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05080147 (2) CITY OF CUPER'rINO "'"r^ me BUILDING DIVISION PERMIT pdCONTRACT;bR INFORMATI BUILOIN ADDRESS: PERMIT NO.O 5 O H O I4 7 OWNEROWNER'S NAME: PERMIT ISSUE DATE RUTH LALLIE 2005 NE: SANITARY NO. CONTROL NO. S BUILDING PERMIT INFO BLDG ELECT PLUMB MECH trop LICENSED CONTRACTOR'S DECLARATION O O O <�C 1 hereby affirm lose 1 an lieu ad under provisions of Chapter 9(commencing Job Description U with Scotian 7000) fDivision 3 of the Business and Professions Code.and my license is n i in full fame and effect. �,\O _pan REPIPE ALL HOUSE �q z m Cut Lie. 'Fn Date_ Contractor DELL k 'y ARC MELTS DECLARATION O - +j < I undcrwnd my plans shall W used as public records JyU Ajh�rnl �] I c a0 Licensed Pmfcssional �)[j p'y /IT7t LED 9 5 OWNER-BUILDER DECLARATION Ir] lly`MMVVV�A�[tt rfNiw'a P<I I henry affirm that 1 am exempt From the Contractor's License Law Boom _p 0 following Oman.saurian 7031 S.Business and Professions Code:Any city or county <m E which mgaima a permit,,cnmwa.eller,impmw,demolish,m repair any swcmre 'I1 3600 6 0 0 Lzvsprior In is issuance,also requires the applicant for such permit to file a signed statement that he is licensed pursuant the provisions of to Contractor's Licence law(Chapter 9 Sq. Ft. Floor Area Valuation yI (commencing wi th Section 70M)of Division]of the Business and Professions Coca)or y that he is camp,therefrom and IW basis for the allegad csmption.Any violation of Q i Section 703 IS by any applicant for apertnit subjects the applicator o acivil Penalty of fy sets j 1' P yap V,^' OccUup"a�ney Type not more than five handrail dollars(15W). 3S� '1� ' iF �1y'k I,asowner of the ro a2- ❑ t sPny,m my 1intencns withwageoard.(sole camps aims. and an the work,and the swnom is nor inLndetle Law do t Out a(sec.Toa+.owner of and Professiom code:Thr iCommmor'smproves and law docs not apply lf an owner of Required Inspections property who builds or ed that thereon,and who anc rot in work himxlt ed forwgh his Own employee,provided that such Improvements arc not intended mpllercd fur sk.IL huwcer ,will haw tieImadeprovement.ssold he not year ofcompletion.Neowner- builder will have the burden of proving onv he did not build or improve for purpose of salt.). ❑I.as awter of the property,am exclusively contracting with licensed contractors to consumer ft pmject(Sec.9004,Business and Professions Code:)The Contractor's Li come law docs not apply to an owner of property who Wilds or impmws thereon.and who comaca for such projects with a contractors)licensed pursuant to the Contractor's - - Licens La . ❑I am cmmpt under Sec. .B 6 P C far this reason Dwncr Data _. .r..:.._..... .._, - WORKER'SCOMPENSATIONDECLARATION I hereby affirm under penalty of perjury oreof the following dalaradom: I have and will maintain a Conform of Consent to alf-insure for Wadrer's Compton- 10500 on,as provided for by Section 37W of the Labor Code,for the performance of the rk for which this permit is issued. 1 have and will maintain Worker's Compensation Imuran=,as m proal by Section of the labor Code,for the performance of the work for which this permit is issued. yWork�ers.C,koamoomfort Insurance carrier and Policy annular art: rtier Sl\� +.Policy No.: CERTIFICATE FEXEM ON FROM WORKERS' COMPENSATION INSURANCE (Thu action need not Wcomplcud if the permit is(mom hundred dinfims(SIM) . or tess.) 1 ccnify that in the performance of ISO work for which this permit u issued,1 staff our employ any person in any manner s a or become subject o the Workers'Compensation Laws or California.Date Applicant NOTICE TO APPLICANT:IL aper making this Certificate Of Ea ragamn,you should became subject to the Worker's Compensation provisions of the IaWr Code,you must forthwith comply with such provision or Nis permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY [-+ I hereby affirm that tMm is a construction lending agency for the performance of C4 the weak for which this permit is issued(Sec.331 Civ.C.) fA A Landers Name z Lender.Address U C I ccnify that I have read this application and sole that thc above information is ly F correct.I agme to comply with all city and county on in umes and slate laws relating to 0 building ematruction.and hereby authorim representatives of this city in enter upon Ne r Ck1 aWw-mentioned property for inspection purposes. F C (We)agree to save,indemnify and keep harmless the City of Cupertino against N liabilities,judgments.costs and expenses which may in any way see=against void City U in consequence of the granting of this permit. ^ APPLIC NT HNDERSfAND$AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR REGULATIONS. i Z✓ —� is ) Re-roofs 4 _fvs�4 Sig cof-AppdcanlContrartor Darr HAZARDOUS MATERIALS DISCLOSURE Type Of Roof Will the applicant or future building occupant store or handle hatardous material az dcfncd by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety Codc,scaanz553z(a),. All roofs shall be inspected nor to an roofing material being I ❑Yea P P Y g g installed. W;f It anp it' `ar future building occapant use equipment or dcvicea which If a roof is installed without first obtaining an inspection,I agree to remove hazardous air conaminana m defined by onto Bay Area Air Quality Management all new materials for inspection. sam" ❑Yrs 1 have sad the hmanbsus materials 5533 0415534, 415534,1uncerChapter 6.95 of the Wilding ho nice Hcahh&Safety Code,Seedunshan it my arsambi4.1 un notify tantrumoccupant Wilding does not currently haw a¢nano.that it u my respomihility b notify the occupant of the mquircor In OttxmetFrioamis`utaeora 'ficateofOccupancy, Signature of Applicant Date own uthomcJ agent L Date All roof coverings to be Class "13"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building De artment JOS ` -t KESS �\ PERMIT# —7 OWNER'S NAME: PHONE # O 6- p /�.crIS GENERAL CONTRACTOR FAX# I am not using any subcontractors: ~ �) i '© Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting • Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing' Roofing Septic Tank Sheet Metal Sheet Rock Tile - Owner/Contractor Signature Date CITY OF CUPERTINO 7 REPIPE/SEERS/MAIN SERVICE CUPEkT1NO PE IT APPLICATION FORM APN # �aZ Date: I�7 Q—� Building Addres :�� l-c1J•�'T �V/�� Owner's Name: (� p Phone#: Contractor: V� _ Phone: License #: 'C�-�,� v'y�� �N}1''� • 2,o56sob X51( `� Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb Job Description: m _ N I l Residential \mow Commercial ❑ Cost of Project: 6 Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING — --� BPREPIPE Re i eofFixtures PLUMBING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING v -� L / 44-- 3 6 �. ��3 _, �, I �7 ,/ q �� / /�• �.�,��_ JCI;. !:�' _ � f, ., ��.. . . r, r