10010016 CITY OF CUPERTINO BUILDING PERMI
IA SWAN PL CONTRACTOR:EAGLE PLUMBING INC PERMIT NO: 10010016
BUILDING ADDRESS: 10286 VIRGINDATE ISSUED:01/05/2010
544 HASSINGER RD
OWNER'S NAME: MUTTART HARRY C ET AL PHONE NO:(408)281-0583
SAN JOSE,CA 95111
ER'S PHONE: 4082578956 �...,.
OR'S DECLARATION PERMIT INFO: BLDG ELECT F PLUMB
❑ LICENSED CONTRACT BUILDING
License Class Lic.# MECH RESIDENTIAL COMMERCIAL
Contractor Date
JOB DESCRIPTION:REPLACE SHOWER VALVE&INSTALL WATER SAVING
I hereby affirm that I am licensed under the provisions of Chapter 9 SHOWER
(commencing with Section 7000)of Division 3 of the Business&Professions HEAD
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. provided for b
I have and will maintain Worker's Compensation Insurance,asp Y Valuation:$350
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area:0
permit is issued.
APPLICANT CERTIFICATION
APN Number:31646004.00 Occupancy Type:
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. AY
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued by: Date:
Signature
Date
❑ OWNER-BUILDER DECLARATION RE-ROOFS:erial being
t from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing mat
to remove all new matenalsof iffor
I hereby affirm that I am exempt installed without first obtaining an inspection, g
the following two reasons:
r my employ
I,as owner of the property,oees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044, Date:
Signature of Applicant:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code). A
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's
I have read the hazardous materials requirements under Chapter 6.95 oft e
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. Chapter 9.12 and the Health&
provided for b compliance with the Cupertino Municipal Code,
I have and will maintain Workers Compensation Insurance,asp y Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this
Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. Chapter 9.12 and the
certify that in the performance of the work for which this permit is issued,I,shall maintain compliance
Sections 25505,25533nand 25534e�
1 ce fy
not employ any person in any manner so as to become subject to the Workers Health&Safety Code,
Compensation laws of California. If,after making this certificate of exemption,I Owner or authorized agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I herebyaffirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
it -ify and keep harmless the City of Cupertino sa d C Cityinothe judgments,
c,, .A1d expenses which may accrue againstARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Signature
Date Licensed Professional