00080074 CITY OF CUPERTINO - PeRM o.'
BUILDING DIVISION PERMIT •l a� OR I i STIR
s
BUILDING ADDRESS: _
' - -r SANITARYN . .+APPLICATION SUBMITTAL DATE
2t775:* 01 WATER 'HEATERS' ON 0( 080074
OWNER'S NAME:' -
t NIC ,. .';CONTROL«
HONE: 500 . •AIRPORT 131—VE •08111/2000
K:. ARCHITECTIENGINEER - t'41 ' + SING?@EItM fIN
5) 349 1747
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U
<Z
c•O= _ -+ m That
CONTRACnOR S DECLARATION,
OZ_p 1 hereby.Rion mos 1 on licensed under provisions of Chapter 9(cammense is •F'. Job Description
F,e�.ai wiTh Section 7000)of Dinmmm3oftheBmie and Professions Code:utl my license is '' - "
IY In full force and effect r 'A
Li naeClesa Lm« REPLACE WATEftHEA R'
co':LL yr"j DBM ' Conkacmr '
O v, ARCHITECTS DECLARATION
y
[understand my plans Mall Wooed as Pubic recmda
C:JQE
ucaused Profaumrul
u�_2 OWNER.BUR,DER DECLARATION t , C\
4 G i hereby Tenn that I am exempt from The Contrai'ioYs License Law for the !!!, J "
❑ following wan(Section]031 5,Busess aid Profeuiue Cade:Any city m coung
wNch requites a permit ro comwct filer,imp.ve,&mulish,m ns any a_._
- Sq. Ft.Floor Area aluation
priormits isaon -afro req-imsmeappheantfor such pamdt to fileani8ned aummet ,
humWislkensetl p....othe prows-ion.of the Cantracmr'c License Law(Chapsu9
(commencing with Section 7000)of Diviaion3 ODIC Business and Professions Code)on APN Number Occu ane T 1.
'mai he i.eampt Therefrom ard me basis for the alleged w empfion.Any violation of tete P y_
Section 4031.5 by any applicant for a permit subjects The applicant to a civil penalty of
t mom than five hundred dollars(3500)r
2793611Ipyo,'MiOMI '
❑I,uowner of the properly.emy employav wim wage.utheir sole competuation - nspections
wBldo Thewoh,and the structure in not intended wagered for We(Sec.701«.Buineu _.
and Pnoleasiou CodThee; Contractor's License Law does am apply to an owner of
property who bull&or improve.than an,and who does such work himself or Through - 106 — SEWER' & WATER .
his own employeed Thu art
es,provided such improvements not intended ce offe.d for
sale.,If,howevee dlu Wilding&improvement is widon one yevofcompledon,the 202, UNDERFLOOR PLUMBING
ser-Wilder will have the burden of proving tat M did not build m improve for per-
• paaeala.le)' ' 301 — ROUGH _PLUMBING
❑1;u ower of the slveld conhacdnwith))shed cntraamn to - -
Construct The Project(psec.7044
,Business aedPafeuians Code)rhe Contractors u- 3f02 — TI.,IB & OR SHOWER
cense taw des not apply beanowner of Prepart,wed Wilds or imp,oraa Thereon,and ,tete -
whm
onlrectsfor such projects with a,.Wctm(M licensedpurmanl n me ntr
Coecmra .�f.Ia2 � FINAL PLUMBING ENERGY
License law. 5016' — GAS TEST . - - .
Cl lamesemptundcrec.S _ .B&PCformis won
. ,yr -
o 507 . ,.FINAL PLUMBING '
wner Dale � ' a
WORKER'S COMPENSATION DECLARATION
+I hereby affirm under penally of perjury ore of Ie following decorations:
I have and will meinsin eCenilkwe of C..sotto xlGimurc for WmIcee.Comper- te te
sarion,m provided for by Section 3700 of to Leon,Code,for she pedomaee of the
work for which This permit is issued. '
❑1 have sed will maintain Workers Compensation Insurance,as ongi ted by Section -
3700of me labor CWa,for the pedo..of the,work forwhich this permit is issued. '
My Worker's Compensation Inamence carrier and Policy number
Canter: Polley No.:
CERTUTCAM OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE •
('ITu sasinnnaA not becomPleued ifine permit nfor one hundred]dollen($100) - a ,
of taste) l .
tete ° IcenifY mat in theperformaneeofine wmkfurwhich thimpemmie issued,lshall '
not employ any Person in any manner io as ro become subject so the Woheaa'Compcn- tete .
ration Laws of Cdifomia.Dose
'.
Applicant
NOTICE TO APPLICANT:If,after making this Certs&ate of Exemption,you should -
Meme mbjafto Ore Workers Compensation Provision.of The Labor Code,you..at -
forthwith comply wim such provisions or this p.it shall W demoted rev AM,
CONSTRUCTION LENDING AGENCY - t
_0 Q "¢-'Ihercby afhrm mum this econewcOon leMine agency fonhe performan of
to work for which This Permit is issued(Sec.3097,Civ.C.)
Ci Undoes Name a
--,IaMerI Addrcu
Ls7 Q 1 certify that I have read We ty mad coun and slum That the above information is
?' conect.l agree to comply with 11 city W county ordinances tad mute laws.lasing to -
-.7 z -building construction,and Wouryauhonre rePrcaenwives oflhiscty to enter upon The
C.I above-mentioned property for inspection purposes. '
IT' Fa ,(We)agree to nave,indemnify and kap harmless the City of Cupertino against - -
0 U Iiebilides,judgmeno,costsand expenses which may in any way accrue against said City
W in coosequcnce of the Brandn8 of this panni[. -
[ti p+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT "
For
SOURCE REGUtAT10N5. Vi tete ,
Siguonv of ApplicanUContractor Date
HAZARDOUS MATERIALS DISCLOSURE' '
Will too'dicaut or Mun,Wilding occupant store arbadle hazardous material Re-roOfS' s '
u defied by the Cupertino Municipal Cade,Chapter 9.12.ars!The Health adi Safety '
Code,Section 25532(.)? , . Type of Roof
❑yes - [I No
Will the applicant or future Wilding.[..Pent use equipment or deviaam whish. All roofs shall be inspected prior to any,roofing.material being,
shoot laar dmai itcontaminants a.defused bythe Bay Ars.Air GailhyManagmten, installed. If a roof,is.installed without first obtaining an inspection .
L]Yes ❑Nu . I agree to remove all new materials for inspection. Applicant
understands and will compey point gl with all non oint source regulations.
I have,ead The huuticus materials.quiremrnis under Chapter 6.95 of me Cali- s' Y
_ forma Health&Safety Code,Sections 25505,25533 eco 25530.1 ubcrstad That if 0te
h
' uildingdes not currently have a tenant,mat is is my responsibility ro notify the acuPus -, "•�
of she requhements which must W me poor to issuae of a Cenlficare of Occupancy. w '
Signature of Applicant .'Date
Owner or authoriaW agent Date '
All roof coverings tolbe Class"B"or better
+•� tete -. -
',.OFFICE