Alam.hall he used as public.'ad,
�<Y6i
i co LiunvA Pn,l'c„innxl
oYy. OWNB...Iasen"I!R DECLARATION
v, ncleny.(See Jwl I urn Cxempl boon the eoaoa,Coo LiAr, Law nor the
C 6 Hollowingl.penclinn cIli Ls.Ilmincse and Pml cn,ian,Cara AnY an olamply
uFO which rtyvisuaa Penni!to comwcl.aper,improve.Jnnnliitt ore a siranydmcmre
. prior toincensed a.also at to[ba thovisio so thefor Csuch ractors License ga (Chaps em
mothmeis ncingwithSetion7(heprwi,ion.nrthecommemrsuamc�won,Casry Sy. Ft. Floor Area Valuation
(commencing r ma,section]ally of Division I nope Business and forlion Atly vi Gael $1
of thin he e,ecmpr mamfmot and me baa,it the alleged eenprnn.Any los violation
class it
JII]I S it ]it
spoils;doll fors$osX)) mnlUelx the uPPLcum re...vil pennlry
orm,l,ntme moon noes M1ltwrea dou,trs(as,Xa APN Number Occupancy Type
C 1.as owner of thepropeny,nr my cntployces with wogcs a,their sole anmpen.alion. 35617/203 1 . 00
will do the wssrk.and the swcmte is or intended nr of Bred far sale(Sec.71111.
Business and pmfeaian,a.11 Me Counci 'a License Law does or.apply m An Required Inspections
thraf pv,peny who lead.ar imrmvev lnemnn,and who Jrx,inch work himaH 502 — FINAL PLUMBING ENERGY
rough his own cmpmyec,.provided he,...h ilnpt,wetoenu me tan intended or
Ola ed Int„de.If.eowaeer,me baildhtg or M1nhroeemea i..nld within one year of 506 — GAS TEST
nnpselion,the owncr.nail jar will have that burden of prod....I as he dill Bol hood or
itnnn,ne r r plapo,e nr,me). 507
—. FINAL PLUMBING
C I,as owner of the property,an exclusively contracting with licensed contractors to
construct the project(see.nw,Business and profession.Call Me Clinical
Limine Law distinct apply a,an owner ofpmpeny who builds or improve,thcmm.
sad who conalmt,tar such is fell,with a commcmll.at Tensed lana am to he
Contractor's Lee Law.
711 am oxenlpt under Sec. .EI A P C or Thi,rvson
Owner Date
WORKER'S COMPENSATION DECLARATION
I thereby aftim underpc hyfpc)Done EthogdP far. /^
C I h 1 'll ' r C l l t r C I ,s It' Ior Worker's
perape e p J J ly S t]IIII Its h C 1 Iia the
p1 have
%illtewnd lorwech [,is ollpet _ n Ins
C 1 have as will maintain WmAcr',Compenwtion .work f as reyuireJ bySitis
3]1X) fill I:,M,r Code for the perfnrrmnce of the work for whop this permit i. O
m: d.M1ty W...A1eS1•,Cyto.ni,a.........�Imumnee carriirl1/and
5pott number are:
CarrierH'1'1!'1(;Al'I(1NTIIIiX1IMPoheYfION IIe(1)1 � � O
COMPENSA'IWN INSURANCE
(This section need not he emnpinN if the pemtir i,for one hundred dollars
IS Hln)or less.)
I verily that In the perlimnunee of the work lar which this permit i,issued.1
se,Jl nor Clookly any perstla Ill ally n r so)a,m becmnu stabler,to the Workcrx'
C'om"neaiott Low,of Cu1hooll o Data
n
Applicant
NOTICCTO APPLICANT:I.attar ,nsior,this Ccrtilwdr of Exemption,you should
O become sul to the Workers Cong¢nwrion provisions of the"barterer.you roust
fnnhwiih comply with wch pmvision,or IM1is permit shall M deemed rteaka.
FzICONSTRUCT ION LENDING AGENCY
CG i I hemny nlEru that them Is tl conxm,nlon leading agency fondle p••,ILnn:mec
ur the work I'ar which this pv,a(Is is,vd ISas.1097,Civ.C)
Q Irnder's Name
7 I.ado's Address
V 0 1 cenily that I have read this applivaion and allue that he alsom information is
[.. correct.I agree to comply with all city and county notional and state law,relating
C.> to)building construction.and hereby authorize representative,rel'This city u,enter upon ,
ky he ahe,c.ntemiaum properly r,rin,pceioa purpo,c,.
E., a ravel agree to,nee,mdataaifymnd keep harmlms the city of Cupenite,agam,l
Vl .I hilitis,.PtJS rams,coon anA exlun.a,which nosy in any way ace a against,aid
U sZ City in cans cote rel the gaming of obi,permin. ///
"a .CA UNDERSTANDSAND 'ILL COMPLYWITH,)Ly. % Issued by: Date
S :[ 'TION
sign.m,� pp �a , a ,F Re-roofs
HAZARDOUS MAIERIA S DISCLOSURE?
will noes uppliem or r,nme nauni,tg«em,atn,l,aao.mlmre M1u,amoasnamlial Type ofRoof
es der ed by the Capemao Marlclpal code.Chapter 9.1x,trod the Health and safety
Code.Section zsslzt>?
°i'es 0N All roofs shall be inspected prior to any roofing material being installed.
Will theapplicam or fmurc hiildingercupam use equipment nr Jevicc,which If a roof is installed without first obtaining an inspection, 1 agree to remove
it hazardous:ur cmvartin:uus m dclined by the Boy Areu Air Quil'uy Management
District? all new materials for inspection. Applicant understands and will comply with
El y" 0N all non-point source regulations.
1 have rad thehazardous, , tWa,,ivl,requimrm Its andercharier4. ma 6.95 of he
Ifthrirnio ngdossof vCnmc.S«aill...al.duliti, and2screa.L l I aadlhm
ifthe ot.o the or no }nmly hav ha�atye/nbe be met
nrymspnflir mnotify the
iAm n 1 the rc cots which nm> h mcrTiGi`� /issuance of 'cnifcarc of
a y' (NI Signature of Applicant Date
n raatmornedaganl nam All roof coverings to be Class "B” or better
OFFICE