03040061 FSU2
TY OF CUPERTINO
BUILDING DIVISION PERMIT ;0NTRACTOR:INF(, A�T70N
xDINGADDRESS: PERMITNO.
0100 LAS ONDAS CT ALL VALLEY PLUMBING 03040061
ER'S NAME: PERMITLSSUEDA7BAKEMOTO KENNETH T AND JUDITH 170 BRANNON DR 04/10/2003
JE:
(510) 376-4816 SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
goo
LICENSED that I A.It ACI do DECLARATION
1 hereby afrorm Net 1 am liamcd under roviaiem of Chspmr 9(commencing Job Description
wit Section TMD)of Division 31 Bassin Pr e,leas Cede.nd my license is �'����®
^ n fu o end
3 Lle=^ 1 L .« REPLACE WATER HEATER
n Dees Canuadur
` RCHI7ECIBD I APR 1. 6 2003
� 1 understand my plans shall he used 4 p c rtards
ys
s Licensed Promsalmnl
5y
OWNER-BUILDER DECLARATION BUILDING
Z 1 herehy Aman that I em exempt form the Contranols License Law for the
00 following mason.scedon 7031.5.Business and Pmfesdmu Code:My city or county
$ which rtyulna A Permit I^ca arooL,alter.Improve,dcmnlmh,or repair any sWclure
prior m its Issuance.also requites the applicant fmsuch permit to role s signed statement
< that he is licensed pursuant to the Provisions^aha Contractor'.Lianm Law(Chapter 9 SQ. Ft. FloorArea CValyii[Ion
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or
Nat he is exempt therefrom and the bash for the alleged exemption.Any violation of Q�Nt�t 7gI�
Section 7031.5 by any applicant for a permit subjecla me applicant to a civil penalty of 3 Syj 2Q})2n6rr O 0 Occupancy
not marc than five hundred dollars(5500). � �M O�U d y P y��
❑I,As owner of the Property,or my employees with wages As their sole compensation,
will do mewod,and me swcture Is nmineMed oro@red forrals(Sac.7044.Business p'y� r�,�,�
and Profsaslom Cade:The Commence.Lt..Law doe not apply te An owner of 502 — FINAL Ite441fE&lfnEj£Bct2ffERGY
property who Wilds or improves Merton,andwho domanchwarkhmuelfor through his 506 - GAS TEST
own employees,provided than such Improvements ate not intended nroRemd f essm.If.
however.the building ar improvement la sold within ane year ofeomp.dam,me owner 507 — FINAL PLUMBING
builder will have me burden of proving that he did not build or improve for onto=or
sale,).
❑L aA owner of the properly,am exclusively contracting with licensed contrition to
construct the project(Sec.7044,Buslmum and Profusion Cade:)The Contractor's LI-
come taw does not apply to an owner of property who builds or Improves Ihemon,and
who concocts for such projects with A eom ector(s)licensed pursuant to the Contractor's -
Licenm Law.
0 l on exempt under See ,B&P C for this reason
Owner Data '
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury oro of the following declarations:
have and will mountain a Certlfic.tcafCament to wlf-insum fm WorUen Compen-
con,u provided for by Section 37M of the Labor Code.for On performance of the
work for which Nis permit is mumd,
❑I have and will maintain Worker's Compensation Insurance,As m4ulmd by Section '
3TI10 of Ne labor Cade,for Ne performanceofthe work for which this permit I. ,
My orkchCompye_n�/tionInaunn prierAdP m.w
Mer: / FICIf�S�ATBOil FBDM W KER RS'
0.1 COMPENSATION INSURANCE
(This section need net he completed if the permit mlnone hundred dollars(SIM)
tor less.) - -
I cemfy that In the performance of me work for which this permlr b issued.I that not _
employ any person in any manner an as at become.ubjauo dm Workers'Compeneellon .
Lows of California.Dem
Applicant
NOTICE TO APPLICANT:If.after making this Cenirocsm of Exemption,you should
became subject m the Worker's Compensation provisions of the laher CMD,you muss
.,Q forlbwl Ih comply with such provisions or this permit shall be dmmed revoked. '
by CONSTRUCTION LENDING AGENCY -
I hereby a fpm that Vert Is cmtstuction lending Agency for the performance of '
7C the wark for which this permit is issued(Sec.31197,Civ.C.) "
Leader.Name -
7 z Lender's Addrus ,
J 0 I certify that i have read this application and sou that the above information is '
3. F correct.1 agree to comply with all city and county ordinances and sum laws meeting to
�U huildingconswnion,ardhereby Aumorimrepraemtivaofthis city toenter upmft --//
G shove-mentioned properly far Wpatlon PUMwhich ma
r (We)agree m save,indemnify and kap harmless the City of Cupertino against
fn IIso,aset)udgm f th cos n which mryin any way amaageiwmid City
;Jz Iaconeequenco of the a rmlt.
rw APPLIC S WILL COMPLY WITH ALL -POINT Issued by: Date
SOUR E UL
_ Re-roofs
cotor
S alum o ApplleaHAZARDOUS MATERIALS DISCLOSE Dam _ Type of Roof
WIIl me applmarc h,future huilding«cupant emrc or handle harardon maudal
defined by the Cupertino Municipal CMc.Chapter 9.12,and ND Health and Safety
Code.&Nen25s3z(.>7
Oyes ON. All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an agree to remove inspection,I
Will the applicant or forum building occupant use equipment or deviser which P
I hevardnus air contaminants as defined by me Bay Arca Air Quality Management all new materials for inspection.
Irict7 P
❑Yes 0 N
,
I have rce eh vandal terms requirements under Chapter 6.93 of the Callmr.
nie Hailh&Se yco ,Sng5505,25533mdT5s34.l understand that l0hc Wildingdoes not ich, a thea Ie my rcaponlhilily o anally Out=coal M me
nal hich t c o luumce of a CcmiOcau ofu cy Signature of Applicant - Date
Ow onmhoris<d agcn a All roof coverings to be Class "B" or better
i 1
CITY OF CUPERTINO
WATER HEATER
. CUPERTINO PERMIT APPLICATION FORM
APN # Date: U
Building Address: G
Owner's me: Pho #:
Contractor: Lim nse :
G 36 747 90
Contact: Pho #:
�u C'/ �S/ az- r
Applicant/Contractor:
Building Permit Info:
B Idg Elect utn Mech
Job Description: 7-ze 6arFt���ma:�bv►
esidential: Commercial:
Sq. t. loor Area: $/Sq.Ft.:
Architect/Engineer. Valuation:
i
Type of Construction: Occupancy Group:
ty. if
ffpplicdble Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
_ BMITIGAT Housing Mitigation Fee BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLiC Business License I BUILIDNG