02040159 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1158 STAFFORD DR CUPERTINO PLUMBING 02040159
OWNER'S NAME: APPLICATION SUB DATE
MICHAEL MAHONEY 10297 S DE ANZA BLV 04/30/2002
ONE: SANITARY NO. CONTROL NO
.r .
(408) 253-0618
ARCHITEC iENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
yiL LJ U
LIC PSED CONTRACTOR'S DECLARATION
1 netm rrmi mat 1 am(menses unser retia t 9 mommencm Job Description
a= y a provisions o p cr g
se<e<in7oW)orniviswn3onneBnxinessnnarroresxmax Code.and myrtmseCOPPER RE-PIPE/WATER SERVICE
is fall tone and affect.
o�u Is em.. G3 tit.« C16
OmcContractor
i ic Orn ARCHITECT'S DECLARAT ON
w; 1 undemand my plans shall be used as public records
awni ,,o Licenses Pr°fcssional
.ji-,,ess c. OWNER-BUILDER DECLARATION
6=
1 hereby afliim that 1 am exempt from the Contractor's License Law,for the
t:Z a following rcamn.(Section 7031.5,Business and Professions CWe:Any city or county $5000 5 O O O
F O which requires a permit to construct alter,improve,demolish,or repair any structure Y
21 e priori t s < also y th ppl 'ant for such forion to file signed statement .__ ___-------
w.
-
n 3= that h s licensed p'rs ant f the provisions of the Contractor's L U (Chapter 9 g p ph p� - _� _- -
ao;' o g ,h b.SePGy 70)to)of Di slon 3 of Business dPrpress ns Code) t,J F,'ti T1+36>g'C7;'t/,O'U7�.-Q521, iti.k i�j".a; Valuation
or mat he is exempt thclefmm and the basis for the alleged:icmptmo.Any violation
of Section 903 L5 by any applicant for a Permit subjects me applicant to a civil penally-
ofnot morethan five hundred dollars(s5W). 2024PN �J�RFL00R PLMBING ' Occupancy Type
❑1,as owner of the Pmimy,or in,a i,lmyms with wr,c,,us their sole eompemonon,
will do the'work wad the'worem.is hof intended m offered for sale(Sce.7614,
Business and Professions CMB The Contractor's License Law does not apply to an 502 - FINAL P) H0slIMPROORGY' '
owner of property who builds or improves thereon,and who docs such work himself
or through his own employees.provided that such improvements are not intended or _. .- 5 0 7 _- , FINAL.__PLUMB ING _
offered far I- Irh to I Ieing'o p - t' told ❑ rte yemrof. FINAL._ _ .. ; _.. .."__.__-._._
Iompl i on,the mvise bu(der will have he burden or proving mm he did not build or
mprove for purpose of sale.),
❑I tr e f je progeny, exclusivelycontractingiwith licensed o ton's
construct the project(S 70x1 Business I e professions Code 0Th C t ctm s •1
and,who ,. , °apply ribs h build p thcmon, e
L �p
_ Can, for h projects itconductorial lie d p t to the
License 1 dawn
C trade Lt W
❑I
a exempt made,sat :e&Pcto, his
reason
Data
WORKER'S COMPENSATION D17CLARATION \„
1 hemby aflimt under penalty of perjury one Of fine following dechmomms: O�NG
1 have and will maintain a C<mificme of Consent to self-insure for Worker's QV��
Compensation, as Provided for by Section 37W of the Labor CMe, for the {{��
performance orae nod,fur which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as raquired by Section
100 of the Labor CMe,for the 1°erformonce of the .,it for which this permit is
:, .. issued.My Workers Compansauon Insurance camber and Policy number arc:
. Cerrieo -tom.,. - '� :If !POIiry No.i��IUNt_fG�71oVxv .
COMPENSAEMO I SURANCE' 1 " ` 1•-lv ri( 1'� ire,"�'sI••g7' 1 i"-+O, v�, :Il.Lia:' 1
11•,'. CERTfPICAT10NOFEXEMPTION PROM N'ORKERS'1' - ° � i •�:.
rfh s sax on heed not b,completed if the permit is for one hundred dollars •.);Cllf• I t OC'
ISI W)or Icss_) '
.
l n fy that i;Person
p f f the work its,ca reh a ect t issued']
Chula not employ any Pers if m any manner w as m become xuh3at m the Workerx
Comitant on Laws of California.Date
-------
NOTICE TO APPLICANT:orers Compter ensationg n
thisCertificatef of the
hExemption.Latour
de.u should
you
becomesubjectcomply
the such
Cnions or this Provisionsll thehabor Code,you must
Z Q forthwith comply nim such provisions' this permit shall be deemed rooked.
,�-f^ _ 1. 1- 'CONSTRUCTION LENDING AGENCY ' "-
1 hereby affirm that mere is a construction lending agency for the performance
W � of the work for which this permit is issued(Sec ie C.
3097.C ) `
.Q Lcndcrl Naani.•comply .-. _...: R
D:Z Lender's Address,' 5, n
V"'C 1 certify that 1 have read misapplicationtyado and secs that the above information is /'t[
tat:-F cdtre8.I e rte to tom 1 with all cit and count ordinances and Statei laws minting
C%U to building conswction:and hereby authome representatives ofthis city to enter upon
the above-mentioned pm,dy for imslat purrocor,,,, ,,,
Fy 1 (we)dgmno de,"demnifyind keep hatmlesstheCity of Cupciinoagainst
I,0 liabilities,judgment,test arta expenses which may in any war accrue against said
U Z City in m se etc Bnntin8-1
Nis permit.
s" APP, 'I' I R f_tjAS AND 'CCCUMPLY WITH ALL NON-POINT I
sou T I .. v2 Issued by: Dale
s at eor p' tanu attattor 'Date Re-roofs
I RDOUS MATERIALS DISCLOSURE
Is am r t n Ia ng«<Pant si eta al tr a° mat .y Type of Roof _ . . ..,as defined by,the Cdpcnrn Municipal Cod Chapter 9.12. d the Health and Safety , v .. ,. a ,f .,
CMeS ion 25A21a1° 1 `_ 0. f ' S y ru, I,.,° t t .
oY �r'No -t `a 1 _ All roofs shall be inspected prior to any roofing,material being Installed. „
.wtll th applicem f \b 'laing�ctupnh use'equ ti t a 'rev which if a roof is installed without first obtaining an inspection, I agree'to remove
1 attractions an,contaminants as defined by the Bay Area Air Qtrubt,Management
ismcn ".-.all new materials for inspection.. Applicant understands and will comply with
oY No � - :" I all non-pomCsource regulations. - ,,_ -
1 h read the hand s ma¢rial' -q rcments and Clone,6.95 of the
Calif aHe.M&S I a tions2550525533and255341understandthat
ifmotiuildm do,,not"comliNya alemon,that it is my responsibility to notify the - - - -
accup m or a ieq hi mtit,be met prior issuance of a Cmmifcaie of
0,,, ahcY. L,a• -U Signature of Applicant Date
''• o e mmtua aBe Date_ , All roof coverings to be Class "B"or better
.:. .-
" .OFFICE