00070061 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING A DDRIiSS: PERMO NO.
10775 MINETTE DRIVE 00070061
OWNER'S NAME: APPLICA PION SUB DAI E
i111111. GIAGET
07/12/2000
ONE: SANITARY NO. CONTROLNO,
O O O ARCIIIT ECrIENGINEFIC - BUILDING PIiRMI'I'INTO
BLDG HLTCT PLUMB N ICH
he
F i w i-U LSI 1=1 I-1
y<7,Z LICENSED CONTRACrOR'S DECLARATION Job Description
0 1 hereby anion Lha 1 am licensed m
aim provisions of Chapter 9(eonnnenang
F rasGw with Secular 7IXq)ofofvisinn 3onhcB dna,and Professions CNe. ndmylieeare
�x ,ill bull fnaandetfeat. �2CvD�jp_ WATER HEATER
z ce< ute)xwro,Clas I.i h
Contractor-
w 3 a n ARCHITECT"S DECLARATION
I"u O<� I ondersmnd my film,shall be used os public rccoll,
2,a Leaned Prnle.,,ionul
e.
y OWNER-BUILDER DIICLARA'nON
WI hereby affirm that I am exempt from the Contractor's License Law for the
F'G< fallowing mason,(Section 7031.5.BaV ness and Pmbexomnv Colc.Any city or e,unly
I C which rb1 pe I t construct,allalle,imp vv.J„i l h.m repair an,gmmure
a3cee prop I" l y d I11'' tl - 9l It II b Ltalcnem
'hat he licensedpursuing u the ,
p fro c t t ,l 1 (Lhaper9 Sq. Ft. Floor Area Valuation
(en n110 necingwthSut,t 71of l) Ru.-
v',in13,f the v, IProf.. ,Cale) Y1000
lir that he is exempt therorrom mad the basis for the alleged exemption.Any violation
-of Secuan 7031.5 by any:applicant for a pcm,it.ubjcun the applicant to a civil p,nahy
of amt more titan five handled dollar,65tw1. APN Number Occupancy Type
01.a, ,ot the propn
an„ ,fly employee will,wag,:.a,m,a' ,ile,am.'e"I nn. 3753'x3051 . 00
will I,,heework.and the saumme i,nut intended car offered for sale(See.Lull.
flux,,and rram„ion,Cale:Thc Commeloo,Lclow Law it,,,,not apply to an Required Inspections
owner of property Who head,o,impmves meson,amt who does such work him,eR
laou'llhis nwnemg,Inycc,.plavw,dotal,achilanrnsema,tt,amnotimendeda, 502 — FINAL PLUMBING ENERGY
offered for sale It,however,the building or improvement is slid within line year of 506 — GAS TEST
nnpdedon,the owocebailder will have the b,adan of proving than he did not build lir
nolo”,firpmmnseaf.m,.L 507 — FINAL PLUMBING
❑I,a,owner of the prupcny.am vxda,ivcly,...fowling with Ills n it onutrannr,n,
I'mstrict the pmjcct(Sec.7144,Business and fmms,inns Code:l The Contractor's
ic'ema I,aw dues not apply to an uw ner of poapmty who build,or itnproves nucleon,
and who conmzcc for such projects with a confrom,(x)licensed pursuant to the
Contrucore Licanm Lnw.
❑1 am exempt under Sm. ,B&P C far thismason
Owner ])are /
WOR KIiR'S COM I'ENSATION DECI.ARA'1'ION O/
1 hereby aftinn under penalty of perjury one of the following declamtioal
❑ 1 have and will maintain a Ccnificure of Consent to self-irwre for Worker's /
Compensation, ;is provided lot by Section 3710 r,1the Luhur Code, for the !�
,e fommace of the work for which this pennir is issued. V
❑I have and will maintain Worker',Compensmian Inmmuce,as required by Section
3700 of tut Lubar Calc,for the pmvlammnce of the work for which this permit is
sued.Aly Workers Compensation Insurance carrier and Policy nnmlaer are:
Carrier: N,,: SA o� 9/9 9
CERTIFICATION Oil EXT•.Im ION FROM WORKERS'
COMPENSATION INSURANCE
('ill.. „limn faced nm he completed it the pcomil is fur enc hundred doll:m
(SI00)or Icxc)
I early mat in the pe,fimam il,of the work for which this permit is issued.I
,hull not employ any person in any manner no a, ,,become subject ,,,he Workers
Cnmpen,atian Iiws of Celimmia.Dam
Applicant
NOTICE TO APPLICANT:It,olicr making dib Catltiave N'Pi,cmpunn,you should '
hem
aoe,ubjcct to the worker',Compensation pro,inion of the Lab,lr Calc.Yno m,nt
'Q O forthwith e....iply with sash provision,or osis Perot shall he licensed revoked.
Fui CON SIAUC'TION LIiNDINO AGENCY
CL = I hereby affirm that them is a comaunbn lending agency for the padomtonce
111 the work lar which pit,permit is Issued(See YNO.CivC.)
Lender',Name
.J z Lcndur'e Adam,
t.7 Q I lenity that 1 have read this application and stale that the uM,ve information i,
roale,1 agree to comply with all city and nmmy oNim,nces and sure laws relmdng
Q V mbuilding construction,and hereby amhorim repre,emmives nflhi,circle emerup,m
the above.mcndoncal properly for ar,pcctln i pal,nvl.
t}„ per, (We)agate to save"indenify and keep hem,iess the City of Cupertino against
VI I'ablldio,judgment,,cusW fouml cxpcn,,,which may in any wary accrue against old
V ti City in conuquance of she granting of this fiction. v
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS, y'
signaler,of npplicanVComraco Dal, Re-roofs
HALARDTJS MATERIALS DISCLOSURE
Will n,e appfcaal or chum building,a',apant,tme ar latm.I"eadan,lnatedm Type of Roof
as defined by the Cul,armu Municipal Cuda Chapter 9.12.and the Health and Safety
Code.Scali25.532(a)? 0N
All roofs shall be inspected prior to any roofing material being installed.
Will he applicant at future building occapamla,eecimpn,nllirdevices which If a roof is installed without first obtaining an inspection, I agree to remove
mil harudous air contaminants as dcfned by the bay Area Air Quality Management
Di,lncl7 all new materials for inspection. Applicant understands and will comply with
CY., E]No all,non-point source regulations.
I have mad the h000de,materials hamir,menN under Chapmr 11.95 of the
Cliovariu llculth&Safety Code,Semon,25505.255P anal 25534.1 ludim,tand that
ifthe build' ,a not currently have a ht that it ilia,re,pansibililytonatify the
,,cap of'he l cgahemlit loch 1st be t ime,m iv imine of a Certificate of _
fecal my, Signature of Applicant Date
6wne,nrauduo"7 agent o f 2� All roof coverings to be Class `B" or better