B-2016-1370 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO::B-2016-1370
7512 BOLLINGER RD CUPERTINO,CA 95014-4333(359 24 007) (RELIABLE
ENTERPRISES INC)
RANCHO SANTA FE,CA
92067
OWNER'S NAME: YAP KAWING D AND YEH CHARLOTTE DATE ISSUED:02/16/2016
OWNER'S PHONE: PHONE NO:888-509-5031
LICENSED ONTRA TOR' DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#1003637
Contractor(RELIABLE ENTERPRISES INC)Date 02/16/2016 X BLDG _ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 4(commencing —MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: Remove and replace water heater..
1. 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 work for which this permit is issued.
G2. I have and will maintain Worker's Compensation Insurance,as provided for
by Section 3700 of the Labor Code,for the performance of the work for which
this permit is issued. Sq.Ft Floor Area: Valuation:$1200.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county APN Number: Occupancy Type:
ordinances and state laws relating to building construction,and hereby 359 24 007
authorize representatives of this city to enter upon the above mentioned
property for inspection purposes. (We)agree to save indemnify and keep
harmless the City of Cupertino against liabilities,judgments,costs,and PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will
comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION.
Code,Section 9.18,
Issued 2/1�1 m �v�1p— . l
Signature Date 02/16/2016 Date 02/16/2016 // /7/e /
OWNER-B TILD R A ATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered
for sale(Sec.7044,Business&Professions Code) Signature of Applicant
2. I,as owner of the property,am exclusively contracting with licensed Date:02/16/2016
contractors to construct the project(See.7044,Business&Professions Code),
I hereby affirm under penalty of perjury.one of the following.three declarations:
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534• I will
by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
this permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 255 5, 533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,I must forthwith comply with such provisions or this permit shall-
Owner or authorized agent:
be deemed revoked. Date:02/16/2016
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that 1 have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance
correct.I agree to comply with,all city and county ordinances end state laws of work's for which this permit is issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize,representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant ARCHITECT'S DECLARATION
understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records.
Cupertino Municipal Code,Section 9.18.
Licensed
Signature Date 02/16/2016 Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building(a)cupertino.ora MISC
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USE OF ❑SET)or DUPLEX ❑ MULTI-FAMILY PROJECT INWH,DLAND Ell YES PROJECT IN ❑YES IS THE BLDG AN . ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE 1PNO EICHLER HOME? NO
DESCRIPTION OF WORK A
TOTAL VALUATION: �Z�® REC1 IVEDBY
By my signature below,I certify to each offhe following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construcfon. uthorize representatives of Cupertino to enter the above-idpritified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INF0=Rr1AT10N REQUIRED Y„ ,oFFic
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AIEPMisct4vp_2011.doc revised 06/21/11