02010111 OF
CI
BUILLD NIG DIIVISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1006 WESTLYNN WY ALLSTAR PLUMBING 02010111
OWNER'S NAME: APPL17TION UB DATE
MICHELIS CATHERINE M AND FIRM 656 N KING RD O1/28�2002
PHONE: (408) 251-6040 SANITARY NO. CONTROL NO.
G m0 zo ARCHITECT(ENGINEER: BUILDING PERMIT INFO
w_ BLDG ELECT PLUMB MECH
y i IJ LJ LJ C_7
LICENSED CONTRACTOR'S DECLARATION
S N? Job Description
O Z v-i C I hereby affirm,M1al 1 am licensed under provisions of Chapter 9(commencing RE-PIPE MAIN W/
t:,:t-m with Scc,iun 7UWlaf Division3 of the Bun cssand Profes+ionsCMe,endmylicense
as,e y, 'cn full force and eifepL �/9
z O60 "Lk.IT
Dam car,
wc li
a.0 g I undo rood my plans shall be used as public ArtcoNs
d Te p O Licensed Professional O�
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am comp,from the Commerce's License Law for the
t-Z following moan.(Section 7031.5.Business and Professions Code:Any city or county, $3200
f s O which mquirs a permit m construct.alte,improve,demolish,or mpair any vmcwm
6 3,a Prior to Its Issuance,also rcqum¢s,he applicant for such pecnn to file a signed statement• a ti $ r �`„ fl, 't m ... .. .. ..... .... .
hist be I c seal pmorohrs to the provixmo sof she Conaaem(e License Law(Chapter 9 �`rs., '(^��W,1/a(� ii••3 ( Valuation
(co n ;98with Section 7000)of Div' l f me B?sitau and Protefsions Code) \,�y03.5 2N090 IC:\-.;i �4-I,�•
oThatM1e 'e empt the&Goat and'the basis for the alleged eumpcon Any violation 1
of Section 7031:5 by any applicant for a permit subjects the applicant to a civil penalty
of no,tome Than five hundred dagars($500). 2 0 2 AEN lYf0$FRFL00R PL MB I'NG.o Occupancy Type
CI 1,as ownerofthe property.or my employees with wa,,,ns their solecompensation, B
'-will Iia work:and'@estmcmre Knot intended isLie offered foe male apply ttoa -' - - ---- --____ -"-''-
Bu. s5 and Profess tens Code The Contractor s License Law dues not apply m an 562__ — FINAL PLIFNBdePffQlts�BTtES&GY
owner of pmperty Who builds or improves thereon,and who dues such work himself 507 — FINAL PLUMBING
or through his own employees providedWilding
that such improvements is
ore no,intended or
"ofincd for sale I(hdwever.the Wilding or imPrbvemem is sold within one Year b(
completion.the owneobufldcr will have the burden of proving that he did no,build or
improve for purpose of sale.l. 1
❑I mowncr _ _..._.--..._.-__ _._._. .......___ .__._....-.__._- __.___-..__�.___-_-_-___-.
_ _ Pmpeny,am exclusivelycomrvaoingwithlicensede citactors's ..1'^.•
-_ construct the pmj no(Sec.]loan Busters and proper,
who
Code)The improves
the
wr's � s ,, r r; 5'
License few doom not apply m an owner of promstr who W lids se improve,hereon,
:. andwho.comeds.[La . Projaa.with.a.conwcmr(s7 littnud.pursuanLm Ne-
El I n. tm License Law.
Olam cxcmp,uMei Sea:" •''•"'' ".BAPC for Nis rtcz
aon ii`l' ll:::.:':;;7U •
Owner . . . .
WORKER'S COMPENSATION DECLARATION ,
Ihereby affirm ande penalty of Pel ry: 'one of the following decimations:
❑ 1 h e and will maintains C niri t, of consent m*,effitione for Worker's
C'moreporion, as pnoTided our by Scotian 3701) of he Labor'C de;-far the
performance of the work for which this pewit is Issued.
❑1 have and will m6inwin WofRdsCmmpeni t' anh,as required by Section
37W'f the Labor CW f the poria,, ``ptn work 1whichth pc ,'s
issued.My W rk e,C pe .at on l sy(�d!'F d Pol'ey itmidder
CUR PKAT/ N j EXEMPTION
XE CYN 1.. ' y� �,: d t \ ..
sst CERTIFICATIONE SATI INSUR1tOM'N'ORKERS'� �.`. "` t5.T , �, f �.0^ � d�^5 I.!a 711.k(.
_ 'rv_COMPENSAt10N IN5URAN_CE
P:A (ITIS sc i!Q need not be camplatcd if the permit Is for one hundred dollars \( � I•% m - v ' I ( " -�
(5100)or Ir".)m
I ri fY,)hat in'iAe perfu'rm$nce of Uic work for which rah pe is. d 1 -- _ _. _._-. .. - - I, - , , ' A" 1 •L n7 __ -. . .-
shall nmi employ any penon in any'manncI so asr m become aobject to the Workers
Compensation Laws of California.Date `
v. . ..
NOTICETOat10 the Works s after Cornmaking tionia Certificate of Labor Code,n. you
most •mi `- L. .
become ghompy the Workers Coions or this provisions Code,you mu.ai
Q O forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I Thereby air,,.th t them is a e6ritinsulfiman'lending ag y for the perfamface
of the workfor whah this food,isissued(S 3097,Cv.LeAder's,Name
CI
QLeari Address -;�• ._ _.._ _ _. ....._ _.. _ -
.V I«nifY that l have read,In application and state that the above information is `
Dr.
.F.. coved.1 a8rtc w comply with all city and county ordinance.,and soon,laws aiming
co t) mbuilJing consmtd'nion,and nereb'y amhorimerepmscro.uses offlil,eioyto enter upon
date abm'c!TmmmmkdpropctiY for inspection purposes. ,-
_F p; , (we)vgfee muvaiMemnify and keephamJes,the Ciiyaf Cupertino Si"gains,
ret' liabilities,jud8mems,creta.and expenses which may in any way acerae again.,,said
V:Z City in mmorpocnce of the gam in of Id J: "'
ANPP.IQA fU•NDEBSTANOSA DWIL' :O]IPLY N'f H'ALLNON1:1`f'
` s6rCCE '� Issued by: Date
ignatu dApplicant/comract r' - Date Re-roofs
HAZARDOUS MA S DISCLOSURE (/
will the pens t f m building occupy,.,rc h ndle bxiardous caudal . Type Of ROOF
as defired
+.n. .. and Safety k
tat �' - I f 't7 at iA. tifv
0Y " All roofs shall be Inspected pnor.to any roofing,material being Installed.,•,,,
Co
it,
e S n 9 t t.5,=pe,ten Mu p Cod Chapter 9 12 pct the , an - -
I it ,will ih o ppli , future build g < p t use eq p t J swhich If a roof Is installed without first obtaining an inspections-I agree Io'relnOVe
on ..ohos airo tat t, defindby theBay Arc A Q ry
1Management
o t t all new materials for inspection Applicant understands and will comply with
all non point source regulations..,-, .,:,
.. 1 have madshe hazardous matenals,equiremen,s under Chapter 6.95 of the
califomio H611W&Safety Code,Sections 25505;25533 and 25534,1 understand that
'-, e i oeM.�cp tenant,that i,is my mspo ibiliry m notify thl
cmfthereux beror to issu a of a ft. 'Ocote of
upa° Signature of Applicant Date
�e o .uthprir ,te , All roof coverings to be Class "B"or'better '
OFFICE