02070181 OF
CI BU DING DIIVISIONVOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10745 S DE ANZA BLVD WEST VALLEY PLUMBING AND 02070181
OWNER'S NAME: APPLICATION SUB DATE
BRIAN MARIDAN 1260 DELL AVE 07/29/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 374-7440
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
u-f;-{ BLDG ELECT PLUMB MECH
;1 U 1-1 LJ
a 8 h Z LICENSED CONTRACTOR'S DECLARATION lob Description
O a-o I hereby affirm tum I am licensed wader p inions of Chapmr 9(commencing P
p-—i w,resin,ionA=f -s. 3afth Basin I aprores.mn.c;y yB«nse BACK WATER VALVE ON EXISTING SEWER
3 d 0.U License a Lic.p T
Date Contractor re.�O rye,p j�
ARCHITECT'S DLSL�A 1 F II�4'S Ila-' ` tl
Is
?p O Licensed Professionaly plans sM1all be uxd as public records
°' off OWNER-BUILDER DECLARATION JUL 3 1 2002
1 hereby alfiim ihm 1 am exempt from 0e Cormactor's License law for the
,_,o
-Z< fallowing mason.(Section 7031.5,Business and Professions Code:Any city or county
$5200 F❑ which requires a pemiii to con.amct,alter,improve,tlemolish,or rtpair any sweturt i
Poor to as issuance,also req to applicam for such pemtit to file a signed statement1 I
n•3 that he is licensed pursuant to the prusisom of the Contactors Li«nsc law(Chapter 9 _
(comment g wiN S49.T") f Division 3 of the Boom.and Profms ons Code) � ��,'•� 1�13 8WIIRCIP vfa{ jg:,� �y 1'1,• i Valuation
ar hot .he e empt theItifouroapii the bass for the allegM,demption Any violation
-of Section70315 by any applicant for a permit subjects the appli(ma to n civil penalty Nw:,F,� '
tofnotmare,thanfivehundreddonara(8500). 106APNSSVJS & WATER 1'"'''I • Occupancy Type
❑1,n ow«rof the property,ur my employes wiN wages az their sole compensation,
-will do the ork'imd he sournme'I,'nprmrcnded or'offered-for sat,'(Scc']Uaa,-'. -- - - �p�,,,�,�,d,F.,
'ow property sa code The Contractor License law d«snot s 1 moan 302 TUB & OR SHOWER'
apply - sections' .•:'��!
ow r property wn b IJ. p , thereon,and who does aarn work himself
3 O 1 ROUGH PidLYt'IPLS'YrilS' P
m ren gh h' own employees.Pro ded that h improvements arc not intended or
�bR rtd'f le lf;h- - the building p - eso is sold within'orie Yam of -"' "'
edmpletion,the ownerbulder will hive the Wieca of proving that he did not build or 502 FINAL PLUMBING ENERGY
improve for purpose of side.). 506 - GAS TEST
------------
— - - '
,1,71 er of the property. m aaively contracting with l' mace conuacmrs to S O 7- - F I NAL PLUMB I NG
consuuct the project(Sec.704,1,Business and Profess ons Code)The Contactors
Litems Law
co does not apply m an owner of property who Wild,or improves to she,end t `ILiceme,Loauch.projects.wiih.a coniracmr(s).LcenseJ.pursuant m-Ne. __-....._-.._ _ --____ . .___-_-_ ___-._-__.,._— 1 _. .-. __... .. . ._ - ._ .....___..
._ l Contractors PcenselaW.. i,.,r-,,i, '.r,:.e
- <... - ... .B`&P C for this mason
t ..
� = ❑let exempt fcc .... ,. .. ..... . ...-,.- .. ....: .,.. '
.. Owner. ...,... - . . . .. .:. '
'WORKER'S COMPENSATION DECLARATION
"- I hereby affirm under peimliy of perjury one of the following declaream s:
❑ 1 hev mid will'm.in.io a'Ccnificire of Consent to self-insure for Worker's
Competisumn:as provided for by Section 3700 of the-Labor-Code: for mho
- «iformanao(mhe work for which this permit is issued.,1 \
❑1 have and will r C de n Work 'sd o'mpc. t this
for hie red by Section
.-. 3]00 of the labor'Cotle,for the pcRomunm of sone work for which this permit is
issue d M W'keraC pe sat Insure an d I a tw nrelj
e Pu '�,T Pel N . riJ ICJGY'G"", t_ ---_-_ .,,.,,.. t,.......
......s. .� y
H, :ICERTIFICATIONOFE%EMPf10NFROMOMPEON INSUR ,WORKERS 1.:��t4 1 Y s } •'} k' ° Ii -0•I k:: thtl!!'ll
COMPENSATION t '
- ... ..._-..
vf@ Rh s t ri need not be cumPleied'f iM1 permit is for one hundred dollars I "' �' ' .•n'. 1 J'e i tf!....... -^�•��•-
HiIBI less.) • t -
I•• Y a -of th k f hmh th Penni mss e 1 _ _ `._ _ -..... �- :. •.- r - _.-. .:.
I en l N n n the In an ntt
shall of ply ,y pe I y mann so in become njeci ro th Workers
Com ton laws of Calf Dam �' -
NOTICETOAPPLIct1.in Aor exomr makingth Cnfcate ofE empbon you shouldi
Z nee me s b)aero the workers Coi...or n p sof the Labor Code;y«must "� 1
(] O fonM1w th comply with sucM1 provis ins or ih s pc.i,.hall be doomed revoked
'CONSTRUCTION LENDING AGENCY -""
- I hereby suffors,that there is a c new tion lend ng agency for th pert 4
W•O of she work for which this peon i I, sued(Sec 3097 C.C}
y.
Lender's Na -_---
i
U 1 mfy th m 1 Ire d this appl'c[ and;late that tbabovef mason is
ormetI atiric t9ply th II city and o ty ndonce t and t I..,relating
1.b ad he
(ding constructio.atsby uutho mrepre Yr4ea fth city to emerupon.
-
_[>, Ithc.abgva-mentioned P,ropertyronlnspccnoi'morscs.fwe)'ngrceto savdeinnify am keep harmless the City of Cupertino against
M liabilities,judgments,costs and expenses which may,in any way tree vgains�vid
f„) Z City n seclencs ofd gaming of thi permit. '
SAP LIC UNI -RS \N N WI L OMPLY WITHALLu I
So ItE 1 u' s r Issued by: Date
tin nim fAPPlicanVC matt p. . , D Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
will de-ppl ca1.m ottoman Wild g c pa i store handle hazi Nous menial T e of Roof-,-.------.
d fn d by the C pent Municipal Cade Chapter 9 12 and the H alth ami Safety yP ,,„ -
Code Section 13 72 e) 5 Y s
❑iYee t 3t Li pit : {w' s k'y s d A L<
Alldroofs shall,be inspected poor-to.any roofing matenal_beingmstallei,
emit hiiiid-ul.-Will theit c6m tar m W IA_ng p nt eq Ip tar de res wn h If a roof Is installed without first obtaining an Inspection I'agree to`remove Diitnct a c t m am as d toed by th B y Area A Quality Manage t'
❑Y N - P - .- . .gP PP pywlth
'B -_I !P e - { ^ -.'. all non- omCsource re u]a[ons Applied unders�ands and tom I
f � 1 h rc d mho hazy d trial ,ui"crd'6d Chapin 695iof the'
Cdl f sola HeaIN&Safety Code.Secmians 25505,25533 and 25534A understand that
-,fifth bild' gtl note nenmly haven mnant Nil is mYresponsibilaymmodythe' ""-' - - -'--" '- - - --- -- - ---- - - -- _
ocd pant of Nercquim wh ch must be e,prion to ikuan of Cc ifwte of
Si nature of A li
.. "� T '�•,�� ._ g - ... ._ PP.cant coverings
el or unhumired ag me: All roof covengs to be Class,"B"of better"',
7 ;1 - t -- - OFFICE . _.. . .... . .. . .. . .. ._. _,_._ -. .. ._ .. . ._. .__ _ .. ._ .. ..