14030124 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10077 LAMPLIGHTER SQ CONTRACTOR:CONSOLIDATED PERMIT NO:14030124
PLUMBING INC
OWNER'S NAME: COUCH JOE H AND JO B 3732 CHARTER PARK DR STE D DATE ISSUED:03/20/2014
OWNER'S PHONE: 6509413128 SAN JOSE,CA 95136 PHONE NO:(408)978-3093
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
r� COPPER RE-PIPE AND PROPERTY LINE CLEAN OUT
License Class Lie.#
Contractor Date
I here " that�I censed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
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. Sq.Ft Floor Area: Valuation:$17500
^ I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:34242001 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPXCTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the %
Issued by: Dat
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source reger the Cupertino Municipal Code,Section
918. ulati
7 RE-ROOFS:
Signat Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Co c ions 505,2 ,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or auth Date
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I TRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9 18.
Signature Date
GENERAL PERMIT APPLICATION � MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 V
(408) 777-3228•FAX(408)777-3333•buildinacDcupertino.ora MISC
C(UPIt-IRITINO
PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS 10,977 f• APN#
OWNERNAME PHONE EMAIL
-6.5v
STREET ADDRE�S� CITY, STATE,ZIPA10 I FAX
_a gaa7
CONTACT NAME PHONE E MAII
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER .[i OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 11CONPRACTORAGENT ❑ ARCHITECT ❑ENGINEER 11DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TY�EN 36 BUS.LIC#
COMPANY NAME C E MAIL / Q ���� FAX --9 30Yg
STREET ADDRESS JI Ole_ CITY,STATE,ZIP �v^ PHO; � 7P
-3023
ARCHITECT/ENGINEER NAME ` LICENSE NUMBER BUS.LIC#'
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK 0
., ow
J ..SPG/
67*
/�t/s J
7flhADO_/ 30
TOTAL VALUATION:
By my signature below,'I certi to each of g: I amtbalrapSW owner or authorized agent to act on the proBprtg o- ' behalf. I have read this
application and the information I have vided is. ect. ave re e Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin uilding struc' n I orize rep ntatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicant/Age Date: �7
LEMENTAL TION REQUIRED _ oFcEusonLf,
�� ,�-CJ*�'OVER THE_COUNTER
INS
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=MAJOR '
MEPMisc.4pp_2011.doc revised 06/21/11
COMMUNITY MANAGEMENT SERVICES
March 18,2014
To Whom It May Concern
Re: De Anza Oaks Homeowners Association
Dear Sirs:
Consolidated Plumbing, Inc.has the association's permission to seek permits for the repairs of any domestic
waterlines or sewer lines located within the De Anza Oaks community.
Since`'
Co munity Manapneat Services,Inc.
Bill I ubbard;Association Manager
De An Oaks Homeowners Association
BH/st
cc: Board of Directors
1935 Dry Creek Road, Suite 203■Campbell,CA■95008-3631 ■voice (408) 559-1977■tax(408)559-1970