02010126 (2) CITY ILDING DPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10495 MADERA DR CUPERTINO PLUMBING 02010126
OWNER'S NAME: APPLICATIONS B DATE
OBERHELMAN THOMAS L AND BRAND 10297 S DE ANZA BLV 01/30/2002
PHONE: (408) 253-0618 SANITARY NO. CONTROL NO.
O O ARCHITECTIENGINEF.R: BUILDING PERMIT INFO
W- BLDG ELECT PLUMB MECH
<wt
r 1 fJ I_J L_]
LICENSED CONTRACTOR'S DECLARATION
o 5 y I M1eren from that 1 am licensed ander Job Description
pi_o yd pndProfssinsColadmmecense REPIPE & WATER MAIN.
1==h with Section 7000)af Divixion3o(thc Business and Professions Code,and my license
al Ls in falluarce and feta D -
-0.U License Cla s Lic,a
Da¢ Contractor
(1 ARCIIITECf'S DF,CLARATION
t m g crsmn y plans shall be tied as public records
w a o O Licensed Professional
n arc OWNER.BUILDER DECLARATION
LL
m I hereby afrnn that 1 am. exempt stain the Cessions Crack:
License Law for the
followt z 0 which ng renoa.(sedan]omstra5. t,mars mesa improve.
de Professions code:Any city at county e' $5000
S,zz o which requires a also to carver,alms improve,demolish, file
mash any swewm
Ce pdormisissuance.alio q thenitors of for such Permmol icense Law
(Chapter
aim Nal hetl<eruedpuhWnit thppq'isiotuofthe ContructarsLmcnselaw(Chaptcr9 3G`0f3`,V'D�CQ{QaR f ♦ Valuation
(m c g„NSecti pl]IX ) rDivisinnJof the Busmesx and Profess ons Cale) {, i�iy {, „ 1 s ir. ..,Y 1.4�1/�. At���: '
or HaPhe is aempt therefrom and the basis for the alleged citempuoe.Any violation -
-of Section 7031-.5 by any applicant far a permit subjects the applicant to a civil penalty
of not more than rive hundred dounrs)s5IXp, 202APNUNIIERFLOOR PLMBI<NG`n Occupancy Type
❑1,us owner ofthe proMrty,tit my employees with wages as their sole compensation, 301 ROUGH PLUMBIN
-will do he work.'And the
structure is not intended or offered for at,(Sale Irate; '-” -'- - '--- - -- - - --
'Business'and Professions Cade:The Centraaor i License Law deals not apply m an 502 — FINAL PI p(II3r�87Pas�N�A�Y^""'
0
wiser of propcny Who builds or improves Hereon,and who does such work himself 507 — FINAL PLUMBING I
or through his own employees,provided that such improvementsintisit are not one year or
offered for'sale.If,howcvct.the pairing - " " eni is sol]-within one yeall
f
completion,the owner-builder will have bund n or yeldor " , "• ,
a p proving that he did not buil)or
improve for purpose of sale.). �
_ .. exclusively
x
❑1,a owner of be pmpcnY• .4.Business and Professions
withCodl The Contractor
ors m
License the does
no(Sec.7044,Business and Professions Code:)The Comtamr's
and wh Law las not apply m mj owner of property who builds or improves thercun, C 1 p 0 A Y C® '
' and who. clods 6r such.❑m11r. with.0 annual1" . . .licensd pursuant m.the ..._ r !Y fY kaaG ..
' Comramors License Law. _ ._. _ _._ _ _ .
,. ❑I am exempt ors,Sec." " ,B&P C fonhis reason i�l'!?.G�G
Owner, FEB 1 5 2002
WORKER'S COMPENSATION DECLARATION
Ihereby afrrmunderpenaltyofperjury'oneortNefollowingdereluarons: BUILDING
❑ I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation, es pmvided for by Section 3700 of the Labor Code, for he
performance of the work for which this.permit is issued.
❑1 have and will moioiain Worker's Cumpensaion Insurance,a required by Scehbrh
37W of the Labor Cale;for the pmfmrnal of the work Tor which this penitit is
_
issued.'M`y�Worker s Computtton lateral al and
pPoll cyl brunch arc:" /
Cam ' Jr/r 1 L�'r11Utfl r. .Pal yNo. 7'1')0/11/11 D�a')71/Q p't) :, :'��; `.al.J*l fli D,''4 �l�l�l tJd.�a.i' li'a'ay. •. .......�._ 1.-- ;\ i_ 11 .�.�.........._.._ .
CERTIFICATION OF EKEMv00N FRUNI WORKERS^
COMPENSATIONINSURANCE" aO' " _
..... .. . r.. , _, ,,. .., _.,__, ----__......,..,..,.I;....... ......_,_,._ -_ _._._...�...:......,« s 1 __ ............. .
N'' (Th s sect nn need nm be cnmplened T He netm t is future proalmd dollars
IS IW)or less;) -
Icertify that in Ipct " hh - rkl wh ch ih, p<tmt ssueJ 1 - t 1 ,1113 _ .. _.
�"hall not employ any Persian in any mann -cal as to become subject to the Workers 'I
Campcmntion Laws of California.Date
Applicant. _. ..__ _.. _... ..... .. _.. . .___....-...,... . __ ._._ . .__._.__ .. __ _. -..
NOTICE TO APPLICANT If afar makfil Cenilcate of Eaempuon you should t "
z became subject the Worker's'^ ' C perm P ni of the Labor
you
ou must
O forthwith comply such provisions or this rdbeddked.
• -- '
t
'" CONSTRUCTION LENDING AGENCY l, __-
1 bal liffloll them is a ronswction lending agency for the performoncc
of b work f t `
'hch,hpv t-' .sued(se 9097 Civ.C)
'Lend N n ._. .¢-.. .n .. ... ._.. .__.. .. ._.__.. _ _ ._._. _ _..._... . ......_.. __._. _
_.z Lend AJdrcse
V 0 ,1 cenifY rho I have red this opplicaion and store thauhe above information is
coil I ngoce m comply with all city'and equally ordinances mad,are laws relating
to building cansuuction;and hereby uuthorikc reprcantatives of Nis city to enter upon
!y the shove-mentioned property for inspection purposes.„
Iwc)agrcc m taus,indemnity and keep hmmlcssthe City of Ctiperiinp uy5inst
to limb i es 1 dg ms. .a d apenses h h m 5 n any y g;nxt acid r
U_Z, Chy c 9 lith fog f!hi p
C, E•S'4 DS AND WILL COMPLY,WIT ALLN M1'POIN'1'"'
Issued by: Da
sigp rlianU t 1 D m_• Re-roofs •/
HAZ S MATERIALS DISCLOSURE
„1
Will the PpTcmtinfuturebuld'ng d t tareanis m nacarda ,;t l _Type of Roof_ ...-.._ _... _.,__.,_.,... _ _ ....
as It!"al th N Considers Municipal Cod Chapter 9.12.and the Health d Safety JJ
CarlS❑acYn 2553,1u7 s s ' / �.� � S b;\I t�t 1 S 3 y 1 n
_ ,All room
fs sball.be. spected.prior to any roofing material-being Installed,_
mW'It N ppru rut'
tld nd h equipment e s n to'remove
eth No oge Bay A.Air Quality tfig pr
ors. 1 _ all new materials for inspection..Applicant understands,and will comply with .
:.
'- ❑lis. - 'all non-point source regulations 4 • .
.. .I hove rcud the hazardoai noderiuls requirements'under Chuprr b45, of the
California Health&Safety Cade,Sections 25505,25533 and 25534.1 additional that
it be bultdingdoes not curcmlY have meront,that it is my responsibility to notify the'bell
ke an of her rs which mus,be met prior m issuance of a Certificate of
m
Oc pan
t Date
Signature of Applicant b-UZ_ - -
_ owner or oat r gem ' Daz All roof coverings to be Class B" or better' '
OFFICE
E-
- . .,. .. ..i�. .. a