02030034 TY
CI BUILDINGDPERTONNO PEKMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10342 NOEL AV ALL VALLEY PLUMBING 02030034
OWNER'S NAME: APPLICATION SUB DATE
JACK CHEN 170 BRANNON DR 03/08/2.002
PHONE: SANITARY NO. CONTROL NO.
q (510) 376-4816
WOO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
E Fpy BLDG ELECT PLUMB MECH
TION
3,y IherebyaRrmLICEihaEDmlicensedudRrpro ions of Chapter9(commencing Job Description
�Ntq with Section 7000)of Division 3 of he Busincssand Pmfessi Cod .and myliccnw WATER HEATER REPLACEMENT.
ag is in full forcev
C, LI[ensod eReLMe.
ClCI C Y"
C Da¢ •a Carlmcmr 6/„C)
�
1 O ARCHITECT'S DECLARATION
3 I undersmnd my plans shall W used as public records
i O O Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Low for the 0
t 2 following reason.(Senn..7031.5.Business and Professions Code:Any city or county $650
f F 0 which requires a Permit to construct.alar,improve,demolish.or repair any structure
urej3$ prior to its issuance,also requires to applicant for such Permit rile a signed swmmcnl - - - - - ---- - - -- --
Wtheislicenudpunuoni(o the pmvisioni of the Cunvecmfs Littnse low lChapter9 .r r. ... y Valuation
Sc'f, lOp F�p�
(commencing with Section.7000)of Division 3 ofthe Bpsiresf and Profession Code) e.,.`. ; r3LCY•/.�Y b'. VVa_• (.
.,,but he is exempt thetefmm and the basis for the a11egM exemp ind.Any violation
.f Section 7031;5 by airy applicant farm ptil subj¢u the applicant to a civil penalty
efamma.the.fivehundreddollars(S5W). 50: kPN "KL PLUMBI ENERG,Occupancy Type
111,os owner of the property,or my employees with wages as their sole compensation,
"will-do the work: ad the'nmclum-is not intended or.fRred for sole(Sec:7044,
'Business:and Prof e..too,Code:The Convenor's License Law does a.,apply to an 507 - FINAL pBM4#gNGPections "' -t l
owner of propeny Who builds or improves d1monn,.11 who does such work himself
,.- g_.P - Phort.y-..P not intended or
or through own em la des Wildcd the,such mpm emenls are
�oRered for sale.IL limikle the lltiding e limprovementof
that
thin one year of
domplai for the own o W!der Will have the hu.den of proving that he did not Wild m
improve for Purpose of sale.).
._. _..._ aprope . a
❑I;uowner of the n am exclusively mm matin - _ - - � - -- - _-�- --�------ - - -
prop y y B with de:) d,Cornets m
- License the project(Sppl 7034,Busowner. and Professions Code:)The ves be.Connector's r
License Law d«s not apply to an ownw with
a c.to who .Ik or improves thereon.
.and.who mmrects.fm.such.pmyccu with a commnor(s).licenscd purwnm-ta the ___---- ---------- .__ _________
ContractorsetcLicense Law.
O I em exempt under See ;B&P C for this reason O" . ...:,,
owner'" . . Daie., .
W RKEPENSATION DECLARATION
" I hereby affirm under pnahy of perjury one of the following daclomtimo:
Ihave ad,will a Certificate of Consent In self-insurc for Worker's
y Campnwdma as m
pvidN labo
for by Section 37W of the r Code, for the
prfofmantt of the work for which this Aril is issued. .„
t31 have and will nommin Worker's Compeniation Insurance,as o quirod by Section
37M of the Labor Code,for the rerformance of the work for which this Permit is
ismad May\/YCoacrs�AConanxa ion Insurance camera Po'polic
Cert r.J7.
C ERTIPIC' f All NOF XEMPTION FROM. RKERS'I'' '/ _ v .. .•
-.r Y A r-t't, t•a
ITh i section head not be completed if the Permit is l
COMPENSATION INS, B; ,
is one hundrc
1510p)or lcssJ '
_. ._..
Icemfy Nal inthe performance o(IIII soul'f r' ic trsp cisme .
shall not employ any prsbn in any mute:w as to becomebsubject io Ne Workers �— I� '`" r '\
Compensation"us of California.Dam
.Applicant
.. _isC
NOTICE TO APPLICANT,IC Compensation
this Certificate,of of Lampiode.youshould
st -
bc2ome subject to it each pr Conlpnmthis provisions of the Labor Cade,you must
Q 0 f.nN nh comply with such provisions or this Artois shell be deemed revoked.
a I t '!'CONSTRUCTION LENDING AGENCY
. I hereby affirm that here I'a curioultion lending agency for the prformu,no.
of the wo k fo wh ch thu p trt s issued(Sec 1097,Civ.C) "
Q 'Leaders Name :.. _ ,.. _. e.• _.. .... .. ... ._. ...__........ .. ._.... . .-....r. . _.. ._ ...
r7:Z Lenders,Addrev,
�+ 1 certify that 1 have reed This application and nam that he above laws relating is
O'U
Comm 1 agree m dimply with e0 city and county ordinances and nine laws mining
Q f) mWildingcenumaiomaMhertbyamhmiiemprcsematives of this cirymenmrupn t
y ow the pmKny for inspection phaunds,
CA m agree to save,indemnify and keep hatmlus the City of Cupertino against
-W liabilities,judgn¢nu,cost M exposes which may in any way accrue against said
NT
V,Z Ciry is aonsequence oft ranting of this ptmh.
M AP 4ko
RC GU DE NSNDSA II.LC�OMP�Gj-YNfTHALLN0 1 Issued by: Date
oe 44 -�- -� � /
me r ore
" 411
" HAZARDOUS'MATIiR1ALS DISCLOSURE Re-roofs
'Il the pplibam 'r furore building oc cpm smre.e handle hazardous maknel Type Of.Roof - - --
ps Oned byth Cuprt noM nc aICM Chapter 912 and the Health and Safety
Code red by ther-
❑Yes ;. ._
All roofs.shall be inspected prior to,any roofing material being.Installed.
Wdl the app
head
o fmure Wilding occupo t equipment or deuces which If a roof is installed'without first Obtaining an inspection, I agree'to remove
mu hazerdouI e r c.nut mus asefined by the Bay Area Air Quality Management
nistact all new materials for inspection. Applicant understands and will comply with
taY a " all non-point source regulations.`
1 has,r al'the hazardous materials regmrcmrnu under Chapter 6.95 of the
California Health A Safety Code:Sections 25505,25533 end 25534.1 undemmnd that
if g. Y his my responsdol ity to notify the
the addict does nil ncnll Which
mut be that
nccupot of the requ mems which muss be mel pHnr to'issuence of a Ceni m e of
ncy... ' ..,,. 3 D
•. Signature of Applicant ate
All roof coverings to be Class"B" or better
.1. .rued agent ' Dem. g
... ., . . ._.'c... .... ... .. .. _. _ . . .. 'OFFICE..