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12110018 CITY OF CUPERTINO BUILDING PERMIT BIIILDING,ADDRFSS: 21351 VAIAVE CONTRACTOR:' PFRMff NO: 12110018 OWNER'SNAME: WECKS FRANKLYN E AND LOIS It TRUST (A 1 DATE, ISSUED: 11/0$2012 OWNER'S PRONE: 4084460768 PRONE NO: LICENSED CONFRACI'OR'S DECLARATTO) r r r . �rC �� BUILDING PERMIT INFO: BLDG ELECT' PLUMB License Class 36 Lie.q 5 MEC11 r RESIDENTIAL r a50MD1ERCIAL F— Contractor Date 1 hereby affirm that 1 am licensed tinder the pnwisiuns of C wpter 9 30B DESCRIPTION: RELOCATE LOW PRESSURC LINE TO IIOUSE (commencing with Section 7000)of Division 3 of the Business& Professions Code and that me license is in full force and effect. hereby affirm under penalty of perjury one of the following tyo declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the stork for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Fl Floor Area: Valuation:$2500 Section 3700 of the Labor Code,for the perfomnance of d 'for which this permit is issued. APN Number:36205044.00 Occupancy Type: APPLICANT'CE,RTI FIC, N I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state Imus relating 10 building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK ISNOT STARTED upon the above mentioned proper}'for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN Igo DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of(lie . DAYS FR)M LAST CALLED INSPECTION. granting of this permit. Additionally,the applicam understands and will comply with all non-poi a ource regulaugoA per the Cupertino Municipal Co •,Se bon y//1 � — 2- 9.19. 9.18. - D Issued by: V` Date: Signature Dale // v ❑ OWNER-RIII LDER DECLARA PION RF:ROOFS: All roofs shall be inspected prior to ane roofing material being installed If a roof is hereby affirm that 1 am exempt from the Contractor's License Law for one of installed withma first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,as owner of the property or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVF,RINGS TO BE CLASS"A"OR BIiTI'ER I hereby affirm under penally of perjury one of the following three declarations: IIA''/.ARDOUS NIAT'ERIALS DISCLOSURE I have and will maintain a Certificme of Consent to self-insure for Worker's I have read the hazardous materials requirements matter Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California health&Safely Code.Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety'Code.Section 25532(x)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additinnally,should 1 use equipment or devices which emit hazardous air e0111aminants as defined he the Bay Area Air Quality Management District I will permit is issued maintain compliance with the Cuperlino Municipal Code,Chapter 9.12 and the I verify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and?. 34. not employ any person in any manner so as to become subject to the Worker's - Compensation laws ofCalifomia. If,after making this certificate of exemption,1 Ow er a rut .e a n - become subject to the Worker's Compensation provisions of the Labor Code,I must Dale: Forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CER'TIFICAT'ION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relining Lender's Name to building conswction•and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against Iiabilitics,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this pemmit.Additionally,the applicant understands and will comply ,\RCII I'I'IiCI"S UIiCL,\R,\"PION with all non-paint source regulations per the Cupertino Municipal Code,Section I understaml my plans shall be used as public records. 9.18. Licensed Professional Signature Date Curro Plumbing Inc. 5810 Obata Way # 8 Gilroy, Ca 95020 Job Name & Location Franklin Wecks 21351 Vai Ave Cupertino, Ca RELOCATE LOW PRESSURE GAS LINE FOR P G & E Existing House Existing Deck Exting Gas Meter New Gas Meter New 1-114" low pressure line CUPERTINO Building Department NOV 0 5 2012 REVIEWED FOR MRECOMFLIF.eCE Reviewed By: ADDRESS: 21351 Vai Ave vD rF. 11/0512012 REVIEWED RV: RDW APN: RP#: 'VALUATION: GENERAL PERMIT APPLICATION M E f G COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300'TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTINO (408) 77c7-3228 • FAX(408)777-3333• buildinacuperiino.ora misc PLUNSLNG ❑�j),EECCHANICAL ❑ELECTRICAL ❑M.ISCELLP.NEOUSS XPROT�ADDRESS �I.3/S-� /�/JIA) I�//�(/ I ! n / W 0� ') / 'N,( OWNER NA/.1= UI-fAVG )VVT'��.t^p�' P �i/��/ �O. rf I E-MAIL STFLEEFADDRESS � / yI /Ili! I CTY. AIT IZTPyJ7�i ejlb I FAX COMACT NAME G V !� PHONE /`Gl (�,V I E-MAIL STP-MADDR=SS I C=l ,SFATE. ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ Ow rN"R. AGTr T ❑ CONTRACTOR ❑CONIRACTORACs'T, ❑ ARC)DT= ❑D- G.T=EA ❑ DEVELOPER ❑ ,-.'ANT COWTRACTORNAM-c LCENSENUMBER LICENSE TYPE I BUS.LIC9 XCOMPANY _MAII FAX STTtF,cT ADDRESS �r.�/o CITY.STATE,zrp&, iJ_ 11.ct A7'j PHOj Opg rr/��.-7 ARC:IIT.CL�JGNEER NAME LC=ISENUMBER (O ( �•Y/(/"' BUS..LJCYp!/-27 COMPANYNAME' I E-M.AIL FAX STREET ADDRESS I CITY,STATE,ZIP I PHONE USE OF I9SM.DUPLEK ❑ MUI i}FA Y PROJECr NJ DLA1.'D ❑ YES PROTECT N ❑YES IS THE BLDG AN ❑ YES BurMDNG: ❑mI^IEacIAL I URBAN WTERFACE AREA ❑ NO I FLOOD ZONE ❑NO EIC D=HoM ❑NO DESCP=ON OF WORK ' XTOTALVALUATIO. RECEIVED BY: O ay my s gnze a blow,I crziI m- ch o;the following: Ian:be prop--y owDcr or anthom=d agent to act on the p:npe, ogre's bchalf. I have and this application aid the info-radon 1 b e roidded is cL 1 hz d the Description of R'o-k and verity it is acv=te. I g'ec,t cornpiy with all zppliczble Local o:dinances and stain laws relating' buw 'ng cons 'oa ] e�rsentzdves of Cuncmno to enter Lhe ab v-id tip• rone.—.l:or inspection pui�oses. Signann-c of ApplicandAgent: Dwx: P limbWALL TNFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER ❑ EXPRESS u ❑ STANDARD U < ❑ LARGE' ❑ MAJOR V—?.bfse9pp_20Jl.doc revised 06/21/11