00100069 CITY OF CUPERTINO, ?-,
iWILDING DIVISION CONTRACTOR INFORMATION
.a PERMIT.•`;i' ' t '
NUIIIIINCADIJRFS ' - p- 5 -'� PERMIT NOv y ' l
(6397 AMISTAD .CT. HdT'. WATER INC 061'00059
OWNER S NAME' - - "' "` 4 APPLICATION SUE DATE
VIVEK 'JAIL'', 2531 GRACELAND AVE 1.0/05/2000
SANITARY NO CONTROL NO. . 't
(E,50) 298,,-84.94'
' OzI11 o ARCFECT/ENGINEER. - ' l , R y "y'• BUILDING PI:RMI'I INFO - "
a wV E - 12 tf - HhDO ELECT PLUMB - MECH'
on
y.N� LICroENSED CONTRACTOR'S
ONTRACTORS DIP CrARAI ION
ae aw,nyl _
oi heen tarn that l an Fcurred ,de'p s of Chapter 9 Ronncvn JbDescripton "
..REPLACE 'WATER HEATER
K�6
pare
CI 'L k
a
ARCHITECT'S DECLARATION '
C O; 1 nderstand nY pl issball he used s public runNn 't _ ." r ' ' - t-
rE ..
a"p
Liverend Pmfessionul
w a N
OWNER-BUILDERInto n,he RAI ION -
I h
By ff ah 1 1 pl f ,h Contract.,,License L ronhe " C""
C 6 toffievin, ,(S , 70315 E _ dl f :C i A Y IY ,y i
FS p
which q (r�. I, -, t I, p d h p Y , I e - k r
u3m Wu t , I. r9 :Ih ppl^ ,f hpc ,in fl 'g Lar n .-
ma,n 1 dp al n p lm c -nl l' L Brine,9 $ ' F[ FloorArea -Valuation '
ao y ms l 7(ron> rD rm Ew u r
as Code) 9 ,' -
.o-an,1 pnb r ' III b 1 d angdc m' Ay
viola, :4'. >' - r b500
ors 't,15 yper a,r p Lnbi�ynlne,npr „ ndeTenally. .Occupancye
ora , J 1 APN Number'", Typ
I
nn Pin p"y v v1 e:wln "y. a
cashier," 3,424501 QL 01D
will
to k 7044 as f
nit d r ......
r, c a Tn c nr CI :L L a n t apply - •' Required Inspections
wn b in d 1 n : a' 502: '= 'F,INAI< PLUMBING°•ENERGY.. '
- ell try
r Ih gl I', ply p Jdlh, -I p , tint J 1
fn d r 1 .u'n .50E —" GAS TEST -
In',n pmt oo,me owners rJLrw 11 navel I ext of Pa,.ng lnoi need,oI.hand t,
fpmee rnr pn rpotenf tale.j. , - x507 �.-FINAL:*PLUMB;ING
❑I tlhc pr pent" I nvv ly vuuFng with h I , tura.an
construct do pre)ecl(Sce 7044 En....s' d Pr R..or,Under) Ce tra....... -
Lic we Law'does ml apply tan,ov,mr of pmp,,y who bu ild r n,pmvice derven
ad h a f h projects with a conme,.r(s)licensed pursuant,.the - fn,' ' • '9
Cont a et r c l.lcoure Law. . "
•Oram raze npl undcrS I,E&PCf thlsr
Ow - D"1 L J
WORKERS COMPENSATION DFCI ARATION
'r Ih h effort unJ penalty, fP Yused,ah hll gd a '
. In Jwill n l CII u, [Consent , L l' Anne,,',
m p , provided f by Section i7fN1 [ Ih haho Core, fur the -
pe'f e of the work for which this p"m, sissued
.
❑i hose one will malnmlo-Wmker'a Compeiumion Insurance:ns rcquired'by Sccliori -
370E of the Lobo Code,for the perfom,ence(I the work far welch this permit is • - -��
kxura.My Work«'s C pe otos Ineurunce courier and Pol ty combe-nee:
' ''
. I` ..
Carrier - Policy Nn,;
CERTIFICATION OF EXEMPTION FROM WORKERS' ,
' COMPENSATION INSURANCE - - -
1.
(This. Y , rads 'heconplemd'f0 permsufi me hand r.ddollam' d' - p"'�
_ r8mm or lett) - • - ., -
I «y thl' 'to p f of In, rk 1'r h hth Perot,is' JI ,
I. shell t pl Y Y Ti' y c m beu,me blest to,he Wn k,,,'
'
Con p sn,o,Laws of Califon a"Da,c
Apel t .. '
N(YIICI rOAPPLICANI`lf fm k g,h' C n', 'I ft p, y -1 ,IJ -
bva bj tonne Wk Ccreaser I tun Lab C y n,, d "•'
�.� forth "In comply with h provisions orthis pe m,shall be dwmed rev ked
i"i 4 uCONSTRUCTIONLENDQI CAGENCY M � • e • '
'� I hereby sRlm,thath t action lending agency r r the perform, ee ' 'ors
,Q aflhewnrklet wh chtl p al's issued(Sec 1097 Ci,C)
land Na rte .i �-
• � z Lent r Address
- - - .
t
V 0. I I[y Ih"tItr - d,h" Iplic I d'I, ,h uti 6 1 n"a' - .,rlor
W'test corn t l p I ply with all city and ry d J'lilt, editing
V 'tobu'Id' g I f and hereby 6uandr' p nt f e fth s city,.cnar,upon -
ay t;T4 Ihul at dp p IYf npecia p 9 '• ,
"Fyfy (w)tilltsave. 1 f dkeep lr "theCty (Cap I ' yams,
til linbil f judb I: ',. d :: h h may'n eny a) c ue: d nd "e
V Chy'n quence af,h ganOng of lhisp tl • 'f -
APPLICANTUNDERSTANDS AND WILT.COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS Issued by: ,Date
f
Signature of Appl'emn/Cora r - r -• - Daae 'Re-roofs A-•
HAZARDOUS MATERIALS DISCLOSURE -
wlltheappre,m futurebuildingnre,panlstoreorh, eI hazam ,nerd 'Type of Roofas defined by the Cupera no MI,c'pal Code Chapter 9 12 and the Health tad Safety
Code Send.,,25532(a), •• -
oY �° _ All roofs shall be Inspected prior to any roofing material being installed."
Will the pr " a fI n "le' s p , :eeyulp , e . -nth - `
canalxiNnn,cona an. a,demednhoBaAreaA Ifa,roof�emstalled-without first an insechon, I'aree [oremove
y v Quality ntvnaycmem g p g
1tlr,at7 ' _ all new"materials` for inspection..rApplicarn understands and will comply with
°
; -
ye, �"° a"� " allnon-point sourceregulations.
1 have read the h`lztadorss nationals s' a " '*
505,requirements under 4. p, 695 01 the .- tar, •. • .ao .1••_
Glif m" H 10 &SaRiy C,dc,Secun rion,P 25539anrest, I ,1 cr I,hai -
if the h 'Wugdoes' f randy hnsea,.nam Ik, t' ym,I silhility to rallythe •' - •. !
occupant of the mgri rem t'which mut,be' e,Prior 10 issuance of Cerl fcme of � ' A
Occupant) .. -
,_' Signature of Applicant,..'s Date
0wn olln o,edaeeal Date• , . All`roof coverings to be Class "B'•or better -