02060174 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONITRACTOR-INFORMATION: ;;
BUILDING ADDRESS: PERMIT NO.
21692 LINDY LN ALL VALLEY PLUMBING 02060174
OWNER'S NAME: APPLICATION SUB DATE
CHEN LEE 170 BRANNON DR 06/26/2002
PHONE:
(510) 376-4816 SANITARY NO. CONTROL NO.
/ ARCHITEMEN'GINEER: BUILDING PERMIT INFO
WBLDG ELECT PL B MECH
� I—il r--t L-J
y 2 LICENSED CONT'RACTOR'S DECLARATION
$ =e !hereby alEmt that I am licensed under provisions of Chapter 9(commencing Job Description
pwith Section of the Business and Professions fessns Cole,and my license REPLACE WATER HEATER
m�.,�
c a LiccnullCf'vx and eff Lie.
qqq o a u Date 3�— C.au cwr ins,
O�+ ARCHITECT'S DECLA ATI N O
I understand my plans shall be teed as public records
ID o Licensed Professional
o OWNER-BUILDER DECLARATION
I hereby affirm but I am exempt from the C moormr i License Law for the
C?a following mason.(Section 7031.5.Business and Professions Cale:Any cit o county $700
F G which requires a permit to constrvct,alter,improve.demolish,or repair any structure'
3 m -Prior to us issuance.also requires Ne applicantfor such permit to file asigned swrment.
thathq if,licegxd puhukn,o,the soon of Ne Contractors Lice nu Law(Chap ter 9 l !�SS'ra.Gt„ I�Or�C Valuation
(commencing with Sepunnt](1001of Uon3of the Business adprpfessio0'Code) J �f _ 'bb��LL 411 � 1�y'ai�'} t'Zt•
or mafhb Ii exemprtheirfroni'sad the basis for the alleged ekemptun.Any violation -
-of Saetiam9031.5 by any
applicant
far a permit subjects Nc apPlicam to a civil penelry
of not mo than ave hundred
dilhara sqj. 502A-PN> YMSL PLUMBIN ENERGY Occupancy Type
Cl 1,as owner ofthe propery,or my es with wages as their sole compensation, 506 - GAS TFRT
willdowork,and the structure'is'not intended'or'offered'far sale(Tec:]pU,' - - --- ----- -- - - -----
�Bmidscax and Professions Cade:The Contractor's License law does am apply to an 507 - FINAL PIAl 4EiRNahspectionS't"' si'is�=,.t"
owner of property Who builds or improves thereon,and who does such work himself
Or through his own employees.Provided that such improvements are not intended or
gar impr6Jemcni is sold within one-year of "_...._.. ..,.___..... _,._....__...__
-;bRe're'd'for Bale:IChowfivh;the'buildin� ®•,,,--.,�---�
completion,the owner-rode.) will have the burden of proving that he did not Wild or '
impm a forpurpose of sale 1.
__ __.. _ s'_ _. _ _. ._�. . ....-.,.... , _
i
e. NOV...1 1. 200
❑1 a rte of the progeny am Basin vela comma ng with reused comma t i
mmwa the project(Sec ]to a Business and Priproperty
who b Code 7 The em the Contractor's
License law does not apply to an owner of pmpcny who builds or improves thtffie '
.end who rs License
for such pmlecu with- mractor(9 bcenscd pursuem to Ne.. ....._._ _. __..__. _...
BUILDIN -- _. .
Contractors Liccnsq law, .
❑Iamexempt under Sec"" I ''•sBt&PCtoo this rcnson its,,
net Dvii'
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty Of perjury dne of the following declaratiom:
0,1 nave and will rft matin a'Ccirifi,F of Contend to self-insuu for Worker's
t Compensation. as providM for by Section 37M of the lobar Code, for the
rfomtande of the wad for which this permit is issued.
1 have'and will maintain Worker's Compensation'Insurance,ai required by Section
J]W of the Labor Cod for me perfrionarce of the work for which this lannard,
i-i" cd My\ork rs C m en m o Insure came$anJ P`ol2cy'nu/mbar arc
e 'PohryN I�/�J✓7W-�� ....,,11..., f1 Vt` t, _._.... e....��,.tt.,... rv,..... .,.� c,:..,�L�.IX., ..-.... ...._...,
i ':CERTIFICATION FPXEMPTION FROFt WORKERS'•' 1./* Y it- ,.. sLl `.s.<.5,: ....Ay�.Y:
COMPENSATION INSURANCE ° t k
__ --------_
` ''^Is(This ieitib'nbeul hot rte contplcmd if the permit is for one hundred dnlhirs � h" - i li'r^Til „' s:"-i L�`,:"h ' ' '
(SI W)or kss.)
1 --
cent(y that in tit rfurmance of Newark for which tit permit a d;1 _- rl ,I: -- - -- "'
'sit 11 of - any pe in any manner so as to been v F e t t the,Wnrkery
sd pc a' Y is mi t
ws
ANT
Applicen
'NOTICE A 1 AN U Workers
sager making this CeniEcate of Exemption,you should ,
z become abj' to the Workers Compensation provi'mmi nfitie Lahnr Cod,you must
Q Q fnnhwiin X ply with such provisions Or this perim, hall he deemed revoked.
411 .... ._ ..- ... __ _ , -_ _ --_ _,.,. _. ..._ _ ..__._-- _. _... ._ _
Ine1 - f CONSTRUCTION LENDING AGENCY
I h eby infirm tit t them is a consuvcimn Icad'ng'agency for the performance , , ! P t
W.Q of the A .far witch this pc is issued(See9097Cie C),
LendeeNames ..__. . .
s . . .. . . . . .....4.-.. ._. "-_. .......------ - ._. -_..__. __...... _ .... ..._.. -_ _.
v . . .
Land r'4Addmx%"
I certify in.,l home read tit Apr ton and vac shot the save information is
-' fT+c E.t cored:I Felme to comply with.11 city and county ordinances and state laws relating
C:U to building commotion.and mrsby.atuhoilze representatives of thi.Jcirym enterypon
ks] the orowc-rionfitored limpirty for .pen n purposes.
har -
y t e,j agree to sa ode n pe and keep h ss the Cly f c Amino st test
f0 liab ites judgments, t. and pontes wit h m v n any y ester against said
U.z Cie. nconsequencemT NDS AN fth perms f �r
API ICANTt3NUERSTANDS AND WILL COMPLt't5'ITH ALL NbN POINT'P'i ! ''
SOURCE RECULATIONS ie.; Issued by: Dale
signature of AppbranUcnntmcmr . ;.Date Re-roofs '
Vy HAZARDOUS MATERIALS DISCLOSUR. , .
Will thepplitat' n ram building occupant store orhndlc haizrdotn mocoil
a9 ill bye he Capitation,MunicipaluCub.Charter 9.12 and the Health and Safety
code seer 25532(0) titan rtR .f- i f 1r.''•N a._..,,, s r ' n. :
❑Yes z. {tl Si :a .•b� rs.�,x" All roofs shall be inspected prior to any.roofing„material being installed.
emit Will tit rte t name,buildingoccupantusc equipment ae tern which If a roof is installed without firs[obtaining an mspecnon, I agree to remove
h NouYa contaminants a Jlined by BeyA�aiA Quality orchl Management
1)n'nctall new materials for inspection Applicant understands and will comply with _
-
l
°Y ” all non-point'sou�ce regulations
I hive readthe,h zardrus materials requirements under Chapter 6.95 of the
California Health&Smi Cale,SF,rtmm25505,15533and25M 1 uiMrrttain that
if the building does no only have a lemam.Nat it is mY responsibility to notify the-
'oic stain of the ray - ants which mu<t be met prior to kon..r of a CenifaaO of
Ipgnry:; . . Signature of Applicant Date
u united agent line All roof coverings to be Class "B"or'better "
._OFFICE. .. . . —
„i �