03030124 CITY OF CUPERI'INO • > ^^ �
BUILDING DIVISION
PERMIT C10N R ,,TQR4NFaRM.�'TI,Q,�N.�
BUILDING ADDRESS: PERMITNO.
ALL VALLEY PLUMBING
OWNER' 170 BRANNON DR PmMrrkss
NE: . . SANITARY 0 OL NO.
(510) 376-4816
ARCHfrECTBNGINEER: BUILDING PERMIT INFO
BLDO ELELT, PLUMB MECH
0 0 0
�oo LICENSED ficumd under
DECLARATION
1 ionhereby70 )of that I am of
Bu under pmvhions of Chapter 9(commencing Job DeBCrlptlOn
with Section 70M)of Olvidon3of Ne Business Pro@natant Code,and mylicense ia _
"oro In full farm and cn - o
� Dam G� Cont�lxemr REPLACE WATER HEATER F8^aA 9 .pC®
9 ARCHITECTS DECLA 0i4
�i 1 understand my plans shall he used As public records '
yG5 Licensed Professional - APR 0 J 2003
J OWNER-BUILDER DECLARATION
1 hereby am.that 1 em exempt from.the Coelacrors License law for the ,
00 following Mason.(Section 71313.Business and Professions Code:Any city or aunty pg
$ which requires a Permit m comtaCl BUILDING
V alter,Improve,demolish,or repair any structure G
_a< priori itsiuumce,also requimube applicant forsueh permi lt,file a signed alammcnt
££F thathc islicented pursuant tothe provkhmsofflc Contaaor's Limine law(Ch%Pmr9 Sq.Ft.Floor Area Sal,jl IIllOn
CF$ (commencing with Section'?")ofDivision3 ofthe Budnessmd ProfeationaCode)or 7vV UU
d..
,at he Is exempt Nemfrom and the bub for the alleged eumption.Any violation of
Section 7D31.5 by any applicant for a permit subjects the applicant to a civil penalty ofyy,vtt pt�sp
not moa than five hundred dollars(S500). - 3 67pp14;gEpher 0 0 Occupancy Type
❑1,As owner of the property,army empioyeu with wages u their mic compensation,
will do the work and the strnctwre is not headed moRered forsale(SO,7W,Business
and profesdom Code:The Commerce,Uccna,Law does not apply b m owner of 502 FINAL IRONS ITA rmci aERGY
property who buthizar lmproveatheranrand who dmuuch work hlmselforthrough his 506 — GAS TEST
own employees.provided that such improvements art not interacted moRered fm ale.If.
however,the building or improvement is sold within one you of completion,the owner. 507 — FINAL PLUMBING
builder will have the burden of proving that he did not build or Improve for purpose of
..Is I.
❑1.as owner of the reopen,am exclusively contracting with liamed contractors to
construct the project(See.70th,Bminw and Profesdom Cade:)The Contactors U.
ttme law doss not apply wnu property who builds or improves thereon.and,
whocommetsfonmhp ge sell c ntranor(s)11.'as p.0,uml he Ne Conbox cto8
License law.
❑tunBkPCf rthba an '
Owner Date
LLL OR ATION DECLARATION
I hereby affirm under penalty of perjury am of the following declarations:
I has and will maintain a Cerdomm of Consent to adf4sum for Workers Compere
ion,As prevlded for by Section 370D of the labor Code,fm the performance of the
work for which Nis permit is loved.
❑1 have and will maintain Workcr'a Compematlon Lotman,As required by Section
3700 of the labor Code,for the performance of the work fm which this permit is issued.
My Worker's Compensation Insurance carrier and Policyn nrpy
Canter: :`m/ /'Q'7 Policy No.: �—
CERTIFICATE OF EKEMP ION FROM WORKERS -
COMPENSATION INSURANCE
md,venom mad not hecompleted if tie permit is fmoa hundred dollars(SIM)
as less.) _
I certify that In the terforromm of the work for which this permit is issued,I shall not '
employ any pcmon In any mmnerm As to become subject to the Workcri Compensation -
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the WorkeM1 Compensation provisions of the labor Cade.you must
.JO forthwith comply with such provisions m this Permit d.
hall be deemed revokerevoked.
.
„Z'„"' CONSTRUCTION LENDING AGENCY
Thereby affirm that Vert its construction lending agency for the performance of
C' the work for which this permit Is Wad IS..3097,Civ.C.) -
Lenders Name
.7 z finder's Addmss
f,Q I certify that 1 have and this application and tune that the above Information is
W H correct,I agree m comply with all city and county ordinances and auto laws relating to
Q L) building construction.and hereby amhoria mpresenutiaa of this city to enter upon the
W' above mentioned Propeny for inspection purposes
f5, (We)agree On on,indemnify and kap harmless the City of cuperoaD against
h liabilities,judgments.costs and expenses which may in my way raceme against add City
t)7 in consequence of the granting of this permit � i
r7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: at 3
SOURCE REGULATIONS, 1 .
Re-roofs
HAZARDOUS
Signature of AppliaDam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ed y he
tourno Muni buildings.Chaptmoan.handle Heard us and Safety al
As defined by the Cupertino Municipal Coda Cheerer 9,12.mJ he Health and SeRty
Code,Section 25532(.)7 �., All roofs shall be inspected prior to any roofing material being installed.
r]Yet
Nu
If a roof is installed without first obtainingan inspection,I agree to remove
t III the apPlicmt or future building Occupant use equipment or devices which g
del?rdnus air cnnu.I,met u defined by the Bay Asa Air Quality Management all new materials for inspection.
,lm7
❑Yes o .. ', ..
Itavc mW tach a rials rtyuimmcnts under Chapter 6.95 afthc Celifor.
ata Hmlug.5afc 3115,25533 and 2553/.l undcrtnwl that lithe Wilding
J ntiy a is my remount hility m notify the ora t of Ne
require ntswhi ct r iuumceofaCmificau, n er. Signature of Applicant Date
wn ora ',. oto All roof coverings to be Class"B"or better `•