02010028 "BinDINGDMSONVvPERMYT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7543 BOLLINGER RD ALL VALLEY PLUMBING 02010028
OWNER'S NAME: APPLICATION SUB DATE
REA WILLIAM S SR AND MARILYN A 170 BRANNAN DR 01/07/2002
E,, (510) 376-4588 PHONE: SANITARY NO. CONTROL NO.
z ARCHRECDENGINEER: BUILDING PERMIT INFO
= BLDG ELECT PLUh METH
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Z w i LICENSED CONTRACTOR'S DECLARATION Job Description
O z_O 1 hereby a%irm that 1 am licensed under provisions of Chapter 9(commencing
QEttw withS«ti )of Division 3oftheBusiness add Professions Code.and my license WATER HEATER REPLACEMENT
11
lE ad YO u<j.'n
CI ss e 'cffp L Contac,•,If r p L
a O ARCHRECT 5 DECIs/owr7Rw,�XTtu00N ante
g I understand my plans shall b used as public records
�r
su R p z Lid Professional
c a a OWNER-BUILDER m the CoAT10N
1 hereby o(Smt that I sin.Burin from the C,scons is Licenu Law for the
L'a a following reason.(Semon]031.5.Business and improve.
de o demolish.
or AnY citystructure
o pooch requires n permit re conawn,alter,improve,demolish,or repair any ewaure 650
n3� poor ad issuance,also requites the applicant for such pcmut to film signed statement _
that he is licensedp armanta,rise provisions of the Centimeters License Law(Chaptcr9 r �[�lppr a., ; Valuation
(commencing with Section]000)of Division 3 of the Business and Professions Code) 3 S2 311.5 L 1 V V.i'
or that he is exempt 0crcfrom and the basis for the alleged exemption,Any violation ' '
of Section 7031.5 by any applicant for a Ferran subjects the applicant m a civil penalty
of not more than Eve hundred dollars(SSW). 502 APNVITPAL PLUMBIN ENERGYOccupancyType
°h as owns,of the property,in my employes with wages as their sole compensation.
will do the work.and me Cade m is not inrcnaed Lcense offered Uw roe ante apply to s.. - - 5 0 7 - FINAL PI�SI9t�� P
owner of and sny Who
Code:The Contractor's License ow rias not apply to an s ec[iohs
owner of property Who Wilds or improves thereon,and who does such work intended
or or througoffered
his own however,t provided slut such improvements are not intended or
ofi pie for sale.IL however,the building or improvement ropmn sold within one year of "" ' _ ... .. _ .. .. .__............ ._ .. .. _ _ . . ..
oparave for the owner-builder will have the burden of proving thin be did not build or '
improve for purpose of sale.).
°1;as owner po the property,am exclusively contracting with licensed contractors to
constrconstructconstructpro
nsthe .«t(Sec. 1. osiers and Pixproperty
aeon Code:)The ova,daramr.
and nsewho
Lawd«s notapply t pan owner of a ornamentals)
who buildson seimproves anon. -
Co who contends.fof.auch Protects with a commemr(s)licenud pursuant ro.Ne. ._.. _ __ .. .... .. .... .. . . .. _ ...._.
Contractors License Law. q Q
❑I am exempt under Sec. ,B&PC faints reason JAN 15 2002 t
... owner Date
WORKER'S COMPENSATION DECLARATION 1
I hereby affirm under penalty of perjury one of the following declarations: BUILDING
° 1 have and will maintain a Certificate of Consent to self-imme for Worker's `l
Compensation, as Poseidon for by Section 3700 of the Labor Cade, for the -
:., performance of the work for which this permit is issued.
°1 have and will maintain Workers Compensation Insurance,as inquired by Section
3700 of the Labor Code.foi the performance of the work for which this permit is
W rkm, Compc_nsation Insumncs carrier anLd Policy numbefam:
.: . testa q }
ams CERTIFICwTf EPolicy No. ._ ... _ _... _ ._ ... _ .... _ . ....... ,._........ ._
�) t
%EMPIION FROM WORKERS' r '
COMPENSATION INSURANCE '•''' ~
(This section need not be completed if the permit is for one hundred dollars
(SIX)or less.)
1«npl that in the P in any ma of the wart for which Nis ct to d e issued,I
shall not employ any person in any manner so u to become subject to the Workers '
Compensation Laos of California.Date
Applicator
NOTICE TO APPLICANT If,after Compensation
softhe
Labor ode,you out - - -
becomesubjentothe such
Compensation provisionll the Labor Cade,you must
Q O forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
�.,] I hereby affirm that there is a construction lending agency for the Performance
of the workfor which this permit is issued(Sec.309],Civ.C.i
-Z Q Lender's Name
Z Lerdee's Address
O 1 certify that I have read this application and state that the above infurmution is
E.. correct.1 agree to comply with all city and county ordinances and state laws raising
Q O to building ocastructien,and hereby authorize representatives of this city to enter upon
} W in,above-mentioned property for Inspection pury°us.
0. (we).,mc to save,indeamly and keep Ismailia the City of Cupertino against
�'L N liabilities,judgment, nx am espsasen which may in any way reams against said
O Cory in consequence a gmming of this permit. / �O
APP'in'CAcon ue ANDSASD\VILIrmit,COMPLY WITH ALL SOS-P01?T r
ce REr, '[ON-S. Issued by: Date
at of pplicnnbC9nuut., Date
HAZARDOUS MATERIALS DISCLOSURE Re-roofs
_ Will the applicant or future building occupant store or handle hazardous material Type Of ROOF
es defined by the Cupertino Municipal Cade,Chapter 9.Q.and the Health and Safety _ .. . . ,. ... . .... --._.. . .
Code,Section 25532(al] ` 1
°Ye "° All.roofs shall be inspected prior,to any roofing.material being installed.
will the applicant or future building refined recepby
Bay Aequipment otdevmswman If a roof is installed without first obtaining an inspection,-I agree to remove
emit hazardous air mnmmmants as defined by the Bay Arca Air Quality blawgemem
. °trine°
Cl Yes all new materials for inspection. Applicant understands-and will comply with
- No all non-point source regulations.
1 have read the hazardous materials s rcqui 23333 a dads,255 Chapter 6.95 of the
i dielmia Hnith&Safely d0.5ection525505,'_5533 and 2$$31.1 understand that
if the building dpesnos cu which
thatbnmyrcarre bf.Cenficat the -
ant of the require its wM1ich must be met prior ro issuance of a Certificate of
cy.
Signature of Applicant Date
actor morrred agent Date All roof coverings to be Class "B"or better
' OFFICE - -