01020042 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRIP PERMIT NO.
°%�'I_6 RAINBOW DR 01.020042
OW N1i R'S NAME: APPLICATION SU69709/2001
.,I�T%�g(C.00 1
VAN KOL HILDEGARD E {{GG
PHONE: SANITARY NO, CON'rR01.NO.
Qcell ZO ARCHI'I HC'I ENGINEER: BUILDING PERMIT INFO
.r^ BLDG ELECT PLUMB MECH
H 2 i
N G LICENSED CON"TRACTOR'S DECLARATION
oz-c I hence.,of iin mal l,an Tic nsed renter prm;sions of Cir peer o n'om,nencing Job Description
withSalon7000Jof Division 3el'the Rosiness an PmRxsions Code unlet license�yC
in bill Ling �O 3 REPLACE SEWER SECTION
C w Lma,ec Clxsn
3 a Dom_ C.. olOcr
a. �' '� DAEf�{I IEC9"S DECLA ATION2
.E7 LL'�� IunJcrsmnd my pinnsswt 11 lwo"dapuhlic rced1� '
Sy.
p5 Ganecd Prarcnsional
ff didOWNER-BUILDER at IIILLARATION
..tor
41-v,a I hurcby assn scene. um r9elopl Ern,Lha Con.mI,Co Ali,C Luw 6a the
F'• ¢ 'Ineft ng rwseo. an,tI 71131 s, I,ante an and Pmras,iens anile.Ali,cityerr a Lure
C whim r11%I—1 u permit le quires e t alter anpr.,for e•domnliil I nr.nal any rleca d
�m tramtar nsicalso y th narw ll hpr ire II L (Chapter
Cha ler9
IL mane . dp til 700(dol - Ire Inc Oral L Co r9 Sq. Ft. Floor Area Valuaf��{{N�{L tf.
tut r g -Inti er ralap Ie 'sir l t n B u, d 11-le—or,nysi CndcJ 5:.650
or Ilan he a 31.5 b ,ntry and the nosh En Lha allegedfie, ds applicant
.Any vivanno
of scene 711.115 by any dreg d ll rnr$pcnni,nunjccs We appliwnuo u civil penally .
nrnnl Ian.than five Irarrdred nnuar,l$SnnJ, •APN Number Occupancy Type
36611.045. 00
❑Las owner ornhenrnphecur.ycisat),cn.wlnhwagesfitheiraxlell,(Se 7044a.,
will ce the work,and the ode Tit is nm intondeJ nr of&ad rnr sale ISO:.7di4, p
Eosins and property
W o h Cede:The Contraanre Lara) Law does now apply a,wI f ppp��((�tI// ed U: -
w nghlov,ow Whonoilds nrivided tat sucn,;mdwhoent4 such,intwork ended
or 106 — SGtr•It� t^t FLICK
f broerect he Ie own however. I provided that such Improv sols are non intended n
(it
mr Sams If.how tithe naJtot e Irden rvng ad wahide,yna n� cQl2 '— UNDERFLOOR PLUMBING
Inr,,orse i r me nwaor-nom Iden will have ore nurdar e�proving arm he did not nal.,m
,pnrver tpmpnse nrwln.,. � 301 '— ROUGH PLUMBING
'El 1.as toacrol the pro,sirly,aar exclusively contratic,wah liccn;vd c tractors 1. 302 — TUB K OR SHOWER
L,n,trucl the acceet(See 9044,Business and Pmfeesione CosIc:)'Ihe Co..call's
iicca,,Law do, I,,,apply In annwacrnrproperty it,,bund,or inlprnne.,neeon. 50.2 — FINAL PLUMBING ENERGY
and who emdrane rnr such Intal,with a eeamewnr(e)licensed Persona no tiro 506 — GAS TEST
Carl ......License Law.
❑lam es lnpt tiler sec, .BgrPanran...lesson 507 — FINAL PLUMBING
owner Dai
WORKER'S COMPENSATION UI!CLARAI'ION
botchy trillion anderpenally of P 1 Y one ol 1 following dP tiu:
0 13 1 broo and v,,II It I C,rifificalle 01 Consent sell instan par Workers
Coorpersertictic its provided 1 by section 3700 It the Labor Code. for the
,ciparriloacce oret work for h het:perraii is %socal, XZ
3/
❑Iha d will or It....Worker's Cora, t [reliance,It,portbySeen i
3700 of the Latin Code,lot the poiGrnancC cI the work for which Ihis Ixxnm is
issued.My o A is Cnnrpcavation Imarancc curzier and Pnlic nun,M1cr
Calricr:_ C (�2 Policy N&
CER31FICA9IGNOFE%EMIIIIPROMWORKERS'
COMPENSATION INSURANCE ,
(Tnh ec,t read all lie Sentineled It it,pennr is I'ur one honied dollal',v
($100)nr lcve.t -
I ernlfy aca in the p,,f c nnnee of the work for which Inn pnmIt,is ,,and.I
shall nm employ any'mole in any Iwnner so ac u,hecromo..I[p cl a,the Wn kI,c
Cnmpenmwion Lows et Celirernla.Dam
Applicant
NOTICE TO APPLICAN'c IL alter making this Cenifical,or 12scranion,ret,inlaid
noun sah,jal a,lhC Wr.s nrkcCnmpcnsminn provisions at Inti E&ICode,you most
Q Q tmlevolb comply with such provisions or this permit shall he named revoked.
VJ CONST RUCTION LENDING AGENCY
1 hereby arhnn that There'I'a palliation lending agency for the pert metal
W A the work bar which floe per ma is issued(See 3097.Civ.C.1
ALender's Nremc
5 z Lender's Address -
C.7 O I verily Lha I have read this Unci)anon vod sate mal the anme inNmmtien Is
❑+ �y
correct.I agree to comply wan WI city and county ordinances rend,tate laws relating
O (� nbidding cnaavotion.and lechyaraherie representatives of this city to enter cron
❑art i JI tyt p f p p .
dry C. (we)agd fy andkeep l I ::tire Cdy IC, . agar
".w V] fichilitic,.,ocignerp, laid exaccolI,wh 1 "Illy in air,w} osel sstend
V z City in conscipta,volth yeardi.,ol his, r I.
n.
APPLICANU
RLGULA'IIISNyNt>V AryD W/ILEO WITH ALL NN`POINTO ItiSUed by: Dat (/
sgnana e— t n o-a1clC,rL/Jr !p Dal7(efj Re-roofs
HAZARDOUS MAUIRIALS DISCLOSURE
W01 the apnlicans m rate.m,ddn"acalpant Mnre m handle on,ardeaa ornedal 'Type of Roof
rs dcfncd by the Cape,,lm,Mnnicip.1 Crvie.Cnnmcr 9,12.told ore Hadco and Sandy _
Cndc,Seaton 255321.!
Cl yes .°No All roofs shall be inspected prior to any roofing material being installed.
Will heanph,son Nation Welding nice apmifreeSpop.canrdesire,wlrint 11'a roof is installed without first obtaining an inspection, I agree to remove
milt hueardous rely cenlnmintms ce domed by IhC Bay Arca As,Qnslay Mire,aam
uNllane all new materials for inspection. Applicant understands and will comply with
°yes 0 N all non-point source regulations.
I have read he hustodeus macriuls prielc halo under Chaplet 695 tit(itc
Call irear,Health&Sufcry Code.Seenion,255115,25533and 2553411 dooandLha
if the banding cine,not currently have omnan n,man it e,r,y responsibility toothily he
kpip rot one Icllniremenn tenow tie mel prior w insuunm el'n CcnlEune oft / Z- Signature of Applicant Date
ncrm aumadsed agent Uric All roof coverings to be Class"B"or better
OFFICE