05040016 I CITY OF CUPERTINO ``
BUILDING DIVISION PERMIT �CONTRACTOR4NFORMATION:",,
BUILDING ADDRESS s PERMITNO.
GIANT PLUMBING, INC 05040016
i ncil n ZITTTCTa1(1ATR T]R_ -
OW NER'S NAME: PERMIT ISSUE DATE
Aft MARK VAi7t;HTT 1 TI I T noV r1PP :_V_ _nn
A Cn}4 y r`F
ONE: - SANITARY CONTROL NO
(4081 ?4l -F(408) 241 -r'141 —_ _ _
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
woo LICENSED CONTR d order S UEsims or hap ON
C 1 hereby affirm thm 1 am of Bu under provuimns or Chapter 9(commencing Job Description
t� with Satian)IXM1)of Division Jof UC BUSineca srW Profession Code.and myliccnxeu
mhRfinectndeffecir -.2 �(�_ ru� REPIPE & REPLACE WATER HEATER
�? License Class Lm N
Z_, Date Contractor
ARCHITECTS DECLARATION
s1 understand my plans shall be used as public records
DyU
+.tip r^ Licensed Professional
OWNER-BUILDER DECLARATION in 1 hereby from that I am exempt from the Contractor's License Law far Oc
O o following tension.(Section 703 1.5,Business and Pm @uiom Cade.Any city Or County
Q which requires a pcomt to comsuuct.alter,otpro c,dcouluh,or repair any 9MCONO �,A n n n
r Z i prior in its issuance,also rrgmtes de applicant far such permit m rile a signed statement
i< that he is licensed pursuant to the provisions of the Contmuur's License Law(Chapter 9 Sq.Ft. Floor Area Valuation- - -
't-$ (commencing with Section 7000)of Division 3 o the Business and Professions Code)an
— Nat he u eumpt therefrom and ha bass for the alleged cumpuon Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 p� ig�3 erp p Occupancy Type
no,roam them five hundred dollars(1500).
1,ss owner of Nc pmpmy,or my cmplOyccs wM wags u deer wlc compcnsedon,
will do NC wank.and thcswclumns notmtcnded or offered for sale(Stec.1044,Business - Required inspections -
and Professions Cade The Contractors License law doe at apply to an owner of q p
propertywho builds or imp ionademon,and who dos such work himseifor Ovough has
own employees.provided Nat Such Improvements art not intended or offered for tale If,
however,the building or improvement is mid within one your of completion,the owner.
bolder will ban the burden of prom,Nat he did not build or Improve for purpose of
sale.). Y
❑I,as owner of ct(Sec. .B exclusively Cammcting with.)Tensed contracmss t- / l
consumer,d project(Sec.1014,wner of and Py who ins Carla)The
ves the on, rid !�
who claw data not apply je an owns of proper(}who bolds or improsea Conuac and /
who contracts for projects with a contractor(s)hunutl pursuant w Nc Convamra
Lice.Law.
1 am exempt under See. .B&P C for this reason w�
Owner Date v
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of Perjury are of the following declarations:
I have and will mamtmn a Cerurtcme of Consent m self-insure for WorluesCompen-
sation,u provided for by Section 3100 of the labor Code,for the performance of the
work for which this perms a Issued.
❑I ban and will maintain Workers Compensation Insurance,u requtmd by Section
31011 of the labor Code.for the p irfamuncc of the work for which this pertnnt is Issued
My Workers Compensation Insurance carrier and Policy number art:
Cannot: 0.O Policy No
CERTIFlC OMPE SATION10NFRAN WORKERS' _
COMPENSATION INSURANCE
(This archon Iced not Inc completed if the perm,,a formic hundred dollars(SIM)
or Icss.)
I cur ifv Nat in the hirromance of Ne work for which this Permit s issued,l shall not
employ any person in any manner an as in become subject lO IN Workers'Compensation
laws of California Date
Appl¢a,
NOTICE r0 APPLICANT If,after making this Ceoficase or Exemption,you should
become subject m the WOrker'a Compensation previsions of the lahnr Code,you must
.J O fmr(hwuh comply ant such prmismnx or Nis permit shall W domed revoked.
Z CONSTRUCTION LENDING AGENCY
I hereby affirm Nat NCre its a construction lending agency for the performance,of
a
Or work for which this Perot,is slued(Sec.309'/.Cry C.)
=ZLarder's No,-
Lenders AdI
U Q I certify Nat 1 have read this application and shot Nat the above information Is
12,F cancer.I agree to comply with all city and county ordinances and sus laws relating to -
O building construction,and hereby aUOOnm oprtsientamrs of Nis city to enter upon NC
V
above ocntiored property for inspection purposes.
Fw g, liabilities judgments,costs and expenses which may in any the City of Cupertino way see=ag against acid against
U to consequent,of the granting o(this Permit.
APPLICANT UNDERSTANDS ACtp WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS, /I II'' � _
�x..a V.- _ tl (7*101)lk Re-roofs Q '
Signature of Appinnn n r De
HAZARDOUS MAT RIA ISCLOSURE Type of Roof
Will the applicam ai fuwre build,.,occupanumm or l uallc huaAaus material
as defined by the CupeninXN,,'
par Colk.Chapter 912,and the Health and Safety
Cale,section All roofs shall be inspected prior to any roofing material being installed.
Will the appleant budding occupa nt use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Oil haiardous air contaminants ss dI by the Bay Area Air Quality Management all new materials for inspection.
lostoet,
❑Yes No
I have real Nc hasallous maerials requirements under Chapter S95 of the Cabfor-
nia Hw lth&SOr L,Codc.Sccums25505.25533and25534 IuMCrstvld NV lfthc padding
does not currently have a cunt that It u my respomibilny m nou fy the occupant or the
teVutmmen mchmustbe Ipnor3rt(ssumceofacemOcateor�N q Signature of Applicant Date
!k//�' All roof coverings to be Class"B"or better
Owner or MiTionized ape IJ / Da
V
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # s— Date:
32-6 �6 o 0.1 lo` ob
Building Address: \ -
I 10510 A 1ti1S wov-TAI L K
Owner's Name: Phone#:
-M 11,V 9, U41Vl
1 Con/ft�ractor: Phone og
`
License#:
I (rJ iu - J �7 aj� Vi S�b l
Contact` � Pho� b�l �',D��f� Cupertino Business License#: l
` va�J C'? ` 3 o`�C f
Building Permit Info: a 1
Bldg ❑ Elect ❑ Plumb.'
Job Description
Residential P Commercial ❑ 11
Cost of Project: II
�yr000, ac�
Qty. if
Applica¢le Fee ID Fee Description Fee Group
f I PPERMITFEE Plumbing Permit Issuance PLUMBING
/ { BPREPIPE ` Repipe of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE I Pblg. Fixture PLUMBING I
{ BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
I � f✓s��2 /feria-/��_ 1