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CITYILDII,
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c nrnRONNO
PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO,
10136 CAROL LEE DR
WATER SYSTEMS PLUMBING
01070043
RLSER WALTER T AND CAROL L
3844 HEPPNER LN
07/12/2001
PHONE:
(408)266-8222
SANITARY NO. CONTROL NO.
zo ARCHITECf]ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L1 LJ 1_" t CJ
LICENSED CONTRACTOR'S DECLARATION
1 hereby
Job Description
P
offim Nm 1 am licensed under provisions of Chapter 9 (commencing
Section 7M)of
REPIPE.
with Division 3ofthe Business and Professions Code, and my license
is in roll force and e c
ULidense Clas Lie. p O
Dam Can,, r
g ARCHRECT.1 DECLARATION
I under0.una my plans shall be used as public recoMs
O Licenced Professional
-
OWNER BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Cmarocma's License Law far the
I
< following reason. (Section 1031 J, Business and Professions Cot Any city or county
$5000
C which requires a Permit m construct.consct. alter, improve, demolish, or repair any structure
.,prior m n, ismame. also requires the applicant I'or such piondi m file a signed statement
-- —-valU3llOn
— that he is licensed Foramina . thre, parce,morry of the Contractor. License Law (Chapter 9r._
fico n8 ith Sct )000) fD -te
sn 3 the Busine. (.sions Code)
e a
!�{.'.•,s 't 31�21Ft3 �6�
of ndP
_ , .blas rc4 it'+S.
or that he s exempi therefrom ana the basic battle alleged exemption. Any violation
of Section 7031.5 by any applicant for a permit subjects the applicanuo a civil penalty
of not more than fvehundred dollars a5o01.
202APNNNdSPL
T
(]CCUaraCYPeRFLOOR
BING'' P Y
El 1. as ow, net othe pmpeny.ofmyemployees %ithwages astheir tolecompentarion,
301 — ROUGH PLUMBIN
-wiH u,ioc, a warom,i the swdmrde C not in, s Li or Less roe waleart apply ]Baa.
' Business a warofes.dom Cade: The is Commit, intens License Law does hat (Sec. to 4,
5 02 - FINAL PLIL&'JI &N(rmsFzbWw GY - -
owner of property Who builds or improves thereon. and who does such work himself
or through his own empl-o'yees. provided that such improvements art not intended or
507 — FINAL PLUMBING '
offered f sale. It. however,thebuilding improvement a year of
------ . .._
compli builder will have the burden ofp gth tMd'd notbuild or
'
Ie1
improve fpurpose fsale'),
t
111 (if the property, I si ly contracting withlicensed ' t t rs to
t the project 1Contractor's
(See „04a Business d P f Cod Th
Lid Ladoes nota I t o f n La builds th rethe
ndn
C _
h c m tttf
or Projects w need pursuant
ant .the
Contractors License Law.
❑ I amexempt undef Sec. •.BNS PC fonhis reason'�is
Ise,
- Own -
C7
WORKER'S COMPENSATIONDatetDECLARAT10N
P hereby iffrm under, penalty of perjury ime ol; the following deelamtians:
s
❑ 1 have and will maintain a Ccnihcce of Consent to self -insure for Worker's
Compensation, as provided for by Section 37M of the Labor Gude. for the
performance of the work far which this permit is issued. .
❑ 1 have and will mainmin Workers Cumpeitcation Insurance, to required by Ser ion
37W of the Labor Code, far the pcAormantt of the work for which this permit is
issued My Workers C pew. Immature tamer anJ'�,q[1
]
^ib.e
. .�
Ca Policy No. "
ER"I^ EK�
1 01
. ... ... . ... i °... ..... .. ...... _,..-:.. :. ,. .... _ _. ..... _,. ...
t; 1
,,�,,.,
COMPENSATION INSURANCE' .'
_�_,
"j (Tli..ecoma need not W comleteditbe
P Perms rc far one hundred dollars
.
f41001 or less 1
1cemfy in to performancenn the u - .. ker 1
F hub
shall not employ any ctpermit
y' n m any manner so is to become subject to the Workers'
to
--
Camicant nn Laws of Califomia. Dote
f Colic
. .. -
ApplNOTICE
'became TOct.,he A IL after ma of iodyou should
eCili-as
-
bedomd object I or, Idirso provisions of the Labor
of you must
K'uch
Camrs
it
or 'his
forthwith comply with such provisions m this permit shall he deemed revoked.
y p timed od,ok
CONSTRUCTION AGENCY
„
5 a cON'LENDING
the work for which this permit is issued (Sec. 3(19]. Civ, C.)
Le" I hereby which that there Is a slued (Sec, lending agency for the lxrfomiance
Lender's Name "- - --'
Lender's AAeicss.
I certify that 1 have reaa this application and eta¢ that the above informmion
..
and county grdi nne.avty laws refining
sect. 1 acme or coon. the all
tobuilding nmaamd Fa.andh
and au i've,
repreeamaives of chic citymenter upon
for inspection purposes.
the ano(We)
o to propend roe ify
o a
I W4 agree m save, indemnify and keep harmless the City of Cupertino against
egmem< outs and ws which may in :my way nccnle xgaind said
y / `
C,tyinec'm in
Cityinconse c (the gm tin of Permit.,
2_Q
Soul I NS.. ND WILL COMPLY WITH AL ON POINT
Soul '' lotus.' - L .
( 1/
Issued by: Date
12 Q/
S1 r P Ilan t acmf Date
,
Re -roofs
H, RD . RIALS DISCLOSURE '.
".-Will
Neu Ilea tar Totem buil
vv n ng«Cpaptsmre2.and H,ollhanmSafel
...Type. of Roof _
he
As dafit¢e by the Cupenirro Municipa Codd. chapter 9.Iz, and the Heahh and Safcry
.,_ ....... _ .,.._..... ....
.. - --- - - — - ' .. - ^•.._ .
-
�f' -
Cod S<n 115J'lal - .'� I �
- e •, r r' , '
-
W,ng
. All roofs shall.be Inspected prior to. any roofing material being. installed...
.. Will the applicant Jumm bu p yAegti pros � a which
smith-. d .,a dam m. a�dcfnW by the ear AreaArQuahty nfamgtnent.
If a roof is it stalled without first obtainirl an inspection'; J'agree to remove
P
- ❑vel ,:. pNa "
c,
all new materials for inspection. Applicant understands and will comply, with
P
I have «ae'the ha>.venuc materials
all non -point source regulations.., - ."
requirements under Chapter 6.95 of the
Califomia Healt Sa IY Cole. Sections 2-105.25533 and 25534. 1 understand that
if the buildingnenlly hacent' . than is my respond ilityio ramify the
ant of rennementc which u e met prior to issuance f Cc ficate of
o Occur
_
. Signature of Applicant. Date
All roof coverings to be Class "B" or better
ow n Acat agent Dxtc
_:-'. t ... ..... .. i OFFICE _
z
O
w
Qu
O�—
ttOK
u'3'
I. yLLyO
ad a,
wtt?
s es
l— Z
ou
c.
c;
CITYILDII,
..
_
c nrnRONNO
PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO,
10136 CAROL LEE DR
WATER SYSTEMS PLUMBING
01070043
RLSER WALTER T AND CAROL L
3844 HEPPNER LN
07/12/2001
PHONE:
(408)266-8222
SANITARY NO. CONTROL NO.
zo ARCHITECf]ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L1 LJ 1_" t CJ
LICENSED CONTRACTOR'S DECLARATION
1 hereby
Job Description
P
offim Nm 1 am licensed under provisions of Chapter 9 (commencing
Section 7M)of
REPIPE.
with Division 3ofthe Business and Professions Code, and my license
is in roll force and e c
ULidense Clas Lie. p O
Dam Can,, r
g ARCHRECT.1 DECLARATION
I under0.una my plans shall be used as public recoMs
O Licenced Professional
-
OWNER BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Cmarocma's License Law far the
I
< following reason. (Section 1031 J, Business and Professions Cot Any city or county
$5000
C which requires a Permit m construct.consct. alter, improve, demolish, or repair any structure
.,prior m n, ismame. also requires the applicant I'or such piondi m file a signed statement
-- —-valU3llOn
— that he is licensed Foramina . thre, parce,morry of the Contractor. License Law (Chapter 9r._
fico n8 ith Sct )000) fD -te
sn 3 the Busine. (.sions Code)
e a
!�{.'.•,s 't 31�21Ft3 �6�
of ndP
_ , .blas rc4 it'+S.
or that he s exempi therefrom ana the basic battle alleged exemption. Any violation
of Section 7031.5 by any applicant for a permit subjects the applicanuo a civil penalty
of not more than fvehundred dollars a5o01.
202APNNNdSPL
T
(]CCUaraCYPeRFLOOR
BING'' P Y
El 1. as ow, net othe pmpeny.ofmyemployees %ithwages astheir tolecompentarion,
301 — ROUGH PLUMBIN
-wiH u,ioc, a warom,i the swdmrde C not in, s Li or Less roe waleart apply ]Baa.
' Business a warofes.dom Cade: The is Commit, intens License Law does hat (Sec. to 4,
5 02 - FINAL PLIL&'JI &N(rmsFzbWw GY - -
owner of property Who builds or improves thereon. and who does such work himself
or through his own empl-o'yees. provided that such improvements art not intended or
507 — FINAL PLUMBING '
offered f sale. It. however,thebuilding improvement a year of
------ . .._
compli builder will have the burden ofp gth tMd'd notbuild or
'
Ie1
improve fpurpose fsale'),
t
111 (if the property, I si ly contracting withlicensed ' t t rs to
t the project 1Contractor's
(See „04a Business d P f Cod Th
Lid Ladoes nota I t o f n La builds th rethe
ndn
C _
h c m tttf
or Projects w need pursuant
ant .the
Contractors License Law.
❑ I amexempt undef Sec. •.BNS PC fonhis reason'�is
Ise,
- Own -
C7
WORKER'S COMPENSATIONDatetDECLARAT10N
P hereby iffrm under, penalty of perjury ime ol; the following deelamtians:
s
❑ 1 have and will maintain a Ccnihcce of Consent to self -insure for Worker's
Compensation, as provided for by Section 37M of the Labor Gude. for the
performance of the work far which this permit is issued. .
❑ 1 have and will mainmin Workers Cumpeitcation Insurance, to required by Ser ion
37W of the Labor Code, far the pcAormantt of the work for which this permit is
issued My Workers C pew. Immature tamer anJ'�,q[1
]
^ib.e
. .�
Ca Policy No. "
ER"I^ EK�
1 01
. ... ... . ... i °... ..... .. ...... _,..-:.. :. ,. .... _ _. ..... _,. ...
t; 1
,,�,,.,
COMPENSATION INSURANCE' .'
_�_,
"j (Tli..ecoma need not W comleteditbe
P Perms rc far one hundred dollars
.
f41001 or less 1
1cemfy in to performancenn the u - .. ker 1
F hub
shall not employ any ctpermit
y' n m any manner so is to become subject to the Workers'
to
--
Camicant nn Laws of Califomia. Dote
f Colic
. .. -
ApplNOTICE
'became TOct.,he A IL after ma of iodyou should
eCili-as
-
bedomd object I or, Idirso provisions of the Labor
of you must
K'uch
Camrs
it
or 'his
forthwith comply with such provisions m this permit shall he deemed revoked.
y p timed od,ok
CONSTRUCTION AGENCY
„
5 a cON'LENDING
the work for which this permit is issued (Sec. 3(19]. Civ, C.)
Le" I hereby which that there Is a slued (Sec, lending agency for the lxrfomiance
Lender's Name "- - --'
Lender's AAeicss.
I certify that 1 have reaa this application and eta¢ that the above informmion
..
and county grdi nne.avty laws refining
sect. 1 acme or coon. the all
tobuilding nmaamd Fa.andh
and au i've,
repreeamaives of chic citymenter upon
for inspection purposes.
the ano(We)
o to propend roe ify
o a
I W4 agree m save, indemnify and keep harmless the City of Cupertino against
egmem< outs and ws which may in :my way nccnle xgaind said
y / `
C,tyinec'm in
Cityinconse c (the gm tin of Permit.,
2_Q
Soul I NS.. ND WILL COMPLY WITH AL ON POINT
Soul '' lotus.' - L .
( 1/
Issued by: Date
12 Q/
S1 r P Ilan t acmf Date
,
Re -roofs
H, RD . RIALS DISCLOSURE '.
".-Will
Neu Ilea tar Totem buil
vv n ng«Cpaptsmre2.and H,ollhanmSafel
...Type. of Roof _
he
As dafit¢e by the Cupenirro Municipa Codd. chapter 9.Iz, and the Heahh and Safcry
.,_ ....... _ .,.._..... ....
.. - --- - - — - ' .. - ^•.._ .
-
�f' -
Cod S<n 115J'lal - .'� I �
- e •, r r' , '
-
W,ng
. All roofs shall.be Inspected prior to. any roofing material being. installed...
.. Will the applicant Jumm bu p yAegti pros � a which
smith-. d .,a dam m. a�dcfnW by the ear AreaArQuahty nfamgtnent.
If a roof is it stalled without first obtainirl an inspection'; J'agree to remove
P
- ❑vel ,:. pNa "
c,
all new materials for inspection. Applicant understands and will comply, with
P
I have «ae'the ha>.venuc materials
all non -point source regulations.., - ."
requirements under Chapter 6.95 of the
Califomia Healt Sa IY Cole. Sections 2-105.25533 and 25534. 1 understand that
if the buildingnenlly hacent' . than is my respond ilityio ramify the
ant of rennementc which u e met prior to issuance f Cc ficate of
o Occur
_
. Signature of Applicant. Date
All roof coverings to be Class "B" or better
ow n Acat agent Dxtc
_:-'. t ... ..... .. i OFFICE _