02030148 OF
C1 BUILLDIING
BUILDING CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10330 CALVERT DR. AMERICAN RESIDENTAIL SER ICES 02030148
OWNER'S NAME: APPLICATION SUB DATE
ANN MANDAVILLI 1479 BERGER DR 03/26/2002
PHONE: (408) 287-2165 SANITARY NO. CONTROL NO.
O O ARCHITECGENOINEER: BUILDING PERMIT INTO
IT U BLDG ELECT PLUMB MECH
c U IJ 1=1 LD
H= LICENSED CONTRACTOR'S DECLARATION
i z_G 1 hereby affirm that I am licensed under provisions of Chaper 9(commencing Job Description
31st, withSccda 7000) fDMaim3UffhcBmin7ralProcessionsCode.andmylicense INSTALL CLEANOUT.
is inF. f dcRe t. JC
'z�'a ua�� �. Licasle -
O y Ui. Camiroyy
l aO In ARCHITECT'S DECeAR
< AT10N
J 1 understand my plans shall be.,ad ax public fecaMx
i�
i S o O Licensed Professional
O's NER BUILDER DECLARATION
u�o I hereby affirm that I am exempt from the Contractor's License Law for the
t:z< fallowing reawn.(Station 7031.5.Boonexs anal Profession.Coale:Any city or county $2200
Y x❑ which requix5 a pemtiPI.consumer,aIle,,improve,demolish,or repair any imorme
al
r to its issuance.alsoreclaims line_applicant for such permit to file a signed statement. _. _.__._._..
d61he,is Awarrard psubstrain,to the provisions of theComr.awr License Law chapmr9 - r r a_ Valuation
(commencing- with Sect, 7")of Division 3 of the Business dP fes Cade) (, • I t3:�3:1-25x7] lTl] '�ty1 �.�'('j1k t;
or that he is extampt therefrom and the buss for the alleged ekempubn.Any violation
of Section-]031.5 bYany applicant for a permit orBecas the.,dica....a civil penalty
of.m marc than five b.nalxd dollars lg5o0). 108"'pN '�19ft`R & WATER il' " "'' Occupancy Type
71].as owrorofibe progeny,mmycmPloyees with wages as their sole compensation, -
will do the work,-and chat macwre'ii not intended or offered for sale(Sec.]040:'
Bminesi ani Professions Cale:The Cammcbm*,License Law does not apply m an 301 - ROUGH PlBfdW(ldX[spections'
owner of property Who builds m improves thereon,and who docs soon work himself
or through his maemploy..provided tht nimprovementsare intended 302 TUB & OR SHOWER,
offered I if,l 'the n Id ng p i .tis Id In o aycw of .. _.._.. _.... .._.. __ .. ___
completion,the owner-builder will have the burden of pravingthm be did not build or 502 FINAL PLUMBING ENERGY _- " ' �•
improve fm purpose of sale.). 506 — GAS TEST
_ —tr — —
❑1umertoowner
loquep(Sec.7 lin....ively Professions
licensed contractors w 5.07- - FINAU- PLUMBING •s ,.r. _. . ..
consumer the project(Sec ]034 Boner. and Professions Cade)The Contractor's. ,
License Lawdoes not apply man owner with
progeny woo builds m improvia thereon, I -'
and,who mmmds for such Projects wit.a commnor(s)licensed.pursuans.m.NeCor
111 on c License taw. ''---
❑Iameaemptunder5ec. ,B'&P C for this rcmon
Owner - . . Dare WORKER'Sunder pCOMP r perjm on DECLARATION �LF�
Ihercby affirm under pcmhy of perjury elle oftM1<following declarations:
❑ I bzve and will maintain a Cellifiale.I Consent to self-insure for Worker's oars
x` Compensation, as provided for by Section 3700 of the Labor Cod, far she
perfom arec of Ina work for which this permit is issued,
111 have and aadirmainmin Worker's Compensation Insurance as required by Staurion
3]00 . th Worker Cod f the performance of the work for which th permit m „ .gVILDING
p My Workers C pen foinsurance c d PI]icy number m: '
2 J'lY �sa�Poloy Na Wc-�iSYJI7 ....-O .. s_ .........
rssu
COMP OF EXPON INSURANCE' j ,♦, t o '� .t"�1 };l f: )''�: "-
I,CERTIFl A 0MP NE TION 110, OM WORKERS'
._.__.. __. _.. _._.__ ._.._..___ ..._..__-_-----
'a""jThis'section ncea not be completed if she pemdt is for one hundred dollars i ----_-----
(S100)o,IcasJ '
" 1 lafy fl t m th perf ce of tM1d work for witch thisptit
em 's issued,l
shall not employ any'pe n to any manner so as to become abject to the Workcrs .
Compensation Laws of Califomia:Dam
.
Applicant.NOTICE
- .. ..^. - .
u
TO APo the Worker's
mmrmakm8 this Ccninale of Labor Code,youshould
became subjectcoply the such provisions
r Compensation Permit provisions oftheal Labor Cede,you mon
Z 0 fanhwitn comply with such pro vis ions or this Permitshallbe deemedrevoked.
CONSTRUCTION LENDING AGENCY
lb
efeby affirm that thore is a construction inicling agency for therformance,
,O of she work for which this
� perm t issued(Sec 309] Civ,C)
Lo '
- nde Name .... ._ -....Z Lender Addrc .. . .-__ .. . . ...... ..... _ - ..__ .. _ .. . _..
V X17 I cenify that l have mad this application and nam that he above information is -
fs,=[:., corrin I agree to comply with all city and county ordinances and stale laws relming
O•V to building construction.and hereby out .rives of ins city to cater upon
.W use,shore-memioned proton 5pcaio.purpose
.p.
We)Ugric indemnify arta keep hat' lathe City of Cupertino against
W liabilities.jud m.cast end expenses wnicM1 yin any way necme against said
V.Z Ciryin co the graining of this pe- t. V V
A PLC SANDW ALL -POINT''- Issued by:
L
Z Date
Si n core fAPpncam/C m " D re, Re-roofs
l - HAZA OUS MATERIALS DI 9 R "
8
Will Ne whc I (s build go IA Part store ore harandoa leis sal Type Of Roof
as defined by th C no M I Cod Chapter9 Ike H 10 and Sak[y - " -
Code Scio 2553 aj Ft t
❑ _-
Ys
All.roofS Shall be inspected poor to any roofing,materia] being installed.
M"'he
aap`io^Smo r buildingoccupantuse equipment odevices which If a roof is installed without first obtaining an ins ection', I agree to'remove
emit harardo u nanrs as defined by Ne Bay Arca A Quality Management g p
Disco" ._ all new materials for inspection. Applicant understands and will comply with
EI yes - 'all non-point source regulations.:- PP.- --
I`r I nout terlalChapter ._ -- .•
q rcmtanss'und fi 95 of the
H.O.I.in eISafety Code Sect°ns2550525533and25534 I unders[andthal
«.capon dng d nd have a mnant 1 tit is my nexponsibility m notify the" -
pant the re m must be t tris a issuance ora Cenific le of
occ tay ..
b Signature of Applicant Date
- .g .. ._.
"amoriva°gent '• me . All roof coverings to be Cass B or'b'etter