01040078RTNO
OF wIN
cl BUw
CONTRACTOR INFORMATION:
IPERMIT
BUILDING ADDRESS:
PERMIT NO.
10533 ESQUIRE PL_
CUPER'TINO PLUMBING
0
OWNER'S NAMES
APPLICATION SUB DATE
HAAS CHARLES J AND ELLEN
J 10297 S DE ANZA BIV
04/17/2001
IPHONE.
SANITARY NO. CONTROL NO.
(408)283-061
ARCIIITEC'1'/IiNGINfaiR:
BUILDING PERMIT_PWO
BLDG ELECTLU MECII
1"1 I-1 - CJ
LICENSED CONTRACTOR'S DECLARATION
]Ob DESCrlptl0❑
I hereby d5mn ,hal 1 sm licensed under provisinm nb Chapter 9 (arm nt ncing
wins.' 'nn'I(XN]yMpI D'vision3of lire llunatic andP I'i�yl ['yglc. r, license
u force al{J 1�7`• - VL.'y{-/J/ J
lass _'i��I Lic.
is9e�--/--� M
COPPER REPLACE WATER HEATER WATER S
_
Cnnlnclnr _
.9 DecLAR
'
.CIRCULATING SYSTEM.
'
1 anders,ana my puns snan bo sae as mmbbp a yds
�
Licensed Pmlessinnul
a ION
DBthe
Dat
exempt
1 hereby ,(Sect that 11. ,Busin, from the Contra
I I Com License law fm the
'
�/
Co
Codi Any city or county
billowing recon (menton 7nM.0. Business and Ise
s/
whirh u penult c a1,ur, m dannns
repair any mmemre
tic ober inamet,
vaccine, Ourve, h perrowh, fi
prior Io its iss...... ho myuires,he anplicanuin mch neurosa file a signN mammrnl
Sq. Ft. Floor Area
Valuation '
that b, is licensed panticuum ic provisionsOfthe Cnmmcme, License Lan,(Chmal"
(eonununcing with Section 7000) of Di vision 3 of the Business and Pmfewi arm Code)
-
nr Iha, Ire is exempt therefrom middle basis Int the alleged eaenptiai. Any violation
'
Sect315 ion 70by any applicant for a pe.it wbjttap
ts,he plicant m a civil pearly
'of
nfunt more Iran file hundred dollars Ia5(In).
APN Number
Cccupancj 0
❑ I, .1—acral he propertl or my employee wont wanes a„hob sole cumpensadnn,
will do Ise Bork, and the stncnrt is Out intended Lir nf(ered for sale (Sec. 7144,
3264402 & e6ed Inspections
Limitless and Pmfesniors Code: The Connector s License Law dyes not apply ,, an
.Onc, of pmpcny Who builds m improves thereon, and who dome such work himself
or through his Own employee... provided that such improvements ore nal intended or
offered for sale. If. huwevep ,he building or improvement is sold within one year of
anowner plelion. the ownbudder will have ore blander Of,nosing that be did ren hood rr
_
106 — SEWER � & WATER -
improve for purpose nb sale.).
202 — UNDERFLOOR PLUMBING '
❑ 1, as owner'It 'tic ant wins The munrn In
P(Sec.
consumer me presort lapel vara, Business a d Praising
7 s and de,)
Professions eras:) The contmnor•a
C
301 — ROUGH PLUMBING
mcaler
Licand wh Law does not apply to an ox'ner of a co ry won W lice se improve therton,
ny ho
and who contracts far wanly prnj is with a atntmpur(d n,enree parsnnnt to he
302 — TUB &• OR SHOWER
Cn1 am exempt
ptunde Law.
❑ I oro exenPt under Sec. , B & P C for this rcnwn
- 502 — FINAL PLUMBING ENERGY
Owner Data
506 — GAS TEST
WORKER'S COMPENSATION DECLARATION
507 — FINAL PLUMBING
I hereby u11fin i render,coalty of perjury one of the 1'o11Owing deviation,
'
❑ 1 have and will n tinmin a Certificate of Consent ,o wIf main, for Worker's
'
Compensation, as provided for by Section 37W of the Labor Calc, for the
-
,al larm.nsc O1"me wad bar which this pmnnh is Isnaca.
111 have mad will maimmir Worker: Cumpemanon Insurance, Or Iequiled by Senior
'
3700 of ,he lahnr C� I L dap pprfonnance or the walk for which this permit its
"one/War�e'�s/�Com
t tion l{Y"_' c:Y%'��(.'n1}iJ'�policy
%nl�umber are
CHRIF CA'lI1NO.E%I 1�1ON F'ROM1I-
, COMPENSATION INSURANCE:
( his sevoinn read as he cnmplond it permit is ren arta harated dollad
-
(m I W) or less)
-
I certify that in the perborinance of the work for which this permit is issoc 1, 1
,hall out employ any puson In any numrer sO a, In ove 0, Objen to the Workers
” -
Compensation Laws of Calibonix. Dale
Applicant
Not CETOAPPLICAN'I: If, nher making this Ceolfnwe of Eselnption, you should
halon subject to the Worker's Compensation provision of the LdWr Ctulc, you must
forhw'ith cont ply with such prawknim or this Penni, shall be decimal revoked
'
CONSTRUCTION [.ENDING AGENCY
I hereby affirm 'bar them is a construction lending agency lin the performance
of he work for which this permit is issued (Sec, XNG, Civ. C.)
Lender's Na e
-
Leadcr'sAddec,,
I crony that I have read This a,micn,ina and stale that mo above inti,nnnllnn is
correct. I agree no comply wins all city and county mdiamma, and slate laws reaming
to building consmndam. and hereby arborize rcpleunm,ives Of this city m enter urym
the above meminnal pro,ry for inspection pumula,,
(We) agree to save, indenmify omd keep Woulass,np City OI Cupcnlnr almost
'
laddli' ,) dgmems, an'and expenses which may in any way accrue againa said
CI I guy tic mf t ranting t this permit,
A ' . CANT NO 'S DS AND WILL COMPLY/1VJ`H Md NON.PP7NT
Issued by. Date / _ 01
si re nprpanl/Cn occur Da,e
Re -roofs
IIW DOUS MATERIALS DISCLOSURI:
Wit ,he applicant O Whom Wilding acpat'al ami, ar hamllc hazardous material
Type of Roof '
as defined by the Cupcni Municipal CWe, Chapter 9. 12, and the Health and Sufety,
Code, Scnlna 255321a1( -
❑Ye, CI No
All roofs s all be inspected prior to any roofing material being installed.
WHO the appOe:Int nr fume bndking occupant use eyaipmem nr devices which
s
If a roof is installed without first obtainingan inspection, I agree to remove
p
emit harridans air commaidant, delined by lire Bay Area Air Quality Manemmat
ag
Damnat?Y
all new materials for inspection. Applicant understands and will comply with
` O N
all non -point source regulations.
1 he read the haa
adnus materials mr,mmmmn.s under Chapter fi 95 OI the
- '
Califon' a ol,h & Stir tl Cod,. Sections 25505, 25533 and 25534. 1 understand that -
-
n,he. Iain do .. Holy naveuten.all.thud's is lnyne"Onnibilitymnntifylhe
cam I ty the yr I' n no, which mull W met prior v, issuance of a Ce iftcalc of
of Applicant Date
�Signature
All roof coverings to be Class "B" or better
mraatta red Irgp Dam
OFFICE