00080218 (2) CITY OF CUPFRTINO
; BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERNf lir NO,
OWra1int s NAM120 — APPLICATION SUB DATH
7ji
I: BACHTEL — 28895, ST SANITARY NO. ^C )N'I• ).e,0,
J J— BUILDING PIi12M1'P INPO
imc T/ENGINHER: BLDG IiLECT I'LUMii MECH
ad
1JCENSEDCONTRACTOR'S DECLARATION1lauchy aRnn ma I ait licensed under pooWi es of Chapter 9(commencingJob Descripiton
Cat1oa7000)ol DI,mun Sol'the Ra,Ina,smat P...fes,iou,Gde,nod lay lec,oc
ull force and CRea.
c Class I.ic,M
er`. Date eoatmmor WATER HEATER
w%C m ARC I HI EM'S DECLARATION
!'= 1 nndcnmad my Plan..halt b,to d a,public rowel,
y`J
u tt p O Leenscd I'rofessimml
a'c— OWNER-EUILDEIt UIiChAItA'110N
a m I hereby affirm that 1 am exempt from the Conroe,.,',License La.for the
F• a' following reason.(Satins 7071.5,Business and Is.bfm,axo Cade:Any city o,county
d c which requires It permit to romaan.alat,improve,demmi,h,or o pair any,waare
w—m pdonoit,i,canre.also r,yuie,the apinieant be...1,perall r e lilc a signad,tatanhCnt
i%— maths is licemcd pursuant to the prosismss of Contractors License Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 70)1)of In,slon 9 of the Bu,i nc,x and Professions Code) ,
Or that he is exempt therefrom and the hats for the alleged exemption,Any violation
mf Section 7031,5 by any app]icanr far a Penni,viblau the applicant to a r,.I Pctmlty
of not more than fisc hundred dollar,f$50l APN Number Occupancy p
D 1,;is ow net of the propcny or my employees w ith wages as their sole emalpen mien.
will do the work,and the vmcmre i,neer intended err olrered for sale(Sec.7011, 1 f J
Business rand Professions Code The Contractor's Licemc Law does not apply to an red Inspections
orr of p,,),rIy Who hand,or Improve,thereon,and who don,,neh work hlmnelr
through hi,own employees,prodded that such improvements are not intended or
owred for,ala.If,however.me banding or impnwemeot i,„rid within year nr 502 — FINAL PLUMBING ENERGY
compl aint.the uwrmr.hoihfer will have the burden of proving that he did ant holm or
improve for pa0w,eal smel. 506 — GAS TEST
D I,a,owner ofine p",cr,am exelo,iody eommctiog wird licmh,ed careaerors in 507 — FINAL PLUMBING
mstmut the project(Sec.7(94.Huorox,,and Profes,iom Gale)The CommeniC,
Lieemc Law does not apply ,,an owner of pmq+nry who baildv or Improve,thereon.
and who contracts for Inch project,with a commensals)licensed pursuant to the
Contractor,License Law.
Cl I um c.cmpt ander Sec. .B k P C far this reavm _
Owner Dam
WORKER'S COMPENSATION DECLARATION F'YA B A G E
I hereby anion under penalty of perjury one of the fallowing declarotiom. - E�I OHO Y®I�S
1 I bas and will maintain a Comihcme of Cnmmnh nI scli-inmm Ila Worker', MAY 2 3 2001
mmemuno, as provided for by Section 3700 of the Lahar Calc, fur the
performance of the work for which this pennd i,issued.
D 1 hate and will maintain Worker's Compcnsmion Insurance,as rcyuircd by Section BUILDING
'V 1 �DI pr^
}71X)mf the Labor Cude,for the perfmm
nnce of the work for which thin permit is MLA '
sued.My Worker's Compensation Insurance caste,and 1411i,y numb'art,
Coniesfolio'No,:
Nunn PICA'ION OF EXEM11HON FROM WORKERS'
CGMPENSAIION INSURANCE
fans section need not be aumplea d if the permit is prime hundred dollars
1$BX0 or lens.)
I rail,that in rhe un-butmmm Of the work far which this Inlimit i,issued.I -
tha11 nor employ any peenm in any manner so as it,become subject a,the Workers
C..... a,alirtn Law,of Coah oora.Date -
Appheant
NOTICE'10 APPLICAN'k If,are,ivaka,this Cenifissue of Enemptina,you should
lwcome subject the Workers Compensation provisions of the Labor Cale.You must
'O Q uo fonhwirh comply wink such provlsiao,or chi,lhcomil,hall he deemed conked,
F ^ CONSHCJCTION LENDING AGENCY
1 hereby olFnn that there is a construction lending agency for the Performance
of rhe Work for which this permit I,issued(Sec.9007.Cls,.C0
Q Lcndcr:Name
ZD z lender',Addees -
(..) O 1 trinity dbm 1 have read 11111 appl¢anan amt.wale that the nbnve irrramhadon is
W F.1 coffee,.1 agree to comply with all city and county ordinance,and state lax,elating
O (� mbuilding ton,Vection,and hocby ntahml.ryre,enano-of Thi,city lin enter upm
W rhe taws-rncntional P ,,Oy far inspection mr,ar .
tra 4 Oa'd agce huavc.anddut expenses
whikeepch
hm may
in an way a crus erg istsiagainst
N CaY ate,,judgments,costs and expenses which may in any way oceans against said
U z Chy Inemmequ ND ol RShogaming of this Per '
SOURCE REGULATIONS, AND WILL COMPLY WITH ALL NON-POINT ISSnCd b DinC
SOURCE REGULATIONS.
Sigwtmc of Ap,iicmht)Canrmemr D1nc Re-roofs '
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or mare holding oralpam,tore or trundle lia.armnr,material Type of Roof
;is detmed by the Cu,ramuo Municipal Code.Chapter 9.12.and the Health and Safety
Coda Section 2553210)1
DYe, . Dela All roofs shall be inspected prior to any Tooling material being installed.
Will the applicant or frame building wcapau,use equipment or&,icc,which If a roof is installed without first obtaining an inspection, I agree to remove
anhheiial sme conmminan,a,ddined by the If..,Area Air Vn:diry Mantgcmcm
Oirim
D Yes LINO all non-point source regulations.
/ 1 have read she bamrdom mataim,cwirernau,under Cll 6.95 tit he
CuliRunia Heard,&Safety Cn le,Sections 25505,25533 and 25534,1 aoder,kn d that
if the building Aeras not ananly have a tenant,that it is no,rcvpn O.,hda,lin n 1,the
cupaut of the ralairements which must he met prim to issuance Of Certificate of
iiecepaneY Signature of Applicant Date
Gwoer or;lon,oeaad,gent Dam All roof coverings to be Class"B" or better