00120053 (2) CITY OF CUPERTINO
IrUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRIiSS VERMIT NO.
1.0959 NORTHSHORE SO BUDGET PLUMBING 00120053
OWNER'S NAME APPLICATIONS SUB DAPI:
OSEN MAY TRUSTEE 2:8695 ROANOKE ST 12/08/2000
_PHONE: _ SANITARY NO. CONTROL NO.
(510) 303-7847
BUILDING PERMIC INFO
ARC111'1'iGf/IiNGINIiE1L BLDG ELECT PLUMB MCCH
w❑
5 N' Job Description
LICENSED I u CUN'BACrder DECLARATION out
Coaster';
ZO L�' 70 allirnh mal nm 0 tilerd undct pmv'uinns of Cs Code,(onnnmcmng
niFF++w wilt lot]ion]INHll nfect.xion3nfthe l3minn5n mN l'rofcxxiunx Cada motor,nlicense
is in(all lince and d'fcn.
tea, LicenwClasn Lla.x WATER HEATER REPLACEMENT
a Dam Contractor
v1 uy ARCHITECT'S DECLARATION
E' I maad my plans shall Itt urea ns Puhlic rcundx
d ;m
�r
ad ae O O Licemed Professional
o LL OWNER-HUILDER DECLARATION
u�= I hereby if irm mat IU.exempt from the Contrition's License Law for the
h
fill,.11111 in,mnsnn.(Scainn]1131.5, ;,1bas and I'mfdicoUl Gds:Any city ar softly
of(�YC❑ wM1lch roquiro'n pcnnil to cansln¢L nhcr,ins is a h,wnra fi rap:nr any mnau em
K3� battleslcenseptic Forward
dtothe I mviion,of for asM1letors License a.(Chaprra;
Inmhe6Eccnwtl SectionomeP f isvi%ima oCnmmnnesl andPelawour,Cor) Sy. Ft. Fluor Area Valuation-
or that
he is a with Section om and
Division 3 of the Business and Professions Code)
or That io 7 exempt therefrom mJ the basis it the alleged enemant to aAny
civil illation -
ofFenian7H3 t iv anydred anlforapemnil subjects me applicant macivil pcnapy
ahr mhl;nam that pee lhaamlrca anunn.($Slhn. APN Number Occupancy Type
E]1,as owner oflhe pmpcny.m oty cmployees with wages as Their mile componxution. 'Z 1711A
will do the work,and the sbuctum is not intended or offered for ale(Sec.70o.
Business;rod Pmfmsions Cdc:The Contractors Liccve Law does not apply to ua Required Inspections
owof property wo ms a
ildr i;nfrnvc,mean..;,and who sww
does such work hin,Ill a;gIthisawnhmuployecs.'paMdcdmmxnclainhprnye;mnnmareaOut cinal0dor 502 — FINAL PLUMBING ENERGY
ruled for sale.II;hnwevcc the building or inaprovemem is sold apnea one year of
completion,the owner.holder will have the number,ofpn,vmg that he did nm build or 506 — GAS TEST
improve let pU,—of m1eJ.
507 — FINRL_ PLUMBING
❑L lo owner of nae p(See 7(out Hiahrc";i contracting Ill wim lieenxttl a C....I ons ail
manmt the does
Pi(See ob a ovitecss;rod property
who s ills or 'I he vev liv fors
did who
f co drcn no apply m;m mann of a coutr who buildsor itnp blia Ibto The
wan crntmen for such Projects with a mmwnnr(v)licensed punuam m the .
O,ovar Contractor's License Law.
❑ pan exempt under Sec, .R K 1'C for this
Uwncr Dula
WURKIiR'S C(lMl'I!NSA1 If1N UECLARAI'ION
I hereby affirm under penalty of perjury one of the following declamtinne Y
❑ 1 have odd will ;ouinmin a Ccnilkao, of Consent hit ncmlr,um for Worker's /Q/) 'C•
Conghenmarn, an pnwldcd lot by Section 39110 of the Isobar Cada. for Ire / �� J
Iwfliommence al'me work Iia which this permit is issued. /
❑I have and will muinmin Worker's Compensation insurance,as required by Section O J
Pill of the Labor Gila fur the performance Ill the work fill which this permit is
x,icd My W..liars Coqui,i utiun Inaunmce currier and Polies number are
Cunicr. Policy No.:
CP.RrincATioN OP ECEMMON FROM WORXERS'
COMPS NSATION INSURANCE
('fbin scefil,n¢d art be wnhpleted if the I l nil's.for ane handed dollars
($10(h ar Ins.l
I eenifv that in the perfummnce of the work for which this permit is issued.I
shall not employ any person in any manner so as to become subject to the Woderi '
Cmnlnrsmiun Laws of Cal Ifornia Date
Applinud
NOI IC17 1'0 APPLICANT:IL all er....king thio-Cenideme of I?acntphi m,You should
n¢nme subject m the Worker's Conhpenmtion pnmisions of the Labor Cade,you must
'O 0 Gmhwith comply wim sucM1 provisions rr Ibis pemhit shall h JeerhmJ revoked
FDO CONS]'RUCI'ION LENDING AGENCY
CG > I brnmy anirm Rid mem Ix a.....maim.landing ogcncy 1'oa dee penormnnee
^
fine work fill which this pe,all(is issued Isle.3097,Ci,C.)
6. Lender's Name
;D z Lcndcr:Address
U O I certify that I bavc read dd.application and sone that she above mfnnllwintl Is
LL ca sen.I agree uh comply will all city unit eounly almlarms amt little haws mbaling
mbuddingem:.familm,and hcrcby:mtbrtim raptesenmi,es of lousily former upmh
r� the nlnrvcmcntimi pmpcny un impcetnn purryhses. -
t�;
M. (We)agree tosave,indemnify and kcephormemithe City ofCatalano against
fq liabilities,judgartal,cos¢and calnennes which nmy in any way accrue against said
U City in consequence of the gaining of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONd'OINIIssued by: Date
SOURCE REGULATIONS. y'
Signature of Apprcant/Commanm Ume Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the appHC;;m or metal budding«spam arm nr hamne m lobo,ou"llid 'type of Roof
o derneA by the Cupsmml)Mm;IelPnl Gdu.Chapter 9.12.and the flcallh and Safety
Code,ecY.25532m)P 0N
All roofs shall be inspected prior to any roofing material being installed.
Wit the arldi.m,orFluor.building iccnpamUse egaiPmentrrdc,icevw'loan If a roof is installed without first obtaining an inspection, I agree to remove
emit hwamo;n:m cnnmminanla its dernud by the Buy Arca Air Qndi ty Mmwgemme
District? all new materials for inspection. Applicant understands and will comply with
❑Yes 0N all non-point source regulations.
1 bale read he haemdous m:ucrids rcquimmenm ander Chapter 6.95 of the _
Callfurniu Health at Salary Cole,Sections 25505,2.5533 and 25534 1 understand that t
inha building than c,.mnnty null x meant.that a my r,elsoo ulhywn idyme
ngmnt of the re9uimnhenb wbkh maul be ran prim m—leame of a Cenircam of
\ (kcupaacy.
Signature of Applicant Date
"owncrrr aummired ngcm oath All roof coverings to be Class "B"or better
/ OFFICE