00070077 CITY OF:CUPERTINO
ntilt,mrvO DIVISION '
PERMIT CONTRACTOR.INFORMATION:
\ HULLOING AUDRFSS: - PERMIT NO. "
22UBE DR ' a _ TOM' S PLUMBING 00070077,
., OWNER'S NAME!`• - "" -` 5t. . . ' APPLICATION SUB HATEON
jr RENEE AND' LI DR 1246 , SARATOGA SUNN VAL RD07/14/2000 ` '
PHONE: „ - - - "' SANITARY NO, - CONTROL:N0. .
f408J:867-60101,
OO ARCHITECTMNGINEER. '^ , . '', BUILDINGPF-RNIFFINFII '
0❑ BLDG ELECT•''i. PLUMB . MECH.
LICENSED CONTRACTORS DECLARATION
,gym - '
i & ,- t .. the - Job Description
I by B' th i I ferried r p f Chapter 9 r s 'r .. •`
O�H� wills a' 9[gfp of i fine BC dProfession,C le and my l' a
inLllr gave on REPLACE WATER HE�ITER
ao�o L1ceneCP : b L' � I !
.w Dal n0 Connector
' •,
ARCHITECT S DFCI A 10
lila wad ,y pl ns shall be mel pM' d •r' - -
;N�}E G r.
m�p0�
LicensedP I. ' I G-
°� .OWNERBUILDFR DECLARATION a I
iil I hereby affrm an 1 1 r5,B an firm,he Gmwa,r :A 'e Law for the ``
J a toll g ei i ]0315 0 ' a P I." 'Carl: y 'IY c re
C
which repaint p I I I I II p droll r tenurially.Ira I
lay pn, I 1_ q me appl and ch
c. marl 1 dpartial,I IM1 p fu Contractor L L (Chapter 9 S Ft'Floor Area'
(i, g-,fillSection7000) fD' : 3 fm H : IP r :cel 9; .,, ^ t, Valuation
-
,rlhth emptor 1 Imob r ❑ anegede pl Any vminion '' -
ofS ,l 70315byaYppl tfar ap 1. tyt, he oppl II istIpenalty
-
ar r him rven a aeImmrsSan APNNumber: - -Occu enc T e" _
El T.as owner if the -t;ern 1, e m In I tion Occupancy YP
p , 49020. 00
will la m k si @ fracture apeact d ff d l of ep l 7M4.,
ow and fc Colic: rl C t r L _ 1 es e work
n - - , Required Inspections
w ghpropertywn e h employees
at d' h a ch k h If
or through nforrae,c p imprthat oves ro pr ' I l ].06' — SEWER & WATER ,
B'e d for If,h th h 'ave t p I n Id lh of build
f
otnpl f n m.aw„er nn mer wll nage 11 burden or proving that Be pia not bu'm nr' - 202' — UNDERFLOOR PLUMBING
m"wefaImpnsunfwlc.1. ^ ,r it u
301.- - 'ROUGH PLUMBING
ID 1, ti Re prpet70 exclusively t tg ,1m' n.Th I en 1.
. 302; — TUB & ''OR SHOWER . ..
con.tmcl Ibe'dwe,g (Sc 9614 Business Iden, no ns Cole)The Contnem.s ,r,9
d 1 I I-Iplyr of lua n m prmann 502 —';FINAL`- PLUMBING%ENERGY•
a 'I ommms far calmjeus w'0 nfinetoi(s)licensed pursu.nr n,the
Communities
1ahe yl en"�er se• B&I Cfsrmisre. - ;'` -.506 -- GAS TESTA
Owe rove+. 507 — `FI,NAL. .PLUMBING.
_ WORKER'S COMPENSATION DECLARATION '
' Ih by ff d legally fp try fthfIl gd l i
❑ I t.willmaintainCertificate t3 tt elft refor eWrk
oinp amount.t a. provided f by Section 37W f me 1 h Cod f Ih
err rm a if the kfwhichm perlvt a d.
V
❑f h d 'll nt W ke :C pe t 1 : d by 5 l
3700 f theint Calc the,n f CII kir h'chlh e permit n ,
- ubd My WorkeleC pe. to,Iuum carruona Ptlnl'eym nAbe�r./re j '• - ' ., ^
Carr er: is 'I A'.a V Ir Policy.Na.: WC II Z�Iy]{O� .. R': • 1
CERTIFICATION 017 EXEMPTION FROICE. RKEkS -
` - COMPENSATION INSUkANCG
(This section need not he completed if the permit is f r one hundred anllars
-I ecmfy mm Ia mo lwrfonndnce or the work for which this permit is issued,1 '
"vluth not employ any P a y.n ser an as m become: be,,to the Wo=ken
5
Compensation Laws efCalifornia,Date
Applicant - -
O�QNOTICE r0 APPLICANT Ir all making thisCertificate f E M , you h ltf
.,become subject m the Workers C mp psa p .oft. Lab rC J y trust
Porro 'th penalty with h p ash permit stroll be homed re,roat _`'• _ - a '
^'h CONSTRUCTION SENDING AGENCY
I hereby hi that e e 7.Elia y f the perfnr na ee -t
Len the work for which th permit s.....ed(See 3f199 C'v.C.) - L t
a,0 Lend Name us
Irna
V O I really thin l have readths application nd,tt thath M' frnalni, I '
RI F a,rte I I g t comply with all city and county ordinances and stale laws relating
O (, n,building construction,and hereby aumadxe repmsenmaves ofthis city muttcrap-rar -� -
„ r� the ab i med pn Deny far inspection p rp e: . - tl -
Ivy es.judgment,
g t d pe dkeph in lanywy warring
0 6 id 1
.y VI City l j dg t. .I. l expenses which only in any ay a agamsl.a d
V z City .sequence R T granting of this pent I I n - _
"y APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
' SOURCE REGULATIONS � 'Issued by: - Date
r Signamre or Applicant/Conroe.. �' m 'Date, -Re=roOfs. ' '•
HAZARDOUS MATERIALS DISCL OSURE
Will til aVprcadarmurebt lding Pm.l hn dl o-' m tmeHi I Type of Roof:
_ se del Sed by the Cuperl no Mun cipul Coa.Chapter)12 ontl rhe Health anJ Sufcly . '
s Cnac Section 25532(a). :A •. ' r�' �'s
- over • Ins ,:_ - All roots shall be.inspected prior to any roofing material being Installed. - -
wu n Apr nt r I r n l r g r t o agnq ,nt ra e:.n en If a roof is installed without first obtainin an ins ection, I a gree to remove
e ........aousvrconmr 19 us defned by lM1C Buy ArexA rQuJty Mv,agement g p .g. '
ante all newonaterials for inspection. Applicant understands and will comply-with
❑Yes' t •�Nn ' '• re'. -all non-pointsonrce regulations. .+. -
' I h ad the t ,ad materials requ m nests and Chain,fi 95 if the y •_ 'r .,
Calif ' H almkS f pCud',,s t 25505,25533 and 25534 1understandmut
if meh 'Id holding Jne,nolo nay lmveale inn metlurzy mspox Nllymna'fy l.e '
wupn n of us 4”
re t I'ch nn,.vl h t m 13su f C raticnm of 1 e ^
Occupancy. -
Signature of Applicant Date' ,
Owl .a..or ea agent Date - •I .- All roof coverings to be Class ;`B" or better
a-
-OFFICE - -
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