01100047CITY OF CUPERTINO
BUILDING DIVISION PERMIT
- CONTRACTOR INFORMATION[:� -`
BUILDING ADDRESS:
PERMIT NO.
875 ALDERBROOK LN
SOUTH BAY PLUMBING
01100047
OWNER'S NAME:
APPLICATION SUB DATE
MASTERSON WILLIAM J AND ELAI
E 441 N CENTRAL AVE
10/09/2001
PHONE:
(408)370 -3535
SANITARY NO. CONTROL NO.
ZO ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
d
LICENSED CONTRACTOR'S DECLARATION
: Job Description
I heeby affirm that 1 am licensed under provisions of Chapter 9 (commencing
m withSection7000) of Division3oftheBusinessandProfcationsCode ,andmylicense
13
REPLACE WATER HEATER.
is in full force and effect.
U License Class Lic.N
Date Cixersaor
y ARCHITECT'S DECLARATION
1 undcrsmnd my ]..,,hall be .,ad as public records
OLicensed Professional
�y OWNER - BUILDER DECLARATION
or 1 hereby affirm that am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
❑ improve,
$450
which requires a Permit to construct, alter, demolish, or repair any structure
°m ,. prior to tissuance, also requires the applicant for such permit o file a signed satellites
— .... .. ......... .._ .._.... ..__ ..._. _._.... _.. _........_...__....__.... ,.__... .... _ .__..._..
— that Veils I e d parduart to the previsions Office Contractors License ' Law (Chapter 9
'th Section Of
(commencing lisines dMofession, Code )
j� ,}7Js�.� .y��s� a .w M1,T
CO Qs,dfiky. `i3.FY-�'2 •,VtU'�'_:f17 k7 /1�!�r� =S [f7.AI{l�'
Valuation
or
or that he is exempt therefrom and the basis far the
basis ed nimpnb0 Any violation
- subjects
o(Senion 7031.5 by any applicant for a permit subjec¢ the applicant a civil penalty
.fact o tom than five hundred dollars ($500)
5024P1*'4Tft14 PLUMBIN
ENERGYOccupancyType
El 1. as owner of the property, or my employees with wages as their sole compensation.
5065 —
will do the work; and the structure is Out intended or ofleted for sale (Sec. 7044,'
Business and Professions Code: The Convector's License Law does not apply to an
507 - FINAL P7R at?IGYlilMspectiohs'
owner of property Who builds ar improves thereon, and who does such work himself
n
or through his own employees. provided that such improvements are not intended or
offenal for sales IL however, the building or improvement is sold within one year of
completion, the rbulde will h a the burden of proving that he did not build or
imp f rp rpn.eofeele)
/rye
rI1VALED
.. ..... ... .. ..
H 1, as owner of Ne property m exclusively contracting with licensed contractors to
......,..., _ .. .. _ - .... ..... ..
construct the Project (Sec ]044, Business and Profess ons Code) The Contractors
- License Law does not apply to an owner of pmpcny who builds or improves thereon,
'.
% % "
OCT ^ '•r ZO1O 1
. and who contracts for such projeca.wida a contmemr(s) licensed pursuant to the..
.. .. _.. ...: t
Contractors License
- '
Sce
D me pt order B &PC for thb maven
-:' '.' -1•.). :.:
Dw a't
BUILDING
WORI BR'S COMPENSATION DECLARATION
' 1 hereby affirm under Penalty of ce pry one of the following declarations:
❑ 1 and will maintain a Ccrtifiedo of "Cmoart'm calf -insure for Workers
Compensmion,-as provided for by Section 37W Of the Labor Code, for the
- performance of the work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the wdrk'for which this prrim, is
'My
isi6ed. Worker's Compensation Insurance carrier end Pol cy number
Ca 1 'Policy NO -
CERTIFICATION OF EXEMPTIONFROM WORI(ERIS l
4, kv�t q f d. ,j, a -.: r(�4 rt av ...
I l Ii ( _ t }.... k- �." , IA fr .' 1
COMPENSATION INSURANCE
" TM1 section .1 ad not be amapihaed if the permit is for one handled dollars
) � s " I r } •�� ) ' '
($100)or less.)
I emly that i , ri-the p rforman - of the'riork for which this rah is issued, I .
^.._ ... .. _ ... .. .,. .. .. ,, .._,.
a
shall not employ any ce t any manner so as to become subject to the Workers
-
Compensation Laws of Cal f miu: Date
APP( ce t: ...
_ _ _. y .. ..'
... ... ._
NOTICE TO APPLICANT If, after making this Certificate of Exemption, you should
should
.. _ ... ...
• .
iions Cade, you most
bedhwith
the Workers Cbions this pmbisinhall fthe Labor
'
or
� forthwith roinply with such provisions or this permit shall be deemed revoked.
comply y deemed
... ..
f
t. :. _.
CONSTRUCTION LENDING AGENCY, '
...... .... ... .. ..., _ _
"
I hereby Nat there iss construction e
hgc cy for the pedurtmnce
iron Icn7,
.,
of hick
f which Nis permh is issueo•(Sea. 3097, Civ. C) ,'
( C
i Le de', Name
u
Leotler's Atldreas " ""
1 hat I have read this a cat
certify t city i state that the above information is and to b build 1 agree lr comply with all
end county ordinances and state laws relating
1 bb au napru i
properhereinspection representatives of thiscitymen¢r upon
mbabove,icamioua
the above -mentioned property For my purposes.
and ke the City o(Capatino against
(We) agree to save, indemnify nntl keep hamay
1 liabilities, judgments, costs and expenses which may in any way accrue against said
in
City m consequence R the grunting this Permit. ,
APPLICANT ""
D
UNDERSTANDS AND WILL COMPLYWITH ALL NON- PoINT
L C
SOURCE REGULATIONS
Issued by: Dale
Signature of Arpl awC ;tact Door'
Re-roofs
- HAZARDOUS' MATERIALS DISCLOSURE 1
W II the t o f tuts building start hand) h
as a Colon
- as defined by the Collection Mun c Code Ch
Chapter
pal 2.
pt r 9 12, a d the Health nil Safety
Health a
Code, Shy
-
4 ci sv
25532(e) 11 No 9' 1I
aw $ �. i1.� a:
roofs shall-be Inspected prior to.any roofing, material being installed.._
,� ; wit tog applicant furore building oc pant use equ parent or devices which
emit haeadous air contaminants defined by
_-All
If a roof is installed 'without first obtaining an ins ection''I agree :to)remove
g P
as the Bay Area Air Quality Management
District?.
o `
all new materials for inspection. Applicant understands and will comply with
: No
'd • - - -
,
all non -point source regulations.. .. -
"' 1 have reaE the h tl s materials qu' ments tinder Ch pt r 6.95 of the
'
California Health k Safety Code Sections 25505; 25533 and 25534) understand that
- ifthe building dues not currently have o tamml, that it is my respongibil iry to nofifythe
-
oce6pam of the requirements which must he met prior to issuanceof a Certificate of
Occupancy' '
Signature of Applicant Date
All roof coverings to be Class "B" or better
'., ..
Owne r or authorize d age nt Date.
s i,, ._, -,. ...'. .'. ' ..;. -; .....:;
.. OFFICE ....... _...