02030144 (2) OF
CIBUILDING DIaVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDIIaG ADDRESS: PERMIT NO.
10286 VIRGINIA SWAN PL TOM' S PLUMBING 02030144
OWNER'S NAME: APPLICATION SUB DATE
MUTTART HARRY C ET AL 12246 SARATOGA SUNNYVAL RD03/26/2002
j PHONE: (408) 867-6010 SANITARY NO. CONTROL NO.
0W 0MIT 0 ARCHITECDENGINEGR: BUILDING PERMIT INFO
be u—F BLDG ELECT PLUMB MECH
g
S y Z LICENSED CONTRACTOR'S DECLARATION Job Description
i z—o I M1ereby afnrm the 1 um licensed under provisions of Chapter 9(commrncing p
_C, wid,Section7")ofDivision3oftheBusinessandProfessionsCedeandmylicense REPLACE WATER HEATER.
m s< h in full fora and effect. (GAS)
oro i 6 Licertm Class Lim.a
Dam Contramor
7 3 A.� ARCHITECT'S DECLARATION
ile O,g 1 understand my plans shall be used as public records
r
I d O O Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby.form that I ons exempt from the Contractor's Co License Low for the
t x g following renson.(Section 703 1.5.Business end Professions Cade:Any city or county
Y x p which rtquircs a Permit to constmct,alte,imprme,demolish,or repair any strvaurt
in poor to it c also requires the applicant for such Permit to fle a signed statement
A. tlulh IcmNDrsuiniomepro .ontofJteContractorsLinnuWw(Chegcr9
(con ecngl_)h
Section 70I0fDvzi°n S9Ft. Floor,AreaTT
soioer7U a 4. kf �l5ail{'55//��� Valuation
or that he is exempt dmrefrbm and the basis for the Alleged'ex'emptlbn.Any iolAtim
-of Section 703h5 by any applicant fora permit subjects the applicant to a civil Washy
of not more than five hundred dopers PISooy A umber OccupancyType
0 h i s Oxeerof me properly,ser my employees with ,,a.,Meir sol,eompenmiion,
willdo'the work,and the'snawat a is AM hoarded or offered for sale(See 7 W: -
'13asimesx and Professions Code:The Contractor:License Law does not apply to An 506 - GAS TE SRequired Inspections''- -
owner of property who builds or improves thereon,and who does such work himself
or through his own employees.provided mat such improvements erc tat intended or 507 - FINAL PLUMBING -
'oRcrcd Boni IL however,the huildin � n Fnvcmem issold one-�A .f
gar it p yeld.
oprove for throw of uilJerwill have the buNcnof proving that hrdid not build or
complaint.,
mprove for purpose of sale.).
.._.._- ..._... . -..__ ._... .. .. ._._... t._. - " ---
_ I, P pe Y,am exdusivdY gwim licensed contracmnm - '-" "" -"-""" "� '""_. .. .._.... _.._... ..:. ..... ....... .. .. .
whermfine (S n co Ponficn
- ocense the does
project(Sec,7060,Business and Professions Cade:)The Contractor's t
License co does not apply man ownerof properly won)lice se improves thereon.
Co who contracts for such.prol.-with a.contmnorts).licensed Pursuant to the _. __.____.__. __.. - ..., _—._._.. _ _...__.. .__ ._....
Contractor,License Low. ._ ..
Owe funder ec "I a ,4,-200Is C r this mason
/F- ¢ARAE ,1ooa-.', FINALE®
.;_WORKER'S COMPENSATION DECLARATION p q
's Ihereby eRnnI.the under APR O 0 2
❑ 1 have eM'will maintain o Cei 8 2ifcae Of Collum I.mW-m ore for Worker's
Compensation, us provided for by Section 37W of the Labor Code, for the
- - ishirmnaea.fthe work forwhiehlhis Permit isismed,.
01 brave and wiRmaiamin Workers ColnpensmmorInsarance.as iequire l by SmOon BUILDING
37W of the'Labri Code,for the performance of the work for which this permit is
inucd.My Workers Compensation Inst mncc tamer and Policy number art:
Corrur s t •(1 1 111(Policy No. ' ro a : !' P {.x"9"r `i -
"'1CERTIFICADON'OPEN MPI'IONFROMWQRKERS' ' �.4 I. I i.',! " ti.
''"COMPENSATION INSURANCE'S?i'- 'd
.r.q .._.._ ... _ .r -n_.... .. __. ... .-
r` (Thisseciioh need not be completed if the permit is for one hundred dollars
(5100)or less.)
Com1 empl that in the Performance n the work for which Bis ct to a irked I i t•�'.li ,
not employ any'Person in any manner so az to become subject m the Workers' "
COmpensatian Wwi of California:Dam
Applicant' -
NOTICE TO APPLICANT.the Worker's
IL after making this Ccnin s of the
Exemption.you should
Auto -
become suomply ffie Wicker's Crimps or this provisionsll the Labor Code,you must
Q Q
forthwith comply with such provisions or this permit shall be deemed rtvokM.
u!) "' '`" CONSTRUCTION LENDING AGENCY' ."
a'5! ' •' I hereby AM.that there is A morm,fran lending agency fai performance
of me work far which this permit is issued(Sec:309],Civ,C.) ";
Lender's Nemc.:.:, _.4 r.._ :
. .. . ._. ...:..: :...... . . .. .... . . ...
fk''l7 Lenders Address
U'0 I certify that 1 have mad this application and nate that the above information is
[Lel.., coircn.I agree to an
with all city and county ordinances and stem laws relating
to building construction,and hereby authorize r,prxmatatives of this city toenter upon
>„ W' the above-mentioned propeny for inspection purposes. . _
tq ' (We)aSree to I.A.indemnify and keep harmlessthe Cityof Cupertino against
W liabilities.judgments,costs and expenses which may in any way accrue against said
U Z. City in consequence of the granting of this Pemor ' • .. "' n
APPLICANT UNDERSTgND DD WIL OMPLY WITH ALL NON-POINT'S 1 '- D �
sou fGy2prydys, yro�,;; .r I ?,Y ,2 Issued by: Date
Si ofnppncant rnamcom'; '''. e,' Ate''' ' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
m defined by the Cu n no Municipal Cod Ch te 9 11 and the H hh dSafetyal 'Type of Roof
Will the PPl cam orf t r bis ltli ig ac p tst rh dl h-ziN
MP
Cod Sectio 255321x7 a� I t - - , _ '! g
El 1, x61 No .1, a is. - ,
,. .,All 'to' shall inspected prwr to any roofing.matenal_being installed.
"Will thepplic6l far.,- b le gOccapamuseequipment de iceswhich If a roof is installed without first obtaining an inspec[ion;-I agree to remove
Am haldfll0 s air coram ran¢as defined by me Bay Area A Quality'himmicmem
Dia mi all new materials for inspection _Applicant understands and will comply with
l(, °Y . "° ' -.i. _ all lion-point source regulations. -
4 ' 1 have scall the hazardous immrials rtgwrcments under Chapter 6.95 or the
Califomia Henle&Safety Cade,Hellions 25505,25533 and 25534.1 undersund that
-ifthe building does nm curtcntly haveaunnn1.that it is my rcspgnsibility to notify the -
may
acpupent of the requircmrmf which must b<met priof w issuance of a Certificate'of
Own
Signature of Applicant ... _ _ Date
Owns aadmri:m aprmr' - "T Date All roof coverings to be Class "B" or better
. . OFFICE .. .