03010186 (2) CITY OF CUPERTINO ° sa' ,W
BUILDING DIVISION PERMIT CONTRACTWINF.ORMATION-1i,;.
BUILDING ADDRLSS: ALL VALLEY PLUMBING FERMIr No.
10430 CORTE DE MADRID 03010186
OWNER'S NAME: 170 BRANNON DR APPLICATION SUB DATE
BOAZ APOTHEKER 01/28/2003
ZONE: (510) 376-4816 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ad,
w00 LICENSED CONTRACTOR'S DECLARATION Job Description
m u F I hereby affirm that I am licensed under provisions of Chapter 9(commencing p
�¢ with Scelm.700(fiof Division 3 of the Buatne`and Professions Cade,an ylicense is p�
mmn mr.Tad err WATER HEATER
1st LiccnseC Lt
Dy—p DaM Con 'or
Q�.V ARCHIl W use DE A I N JUN 9 2003
5y5y I understood my plans shall M used as public rca'uNs
Licensed Pro@ssional
OWNER-BUILDER DECLARATION BUILDING
Y Q p 1 hreaso .(Sect on 1 am cBusin from the Cssionsr i Liccnu Law for the
i 6 p O following reason.(Section]113 L5.Business and improve,
de Professions Cnde:Any city or county
a�S which requires issuance,permit re poroma,alter,improve,demolish, fi ea sig any swment
r y pdonoits enseparstoreporesmtothe the
ovisio antsof for such permiuoiecron aw(Ched temem ,,,atte:r�aa
x�x< (hal ar islicenseduJ pSnuam 70M)provisions of the Cnmmness Liccnu LawlC Code)or Sq. Ft. Floor Area $�ayaµl100
F S Oust he is exem t theron efrom
and the
basis
3 of NC Busaged exemptand on.Professions lation or
., Net he is exempt theufrom and Ne bazis for tire alleged Gumption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
nm moo Nan five hundred dollars OiWfi. 8 Occupancy Type
I,as owrtcr of the property.ar my cmployces with wagsazNeir aolc compensation.
will do fee work.and Ne structure is not intended oroffered for sale(Sec.7W,Business —
FINAL
and Professions Cod,:rhe Conuaemr's License Law does not apply W an owner of 506 - GAS TEROUire nspec Ions
IRGY
property who builds or improves thereon,and who doessuch work himulf or through his
own employees,provided Natsoch improvements aconin intended.,offered for We.if, 507 — FINAL PLUMBING
however,Ne building or improvement is old within mm yese.f completion,the owner
Wilder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contrac Wn to
construct the project(Sec.7014,Business and Professions Code:)The Contnnofs Li.
aced Law does not apply to an owner of property who Wilds or improves(hereon,and
who contacts for such projects with a contutons)licensed pursuant W the Contractor's
License Law.
I am exempt under See. ,B A P C for this..on
Owncr Dow
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury.rte of the fallowing declanlions:
_./ I have and will maintain a Certificate of Continuo Wf-iMurc for Worker's Compem
dt.on,as provided for by Section 3701 of the Ichor Code,for the performance of the
work for which this permit is issued.
❑I hese and will maintain Worker's Compensation Insurance,az required by Section
J]00 of Ne Labor Coda for Neperfo ante of the work for which Nis permit is issued.
My Worker's Com ration a... triermd Polity mberam:
pe
cr.Yea[ Polis
CERTIFICA OF EXEMPTION FR : t1W!,�ORKJyER1y
COMPENSATION INSURANCE
�
('Otis section need not W completed Bits,Nrmil is future hundred dollars($100)
or less.)
1 certify that in the perfmmance of the work for which this permit is issued I shall net
employ any permn in any manner so as to become subjmt to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,atter making this Cent fare of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
OO forthwith comply with such provisions or this permit shall be deemed mvoked.
z CONSTRUCTION LENDING AGENCY
�N+ I hereby affirm that more is a construction lending agency l it the performance of
(Y, ? the.,it d which this permit is issued(Sec.3(191,Ci¢CJ
aQ Under's Namc
z Lenders Address
U 0 1 cenify that 1 have read this application and slain Nat the about information is
F torten.I agree to comply with all city and county ordinances and state laws reading to
O U building construction,and hereby auNodm mpuunulives of this city to enter upon the a
W above-mentioned property for inspection purposes.
4 (We)agree W save,indemnify and keep harmless the way accrue
Cupertino against
04 liabilities,judgments,ince to sown Inde nify and keep
may tnany the
fCupenatsa against
U Z inconsequence of the granting of this permit.
APPLICANT UND STAMPLY WITH ALL - INT Issued by: Date
�OZZSREGUL IONS
Re-roofs
tgn rc o Applicd UC.i trazmr Date
HAZARDOUS MATERIA ISCLOSURE Type Of ROOF
Will the applicant or future buildingpa ammo,londlehnmdowmaten.]
az defined by the Cupertino Municipal CW,C pler 9.12.and the Health and Safety
Coda See b❑Y,a aa 255J2(.p—9k," All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment ser DeviMaces which If a roof is installed without first obtaining an inspection, I agree to remove
it havardous air contaminants as defined by the Day Arca Air Quality n.gcmem all new materials for inspection.
istrirG
❑Yes �o
I have read she hatomb;us mawrialsrequiremenes under Chapwr695 of the Califor-
niallcaWdrSadelyGdc,Scstiom 55(15.25533 and25534.1undersund Nal ifft building
Does not curteml havice¢nam t' yrtsponsihiliry to notify the neupant of Ne
r uir5 ants tubi m met prio once of Ccnificare of tla'u ey. Signature of Applicant Dale
ncr nr authnrizcd agcm Da a
All roof coverings to be Class "B"or better