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� EBEF2R PERMIT. CONTR1764 NATVWTAP 07/11/2000
-BUILDING ADDRESS: `•" 1 ' W, - ' - PERMIT No ]I" '
@510)c^9G X9901
OWNER'S NAME: API' C I N SOB DATE
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1 ONE' i -, SANITARY NO. 'CONTROL NO.
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aas o ARC]1nnQDENGINHER: WATERHERTER' REPLA EN T+Huu.uwcrn nT NFo
a m i i F.LF.CP PLUME MECH
Z S?Z `+ L.ICI NSI D CONTRACTORS DECLARATION ^' ' • Job 6CSCr1Ph On '♦ V
hereby affirm that l act licensed order Pr n. 1 Chapter 9(commc,c'ng ,
ter, C� with5 f 9[KKq IID 3' fthe Run a,i Pmfe,ions Code,pndmyl'cense tf
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qq �-t ko.fallforce d ff tmal I
S tr a Lic c Class ' aL c A
w c.0 a y Data comrpcmr
ARCHITECTS DI CI ARAr1ON
0 5records
� I d 0 I y,l h II'he user! p bl
Licer7d Probe s.Coml - -
a a OWNER—BUILDER DECLARAI ION. t w 4847 ' _
I hercb,afrrm Fact I onexempt forn the Contractor's License Law for the - -
C,�C loll 6 a (S t 7031.5,B d P I .. C I'Any any county
- o we' n I - p 't(destruction. ❑er,inTrave,deroakh, p r dotuduae + 37522055..00 ..
i3� prot t' q ' .drnln tt hl II tl 'g drtencn
natl ` -
tlicensed : II thp ftn c t I - L (Clat1) Sq. Ft.Floor Area t •Valuation: "•
(ar rancid, ah Swan 9000)of Divisor,3 of the&s c. nd Profes6o,s Cede) r
orthan l pd Rapaport are tee ba f ll llegede. N Ayvi6m,en ' , - '
of s i 9031.5 by ry apnl cant for a patrol bj t,the applicant all Penally ` _ ,
of, Inoretha fl, hrddeddcRus($500) _ ,�e[INDERFL00 , PLUMBIW9iiparicyType
'JIasowcoral the property,da.,en ploy , '@ wages as meisoln eiinpereunion, .
will do the k d the fractions,is n t intended It d f (S 9M4. "
B.Ohniv,add Profid,sicip,Code I he C vat License Law dual not apply to an 302 -- TUB R&q!ORd 19MWE'Fls . .
;w rofpmPe c,Wh h II p - ,hand hundec—lach vo,k1urovelf
r though his own emlly ..P addt: h,' P m t rtadd - 502 — F]iNAL . PLUt4BING ENERGY
auupdr,rstheower l the riking9rinPnvementnsold wtd Onto yen, ,r� S�6� GAS TEST
couplelion,
f pry I .I1J 'llh 0 burden fprov r,8 that hI'I not build =
507' —�FINA� PLUMBING
711 Ithe p„,,cry, 'lr criftactiii,withI d panic.....
constructth project(See 11D4B ' dProfessions Cd ) IhCt t it r
Liciow Low coas ,applyt fp I ty h builds p st 1
and h u t. f with coradeprojects x courp) I ed sumo t the
Contractors License L
❑lith warpttndmsc B&P C r,,this E...a
.:owner - Doc
WORKER'S COMPENSATION DECLARATION - a” "
•I horrify aR¢n ad, P;yruillyolp,ary oric fda,l ll' gd !art
7 I have and will topindin a Cerrificurn of C- al in If for Worker's
C.an,prainction, a, d d r by Socnituri 3700'of the [.,,be, Code, In, the -
�I dCl anWorker's C P , I : y I6,Section
- -
37I10 I th Labor Code,
d for ha'pe adifeci,of II k f r h h h':-p r t a „^
iswed,My W rpke'r..C , t m.Ineum ice carrier:nit Policy ou ober are
inr C �rAgNc I,� ' I •. .
CER IPI T N OF EXEMPTION FR WORKERS
COMPENSATION INSURANCE
(Th ssecnan head no,bcmm IoW'lithe pence,is forme hundred dollars '
Slip or less. -
:T..
1 avidly that in the perforreence of the rk for which dhis per ri t is issued,I
shall not employ tiny person in any turner so as.ijawroace,uInce on tee Workers
Conrye sm on Laws of CJifom ti.
Data s -
Apt
NOTICE TOAPPLICANT.If,afturnea6 gd' C'nllicaut Focanptimt,'yoe should
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nee bl uotheW k .0 p t I I. dl he Lubar Codu youcoast • - a `Innhw N cemPly with uch Pn s ons orN s Perm,.vhall be Aee nal revoked - `
4 - CONSTRUCTION LENDING AGENCY -` s.1 - p
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'I heaby nR rn In I Ih a enstmci o,land ng aside,16,the par fn-mac
IWC of tna work for which?[its Prm't is issued(Sec 3099 C', e) - 'e
Lenders No.,
_ -
,a z Lend Address
1 carlifyto that read this pal I duds that h interaction is •Y
W,U cmrenI6 I PIY hereby ai I ,y d' nd.tr,P Yg R
«' +(, mb 'Idngcinined dyforsspecs posenteti,es fth Pi ty to dnmr.,on
the uho(We)agree in property torso%pe i cams anile. - ` f
F Ln liabilitiesW)agree in save.' d pen I keep har ay in the way f C accrue
aagainid ' -
1 db onto, I ' �f xPen'es wh ch nnY ,any y ge'nv veld
U �i CilY,n enee of lh B-�i 'n of lhix pe'mt
APP C I DER Syff . A HiY LCOMPLY WITH ALL NON- I ISsned b
y; Date
c SIgnamre ,p ra,uct,e nr Dat Re-roofs
HAZA get
MATERIALS DISCLOSURE
I l the apt cant or future building occtpam-store or handle hazardous nateriel Type O�ROOf _
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety - t ' '
Code,Section 25532(a)a- 'S
CI ❑No
_ ( ''� n:, -'Al] roofs shall,be inspected priocto any roofing material being installed. '
WIII the a Ilm I future ildib t t so 1 d - s which <
_ pp d eamp°° repo p If a roof is installed witliont first oblaining'an inspection, I agree to remove
emit hazeraous air eonC t. :defined b)5ee Ba,Area Air Q �I ty M nagemnnt '
ores - - ❑rva� - '• all new materials for inspection: Applicant understands and will comply with
_ _ - all non-point source'regulations*
phase reuJ the h d mahaiel. q - mm�ts under Ch.pmr 695 of the
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C°Iilornla Healtr&Sofery Cade,Sections 255().5,25533:md 25534.1 und°rsmnd Not
fN b 'Id gd tot ndYk t ttbt t'. y .pou"Infity to notify the • , ,
Occup ` t 0 eq,rp^ t: h' trust b t Prior to ss I C ufGemc Of a
- "I - /� Signature of Applicanta a - Date
I I }a
w,eno Date All roof coverings to be Class `B" or better ,