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05090147CITY OF CUPERTINO �CONTTtAGTQR.INFORMA.'TIO_ BUILDING DIVISION PERMIT BUILDING ADDRESS: WATER HEATERS ONLY PERMITNO. 05090147 1021 TUSCANY W NEWS NAME: PERMIT ISSUE DATE ARDITH WEST 970 E. MAIN ST 09/21/2005 NE: SANITARY NO. CONTROL NO. (800)835-5946 ARCHITEC (ENGINEER: �j T BUILDING PERMIT INFO Gj BLDG EO PLO MECH I p7 S DECLARATION Chapter �the Job Descrh'`ipHon' with Section iafDivviidaalLICENSED BusinesRundNohmuett lse�lii tij ® I. full fart. and 2" � Licenu Clsss U p REPLACE WATER HEATER a ?oo(v Date n ARCH t%✓✓ 1 understood my plant "I he used u public records ))) n I1:4tY7(/ � Licensed Professional OWNEm DER DECLARATION exempt I hereby a(fnn than 11. exempt from the Contractor's License Law for the UUU��fff///111 following semen. (Section 703 1.5, Business and erns Code: Any city or county de impmsu demolish, or repair any atmetare$1000 which i ssu • permit ro enniWCL reprove, loth m its seroma, area re t its pplie Unk the aision of for such permit to Ne a signed Raumem Sq. Ft. Floor Area Valuation to ItlicensedSeoael10th)ofDivlomofthe (lost nom BuinesiUcenmcdoeClupser9 (communing with Section nand of Division 5 of Code) e( Business and Proon. me al Anyavl Nel be V exempt IMrt(rom and de bola fm Ne alleged exemption. Any violation of than a is 3UR r Occupancy Type Section 70513 by any applium me. permit subjects Ne applicant to a civil penally of oat thou than five hundred dollars (5300). , Dl.uownerofdu:pmpmy.wmyemploymwiUwgpu Neuuleeompe Oon, e Required Inspections willdo thewd lemd theswmme bmtintended thelfeud mrsau(Sm. 7044, Business and Propensities Code: The Conuutoes License Law dean set apply to an owner of q P property who Wilds orimpmucs thereon, endwW doessuchwarkhimselfththrough his own employees, provided Nal such improwmenu an, notimended oroReud for We, If, however, Ne building or improvement is told within ore Sear of compo ion, the owner. builder wW how the burden of proving that he did not Wild or improve for purpose of sale.). ❑ 1, an owner of that property, am exclusively contracting with licensed conumpas to construct the pmjecl (Sec. 7014, Business and Prof inions Code:) The Contractor's U. cause Law don not apply be an owner of pmpeny who Wilds or Improves Neeson. sed, who contracts forsuch projects with a conuacter(U licensed Purses to the Contractors Licence law. ❑ lamaemptueder See .B&PCfar Numaun weer Data WORKER'S COMPENSATION DECLARATION 1 hereby aninn under penalty of perjury one of the following declaratiom: 1 have and will maintain a Certificate of Consent te self-lanurt for Woden'sComp.n- Amon, u provided for by Section 5700 of the Law Code, ran Na performance of W work for which Nb permit is Issued. I hove and will maintain Workei s Compcmation Insurance, m Inquired by Section )700 of the IaWr Code, for the performance of the work for which this permit It issued. My Wartime, Compensation artier and Policy number are: ``11 ff ��insu�n�ra�c CAaiwis+!s-�-`• Policy No.:iti—r�T54)•"� G TIFlCATE OF EKE mope PROM WORKERS' COMPENSATION INSURANCE (Thu auction need not becompleted Ifthe permit U forone Wmmeddoltars (Sin) or less.) L certify that In time performance of the work for which this permit is intend. I shall net employ any person in my manner an As W become mbjest to the Workeri Compercadon Laws of California. Data Applicam ' NOTICE TO APPLICANT: IL after m W ng this Cantil ate of Exemption, you dWuld become subject to the Workers Compensation provisions of the Labor Code, you most forthwith comply with such provislans or this Permit Nall be decmrd rewtrd. CONSTRUCTION LENDING AGENCY I hereby afrmm that Neu its construction lending agency I'ar the Performance of the work ro which tiffs permit Is issued (Ser. 5097, Civ. C.) ' Lenders Name Landers Address I certify that I have read Ons pplication and state that the abe" Information Is ' cathect. 1 ague to comply with all city and county ordinances and sus laws relating in building convection, and hereby mahodu mpreuntauves of this city to enter upon Ne aWw-mentioned property, for Inspeedoe purposes. (We) ague or non, Indemnify and lump han fleas the City of Cupertino against liabilities, judgments. costo and expenses which may in any way accrue against old City In conceque of the gmn Ing a lcZZ' APPLIC UNpE A ND WI OMPlY WITH Aly Issued by: Date %N•POINT S R S iS Re-roofs J Type of Roof Signature of Appli.antlConutctth Dau HAZARDOUS MATERIALS DISCLOSURE Will de applicant or future building aceupmt slam or hontlIc IaoNom material As defined by Ne Cupertino Municipal Code. Chapter 9.11. and the Health and Safety Scctk. 255320)?All roofs shall be inspected prior to any roofing material being installed. ❑Y19a1a� If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or fuluu Wilding occupant use equipment or devices which It hazardous air contaminants m defend by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes QRS 1 have toad the hmanims materials requirements under Chapter 6.95 of the Glifon Aix Hut" Safety Cade, Sccdons 15505.23555 and 35534. l undcraanW thstifebe Wilding deed not currently have a It that it is my responsibility in notify the aceupam of Ne requirements which mtWmetpdarm seance err. cnifatcof Occupanry' Signature of Applicant Date a All roof coverings to be Class "B" or better Own.ra Dam Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 �CI OF Fax (408) 777-3333 UPEI�TINO Building Department JOB ADDRESS: 10 1 %� �L PERMIT 50 90 1 47 OWNER'S NAME: PHONE # _ -s GENERAL CONTRACTOR: a FAX # I am not using any subcontractors: A)a.& tyea;&o Signature Date Please check applicable subcontractors and complete the following information uze,a,z, Owner/Contractor Signature 9/-)-p/as Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile uze,a,z, Owner/Contractor Signature 9/-)-p/as Date 4 CUPERTINO CITY OF CUPERTINO WATER HEATER PERMIT APPLICATION FORM s-7iFJ!Y7 APN # 3 Z% `, Water Heater / Vent Date: p/Z0 10:5- oSBuilding BuildingAddress: /O 2- t4.4 n / PLUMBING Owner's Name: n.� p Phone #: q � 3 S Contractor:ne: l t License #: 3 *� 45 .7 3 Contact: 5 Phone: , Cupertin Busine$s License #: Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: Residential i"- Commercial ❑ Cost of Project: Strapped El On Platform ❑ Bonded New Location ❑ Replacement TA ❑ Qty. if Aoolicable Fee TD Fee. T)rcrrintinn Fe.e r,rrnm BPWHEATER Water Heater / Vent BUILDING 1 PPERMITFEE Plumbing Permit Issuance PLUMBING 1 BENERGY Energy BUILDING BUSLIC Business License BUILDING