02050024 TY OF
CI
BUILDING DPESSIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS'. PERMIT NO.
18635 LOREE AVE SAN JOSE PLUMBING
f P 0
2050024
ogNAP� A�ISf%UYEN 1732 HILLSDALE AVE 56Mb2
HONE:
(408) 296-1820 SANITARY NO. CONTROL NO.
nn O C ARCHITECT/ENGINCER: BUILDING PERMIT INFO
rem BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
1 hereb firm that I am licensed under f Chapter 9(commencin Job Description
jN ya p`OV151O°5O pr g REPLACE SEWER LINE & CLEANOUT.
-t with Section 7000)of Division 3 of the Bus sand Professions Code,end my license
yy�� ¢in fol dant�cRc'nL �S'��
:0 6 u Otalense ,y� Co.,
mg J Z�
t LL 0 ARCHITECT'S DECLWI ATION
ao
5 I understand my Plans shall be used as public records
i p O Licensed Professional
fS o OWNEILBUILDER DECLARATION
v I hereby affirm ihm 1 am exempt butane Comma mr's License Law for the
k z< following reason.(Section 703 1.5,Business and Professions Code:Any city or county $5200
F G which requires a permit to construct,alter,improve,demolish.or repair any structure
�3C$ primo its issuance,also requires the applicant for such permit o file a Signed annealing g�.- - -- -- -- --- - _
thmheimainnudpursuaon7"o she of Division
@e h,Busines License Law
ons(Chapter Code)
v./ _,ria ♦ ' �__�)., Valuation
(commencing with t theref out 7")ofDivision 3 of the lciell x and Professions Cade) i t'(.7
or that he is exam t therefrom end the basis for the aIle e0 exam tion.An
P B P is violation
of Section]031.5 by airy upPlicom for a permit subjects the epplicanuo a civil penalty
ofnot..,athan five hundred dollars(s500). 106PNN9E?#9R & WATEF Occupancy Type
❑I,as owner of the property,or my employees with wages as their sole compensation, 202 UNDERFLOOR P UMBING
will ne the work:and the,wean is not Li en a feredLaw for snot apply
toa n 3 0 1 - ROUGH P iPDBI$Q .actions'
Business and work,-
and the
structure
The Corot Imes License Law docs not apply wan p
owner of propcny Who builds or improves thereon,and who does such work himself 302 - TUB & OR SHOWER
or through his own employees.provided that such improvements are not intended or
-°Rend for sale If,however,the building a improvement is tela tannin one year of
cianpla502 = FINAL PLUMBING ENERGY
improv limpr<owneobuilder will hove the burden of proving that he did not build or
impsvemrparPoaearule.l 506 - GAS TEST
__
- ..
❑1,as owner of the p(Sec. 7,am exclusively d Iia lian with licensed c Cont,at to ,
Lacomn the ice (Sec.71,, Business and Professions Code:)The Contractor's ..
Liccme Law tact nm aPuc pan owner of a contractors)
who builds s improves thereon,
und.who commas for such Projects with a comrucmr(s)licensed pursuant to the. .._.._... .. .. _ . .. _. ... ._-._ _. ._ .:__ -..._._. .__...._... . __. . _.. _.. ...
License Law,
ElCentimetersIex
❑ am exempt under Sec. ;B&P C for this reason .
Owner Dale D INALE®
WORKER'S COMPENSATION DECLARATION
1 herchy of irm under pe malty of perjury one of the following declarations:
i �❑ 1 have and will maintain a Certificate of Consent to self-insure far Worker's MAY 0 9 2002
` Compcnsetion, as provided for by Section 3700 of the Labor Code, tirt the
performance of the work for which this Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section '�D��G' .
37W of the Inbar m
Code,far the performance of the work for which this permit is BUILDING
--' issued.My Workers Compensation Imrmal carrier and Policy number arc
tr:4lln WtSf' :rab PohcvNY ��. e1 .�0�1 . _ _. ._ _ ... ... ,.
CERTIFICATION OF.C%EMPTIb FROM WFROM OR�- s, .,d'�`. ]S.a, k•t } '`i J it 4 s L s l.'..
COMPENSATION INSURANCE't'
" (This section need not be completed if the permit is for one hundred dollars
(g 100)or less.) t
shall not employ any Person rf any manner e-as to become subject pa to the - --- '- - ..._,.,-
I cemploem IF y al in pert f r w k farco ch to t e issued,l - - {.Ip, t .
Workers
Canape nselion Isws of California.Date
Applicant
NOTICE TO APPLICANT:Worke's after Compensate this
ovisio s of of Exemption:e,you must '
� become subject w the Worker's Compensation Provisions s a of NeLaboremand Code;you muse.
fonhwitn comply with such Provisions or this permit shall be deemed revoked.
I .
f�. CONSTRUCTION LENDING AGENCY
1 hereby afTrm that the s aconstruction lending agency for the performance
of Ihe work for which this remain Is Issued(Sec 3097,Civ.CJ
M O ode , me ..
. rNa _... _. . . . ..
::).Z Lender's Address
V 0I mnify that l Wve reed this application and stand thenne above infmmaRon ie '
Iy.F.t mrreet.1 agree to comply with ell city and county ordinances and slate laws relating
Q V to building commordon;and hercbyauthotis reprcsemmissm alibis city w erne,upon
-W the idsm,amemioncd property for inspection� purawl,a.•(We)dg,ce(asave,inm
denify end keep hamlets the City of Cuiieno'bi.i maw
r•e Ln liabilities,judgments,costs and expenses which may in any way accme against said
V,i City in amim mare of the granting of this permit. '
APPLICANT ^dDERSTANDS'AND WILL COMPLY WITH ALL NON-POINT
5.,_r Issued by: Date
NYgnelurc of ApplicenUCommum - ate Re-roofs
_ HAZARDOUS MATERIALS DISCLOSURE
',..
Will the inflation or future Wilding oc2upant store or handle hawdous mmenal
Type of Roof.,
P
-
as definedby the cnPmu M av lead Chapter 9.lz arta maHealth arta Safely
-— -_
coma oxen zssvzca) I s '_-Alj roofs shall be ins ected nor to an roofin material being,
... _ _ P Y. g. g installed. _
Will the applicant or future building occupant use equipment ordevims which If a roof
emir is installed'without first obtaining an inspection, I agree'Io remove
6framdoui air conformations as defidad by the Bay Arca Air Quality Managemem
Dgmiss? < - _ all new materials for inspection. Applicant-understands and will comply with
El Ys " `:. - - -fill non-point source regulations. -
1 have,cad the hero dou renals
- req ta and Chapter 693 of the c
CaliforniaHealth Safety Code.Sections 2505.25533and 1 understand that
Inhe Wilding do,,
rhave acnamlthliram.,responsibility
cupomofthe recioncoenis which mstbemeiom issuance
ff.CenilmeofO
Signature of Applicant Date
net orauthorized agent " All roof coverings to be Class"B"or'better
OFFICE'