00070040 (2) CITY OF CUPERTINO '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
NUILDINGADDRESS: PERMIT NO,
OWNER'S NAME; APPLICA'T'ION SUR DNI I$
HONE: 7848 ROBINDELL WY CUPERTINO PLUMBT.NG SANIIARYV0070154V 01-NO.
co RCHITECr{iyW&: ARTHUR H AND RUTH M TRUST 10297 S DE ANZA BLV OE��;1'FTP/�}'��}r °
F BLDG L t'1:'e'.Iti MECD
a�a+G
N i LICENSED CONTRACIOR'S DECLARATION (408)283-0618 fob Description
O a_,• 1 herehv animm,ha,1 am licenced under provisions of Chapter 9laommencing
rmCu wiin Sccuureen 1mf DivisionJof the Nuzinex and Prolessiom CNc.mnJ my licenu ,
�yy� is in liJl force nnAe ' , (,(O� _
z d¢ Licem,• Lic.p. i�
pOM,
w wet C Dom_l=I—CU b cumranm_(-
G ARCHITECT'S DECLARA'll _J
I understand my plan.mill be used ac public mco ix
�doo uemrr,m rrnresai"nilREPIPE/WATER HEATER
OWNIiR-IIUILDER DECLARATON
tN1-. 1 hereby affirm that 1 am exempt limn the Contractor's License Law for the
C Z< following mason.section 7031.5.Rosins,,and Pmfessions Code Anv city maturity
5 t O which mquims a pemail 1.continuer,alter,improve,demolish,or repair any stmclum
w in prioto its ie,,ran,c.also require,this applicant bu,rich renniutemc
n file a signed amm
a. Ih,,Zisheen,edr.snamt„arepookinn,otllreComracu,r.,Licensel.;,. chaper9 Sq. Ft. Floor Area Valuation
(commencing with Section 901(1 of Diviann 3 of the Business and Pmfc%vions Code)
or that he is exempt therefrom and the basis for the alleged exemption.Any s'iolation
of Section 703I.5 by any applicant for a pem,il subjects the applicant u)a civil penalty
of rime man rise haadmd dollr.rs(ss(Xd. APN Number Occupancy Type
❑I,as owner of the prupcny,surmy Employee,with wago as mei,wile Impetration,
will du the work,and me structure is not intended or uRrmd for wale(Sec.70,14.
Business and Pmfccslons Code:The Contractor's License Law does not apply Or ail Required Inspections $5000
r td pm,puny Who builds or improves mem rte and who does such work himwll'
Orvth,nugh hi,own employees,provided Thin such is nem,are nm in,nded ur
offered for sale.If:bnwever,the building or improvcmcol I,sold within one year of
completion.me nwnerdwilder will have the burden of proving that he did not huJd or 36219030. 00
improve for parpose of cafe.).
❑I.n,owner rel'the propcny.our exulwivcly enntructlng with licensed contrucnev to
instruct me pmjat(Sec.n94,B-dness and Pmr,.im,s Code�.I The Contractor, 202 — UNDERFLOOR PLUMBING
License Law docs an,apply n,an nwnerofp open,who builds ter improves themra, 301 — ROUGH PLUMBING
and who contracts for such projects with a contmetor(,)licensed pursuant to the 6 .
Commemr,License Late -502 — FINAL PLUMBING ENERGY
E]I; exempt is,Sea. .B ffi P C Gtr IDI,mawon
Owner Date 507 — FINAL PLUMBING
WORKER'S COMPENSAr10N DECLARATION
I herehv ulti,nl Bader paullry of perjury nneol'(he follnwing dalnmtion,I
7 I have and will maintain Centiliter,alt Consent in-®If re for Worker,
Compensation. . munded bor by Steiner 3701 of the Labor Code. for the
pnL..... f,h ,d f h 1 th a pentisolated A
011 J..If ainurined kea':C ml li a InOilloce.a,uNpamd by Seat i
3700 of the LuMi Cale,for,hc larlorraturre,,or the work for which this pcnnil Is
J_M�-fperx Cti I�uirytln VolieRe o.:r rte -7 �3—MQr�nre: w1
Cmr¢c A' 'Toll UM 111 ON Y9
CI: 'III IC I[ON OP VI[ON TINS RFROMANO WIIRKhRS
CO.M I'IiNSd1'ION INSURANCE
(This section need no,be completed if the permit is for one hundred dollars
n I(10bor less.)
1 certify that In the perfurrnm,ce of the wurk for which this penton is issued.1
shall not employ any person in any manner v,as to become subject n,,he Waders'
Compensation Laws of California.Date
Applicant
NOTICE 9'0 A11I1LICAN'1:Il:suer Tonkin,Thi,Ccnilicumof Eaamptlon,yam should
hcconm sunvcl to the Work,,Compsmall un prnv kinin il',he Labor Code,you muw
Q Q forthwith comply ,in such pnwlsinns or this permit shall he deemed revoked.
F In CONS'1'RUCfIIIN LENDING AGENCY
I betnby abion lhm them iso u,ngr,etion lending agency for the performance
WLir the work I'm which This permit I,issued(See.3007.01.C.)
0. C Leader's Name
= Z Llmder'a Address
I comfy that 1 have read lis uppllcaJon amll.,ate flan me above Otnnmation is
W correct.I agree In Imply with all dry and county unllmmue,and cram laws relating
Q U mbuildmg conwuclinn.and hereby authorize representative,ofmisc'dy Insurer upon
uMwoan ,
,be rncvred property far impection palpitates.
Oke)agree to vase.indemndy and keep harmlc,s the City ol'Cuperin,again
A hadfidnics,jmdgmems.cm0,and ca,nm,which may In any war accom ngaimsl said
U Z
AA
ity' ,ser 'm r'Iho gntming of Ibis permit. ���
tl
AI'I ST ND ND WILLCOMPLYWITH ALL NO POINT Issued by: Date
S IRE' ��I J�JD
Signature of nppls venal) wour Dam Re-roofs
II )OUS MAIHWA S DISCLOSURE
Will the applicant ter future Waiting necupunt store or handle hazunlous nmmrial Type of Roof
as defined by the Cupcninu Municipal Code.Chapter9.12,and the Health and Safety
Gale,Seen..235320)?
❑Yes 0N All roofs shall be inspected prior to any roofing material being installed.
Will mcapprrnrm or Oure nuudingmeempam use ,i,normor deems,wniah If a roof is installed without first obtaining an inspection. I agree to remove
•mi,htrictuz.Mo.,air conmminan s its defined by the Bay Area Air Quality Management
oi, + all new materials for inspection. Applicant understands and will comply with
oyes 0N all non-point source regulations.
I have,,ad the hnamd... n awnd,returem,e 1v undev Clot,,095 of the
California Healm&Safety Gala Sections 255'5.25533 and 25534.1 undersmnd that
iI the building does not runetnly leave a tenant.that i,is my mspmnsib'iity to notify me
cupanl of the mquimmenw which mm,he me,prior m issuance of a Cenificate of
Ops°pr'a`y' Signature of Applicant Date
Ownc,oraamad,edrival - Date All roof coverings to be Class "B" or better
OFFICE