03080001 A
CITY OF CUPERTINO `:= f < w's
BUILDING DIVISION � PERMIT CONTRACTOR INFORMATION
eulLDlrvcn°DREss: GREAT AMERICAN PLUMBING CO PMi!N003080001
OWNER'S NAME: 166 GRAHAM AVE PERMrr LvSUE DATE
CHRIS WENIOT 08/01/2003
IFNriI (408) 995-6400 SANITARY NO. CONTROL NO.
ARCHDECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
100 LICENSED CONIAACI'OR'SDECLARATION ]obDescri tion
i I hereby affirm that I am licensed under provisions of Chapter 9(commencing P
n�� with Section7(11Kl7 of Division 3nf the cosiness and Pmfcssinns Cole,end mylicenac is
lLfull(arceandcf `. [ Nm WATER SERVICE FROM METER TO HOUSE
sg? Date fflazs L'c.N
Dam FYa411 Commcmr
e ARCNITECI'S DECLARATION P(,rA.n N(N-
`� 1 unticrsmnJ my plans shall W coed a Puhiic rtcoNa
° Licensed Professional WALE®
ROatNEBUILDER DECLARATION
I 1 hereby affirm shot I am
exempt from Ne CnnOaaors License Lew for the
MLfollowing mason,(Section 71171.5.Business and Professions Code:Any city or county AUG 4 O , q 9
which requires a permit m connrucL alter,improve,demolish,norrepair my structurere OOJ12 Q
far pow to its issuance,also requires the applicant rm such Permit file a signed statement
n'-o that he is licensed pursuant to the previsions ofthe Contrxmr'sLiccose Law(Chapter 9 Sq. Ft. Floor Area Valuation
� $ (commencing with Section 7")of Division B of the Business and Professions Cmle)or 32630013 . 00 1
that he is exempt therefrom and the basis for the altri exemption.Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant too civil penalty of araC APN Number OGGII
not mom than Five hundred dollars(5500). Occupancy Type
C I,As owner of the popeny,or my employees with wages u their ole compensation,
will do Ne work,and the structure is not intended or offered I...1.(Sec.7014.Business - �Qt�nnc
and Pmfessiom Coda:The Contractors Liceme Law does not apply to an owner of 2 0 2 - UNDER Ulvlj'S.LNG
propeny who builds or improves thereon,and who does such work himself or through his
own employees,provided thm such improvements are not intended or offered formic,If. 301 - ROUGH PLUMBING
however,the building or improvement is said within one year of completion,the owner.
builder will hale the burden of proving that he did not Wild an improve(or purpose of 302 - TUB & OR SHOWER
sale')' 502 - FINAL PLUMBING ENERGY
❑1,as owner of the property.am exclusively contracting with licensed contractors to 506 - GAS TEST
construct the pmject(Sec.](44,Business and Professions Cade:)The Contractor's Li.
came law does not apply to an owner or property who Wilda or impmxes Income,And. 507 — FINAL PLUMBING
who contracts for such pmjeess with a contranor(s)licensed pursuant in Our Contractors
Lie mx Law.
C I am exempt under Sec. ,B&PC for this mune
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby air-under Penalty of perjury one of the following decluationar
11.m and wul m,mwn.Certificate of cmnxm to self-insure for wmrkeracmmpem
cation,as provided for by Section]700 of the LiWr Code.for the performance of the
work for which this permit is issued
C 1 have and will maintain Worker's Compensation Insurance,u required by Section
8700 of me LAW,Code,for the performance of Ins work for which this permit is issued.
My Workerna
.Corebeatier Insonna prier and Policy number art: eek
CaConflict: lr717M �N 704/7^ Policy No.;� may, -2,
CERTIFICATE OF EXEM MON FROM W RKERS'
COMPENSATION INSURANCE
(This section need not W completed If tie Permit is formic hundred dollars($1110)
in,mss.)
1 coif,Net in tW R Orman u,of the work for which this permit u Issued,l shall not
cmpNyany perame n yman s t o asu ject to that WWmAcis Compensation
Laws of California.D to
APPlicam__
NOTICE TO APP I ANT: L after making this Ccnifrole of Exemption,you should
Wcome subject to Work is Compersaim provisions or tie labor Code,you must
�O forthwith comply with such provisions or this permit shall he deemed revoked.
ti N CONSTRUCTION LENDING AGENCY
I hereby affirm that there its construction lending agenry for the perfurmamm of
3i > Ne work for which this permit is issued(Sec.7097,Cih,C.)
31 M I cmi Name
:tvU builder's Andress
;)Q I certify Nve at I hamad this application and sole that Nire e above inforn is
i correct.l agree to comply with all city and county ordersoces and sum laws relating to
0 /
V buildingantl herebyyauthon purposes.rarives of Nis city to cnmr upon the
�� shove-mc e)afire 1.saveroperty for inspectionkeeph
(We)agree m rove,indemnity end kith harmless the City of acme
against
to liabilities.jutlgmcno' ormind oexpenses thiswhich may in any way seems againn mid City ' O�
J z Aeonse ucncc NCENTANDS this Permit.
APPLI NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC REGU TIO
Re-roofs
Sig m ofA lieam/C ntnaor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
III Ne applicant or future building occupant store or handle ha'�uus m clonal
as do rued by the Cupertino MunicipalGodc.Chapter 9.12,mJ the Health and Safety
and.seeaan 2"x32(.)7. •/' All roofs shall be inspected prior to an roofing material beim Installed.
❑Yea pNu P P Y 8 g
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haramous air contaminants as defined by the Bay Area Air Quality Management all w materials for inspection.
7M,a
rict7
C Ycs b No
I have man the hameh uurnmu rials requirements under Charleroi 95 or the Califor. 1 _^
his Nick,
Salety Calc,Scc6.25505.25535 and 25574.1 uremorond Nu if dte building I L�
ot c rremlyham a lenam,Nat it is my mxponsibility m notify the t.c,p.,of Neumc owhich ustWuolcmucofe oaf Occupancy. S tur4 of Applicant Date
Owner ruthon cJ agent le C' ta' " All roof coverings to be Class "B"or better
Da
r
1
CITY OF CUPERTINO
1 REPIPE/SEWERS/MAIN SERVICE
CITY
CUPEII;TINO PERMIT APPLICATION FORM
APN# Date:
Building Address: _
Sl
Owner's Name: _ Phone#:
�N ,c
Contractor: Phone: License#:
9fA-1O 'PbAMb N6- U -945 S-61 OS
Contact: Phone: Cupertino Business License#:
J"AAJ r
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
V1 c
Residential Q/ Commercial ❑
Cost of Project: Q
iao
Qty. if
Applicable Fee ID Fee Description Fee Group
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE Pb] . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
79 -2- 2 6��