00110057 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NU
22484 RIVERSIDE DR # 4 THE SEWER DOCTORS 001. 10057
OWNER'S NAME: APPLICATION.SUB DATE
WANG FRANNY T AND STANLEY TRUS 1743 ROGERS AVE11 /13/2000
PHONE SANITARYNO. CONTROL NO.
(408) 452-0669
M O p ARCHI'I IiC"RHNGINiaiR,. BUILDING PERMIT INP
W Bl'I G ELECT U MECII
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LICENSED CONI RACIOR'S DECLARATION Job Description
Z S� 1bemby nBlrnnhv]n it3licensed nndvv pruv Pmfiv NI..,Code,(,,,a in,
0 1—w :llgue NM:::p���o111f pUivision3 nfthc ltusines and Profession,Cede,and my licenx REPLACE WATER HEATER REPIPE HOT 8- COLD
z w,, I.iccn,clCl�ar: y
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ARC I IITE(:1"S nECI.ARs
I undemand.n plan,shall M used a,public rnnrd,
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OWNER BUILDER IlEC1.ARAfION
d^ 1 hoo by anion that I am exempt in,.the Contract.,',LivCmw Law for the
(r[¢ following realm:,(So,, 7131 5,Bu,inax and Pmle,siun,Code Any city or c"nnty
E 2 a which require,a tomtit lu con.wcl. he,innpm,e,Jeaa9i,h,ar o pair any"norno e
polar m its issuance.also require,the applicant for atch pormitto file a signed statement
Chat he i,Ii,onxed pnnamtt.ntcpmvism::,of the Con,mumds uamsc law(Cbapmr 9 Sq. Ft. Floor Area Valuation
(commencing with Seetinn 7000)01 Divi,ion 3 of the Business and Profe,sloa,Code) $1
or that he is cxcmpt therefmn+and the ba,is for the alleged exvnp,ion.Any violation
I,]Secti"a 7131.5 by any uppiscaul lin'a"unit vuh"in,the upplluvn an u civil fenaft,
"foot more than five handled dollars(N500). APN Number Occupancy Type
' ❑LasNwaerodbepoperv.,not,oull,nyce,wid,wage,,,sthei,salecotnpemmhnt. 35602031 . 00
will do the wo,k.and the,wvurc i,nal intended or oRertd for sale Nov.]Om,
Bus w x and Pa,fe.,.aot„Code, Contractor's Lieen,e Law does not apply m no
Required In��sppec[ions
„a property WI build,noimprve,(nerersm adwnodun;a,hwmkldmull 502 — FINAL PLUMBING ENERGY
o,rvtbnagh hi,own employees,provided that such improvements am nm intended or
ffered ror,ale.lf,however,roe blinding or'm,prov"nem i,wt.within ane"a,of 506 — GAS TEST
mpletia.,be ownerlwilder will have the burden of pawing that he did nal build or
„p stohorpntpo.eof,ale.). 507 — FINAL PLUMBING
❑1,as owner of the properly.am exclusively camrrecting with licensed contractors I,
m,...I the an,vc,(Ncc.7044.Bu,irI and 1'mfasxtoo,C,Ac:)no Contmelor's
Licca a Lt.dnc In apply m hn owner of prop on,who build,or improve Il a e C.
and who e'" c4f wc'
h prjects wall a nnnmcxds)licensed pnum to the
Crarnallo" Lew.
01.,1rxcn"andsr
Fu:. .If&P C for thlx reason
Owner Dllm Kilt Wl1HKEH'S COMI'L'NSA'PIDN UECLARA'1'ION
he:nhy will a nntla: a Celty of perjury ones the following declarations Wer /
C I have and will ...main a Certificate Sone of Consent m sd6iamm for worker', /
Crkarru een, he aa,kf r which
by Seermit 9741 or be LnM,r'Code, lin the
performancc of the work for x�hicM1 this permit i,isued. •tl�
❑1 have and will nwinwin u, c Gmtpensud"n Insumnee,as rcquirtJ by Section
3]fJn of the Irhen Code,fur a perfmm�ance of the work lin which this pemm is
37M of[flp��,"�Ib/9�,,',C npcn. nn lnsurunw cuni/cr agf k icyy_allmnMr,no
CarmicrCYl/�F/_ Policy N".:/�
RRfl . C..pE%CMPrIO1177 FRIM WORKERS'
COMI'IINSA'1'ION INSURANCE
1'I hl„a,lan nenl nal be cmnpla,nd if @c tannin i,for enc hundred dollen _
C1I{10)”,Icas.l
I cool Ina in nm p,dar msec of LIN work for which thi,Izund i,I"ucd.I
,hall net employ any person in any manner sol a,to hoeome subject to the Worker,'
Co:npcnsm ion Laws of Cahturnia.Dam '
Applieemd
NOyHCE tf)APPLICAN'e If,after nwking,his C'enificate of Exemptiom you should
Deco+:...xnhjec,m the Worker's Co:npcn,ation pmvi,ioms ofthe L,Na Code,you must
Q forthwith comply with such provision,or this permit,I:all be deemed revoked.
.^�.oCONSC
'rRUI ION I.F.NDING A(II!NCY
7 I hereby.(firm Chat the.is it eonsmaoli er lending agency for the"Ituarance
of the work for xhwh this pem,it I,:nsuoil/Sec.3(Id7.Civ.C)
Q Lender',Nana
D Z Lender's Address -
f..l I coni l y that l have read flax apaid Catlonund,state that lire uhove milannanion i,
fist E„ mica.I ague m comply with all city and enmny ardinonce,and,tate law,multi,
f) h,huddling cnnvruetion,Cod nerehy.authorize rq+,escmmlvev of this city for enter upon
the nds vo-tnen,innoil pnq,eny to,inspection purposes.
tri 0. 1\Vd agree nr,suet indemnify anA keep harmless the City of Cupertino againv
fn liabiliden.judgna I,,Inns and expenses which may in any wary nc rue agnin.a,aid
V z Ciry in conwyuc: a of Ne 6mnu g of Ihia permit
.IC NT '. U'RSI'A A ' IL.CQMPLY wlTll A Nr,-POINT Issued by: Date
sign vpficanveanVae „ nate Re-roofs
HALAROOUS Mdeog I1AI.Sa%NCLO.handle
n P.
ounce,plicantmfMIcipalCode,Ciant,m.12,anteImtaoan Safetyoal Type of Roof
ax derated by,hc532(.)inn Municipal Code,Ch'antcr 9.1'_-,and the❑calm and surety
Code.Section 3532(al:'
❑Ye, ON. All roofs shall be inspected prior to any rooting material being installed.
Wil the applicant at future lwilmat;n'eupant use equi Anent or devices Is hivh If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contan,invns us defined by the Bay Arca Air Quality Management
Dila sn' all new materials for inspection. Applicant understands and will comply with
oN
all non-point source regulations.
I lave rami the hu'rolou,..aerial,"Ifurcn"Id"ander C111 to,0.15 of the
California Health A Safe,,Code sections 25505.25533 and 25534.1 understand that
HIhc iII dux L nnfetnlyllme n tenant,Chat it is my responsibility to notify the
Pam nl'the reqs re:nm,u s 'ell t is(be net prior to issuance of a nfi'um ul
ot "`' Signature of Applicant Date
- - --���`�t All roof coverings to be Class"B"or better
O nn — agent to
OFFICE