Loading...
09070091Cc Z u00 1<91. rA rv� ? i .. ;aL 0, �Oi Aye pC yZ> EFC �2 zr4 C � U r F� � (Ia fSr UC wE 0� Fco � co Ue CITY OF CUPERTINO DIVISION PENT��am Z�T� N. BUILDING ...... BUILDING ADDRESS: PERMIT NO. 20115 SUISUN DR TBD — TO $E DETERMI ED09070091 OWNER'S NAME: ITT PERMIT ISSUE DATE -TRAM ,TONE: S A CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a 0 o a LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is INSTALL TANKLESS WATER HEATER in full force and effect. License Class Lic. # DateContractor ARCHrmcrS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement License Law 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's (Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $3000 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 36928008 .00 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, ns Required Inspections P will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of q 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 offered for sale. If. however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and, who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under S B & P C for this on Owner Dare RKE PEN ON BER7fIT0 I he affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Workces Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need riot be completed lithe permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any m r so as to become subject to the Workers' Compensation Laws of California. Applicant NOTICE TO APPLI : If m r of Exemption, you should become subject c Worker, s Compensation provisions of the Labor Code, you must forthwith core y with such provisions or this permit shall be deemed revoked. ) ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address 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 laws relating to ' building construction. and hereby 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 j liabilities, judgments, costs and expenses which may in anyway accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date —�/ SOURCE REG S. r1 ' Signature anVC or D MATERIALS DISCLOSURE Re -roofs Type of R sof HAZARDOUS zill!!.pelicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Cole, Section 25532(a)? All roofs :,hall be inspected prior to any roofing material being installed. ❑Yes — If a roof i:, installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m iterials for inspection. District? ❑ Yes /7 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements t P19parifiti m� Signature AApplicant Date �e I All roof coverings to be Class 'A" or better Owner ora rued agent ate CITY OF �UPEKTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: Seri S« P1a , - _ l . / V PERMIT # 0 ,�F 0`7 O 0 "t � OWNER'S NAME: Te PHONE # GENERAL CONTRACTOR: 5 a e FAX # f�o - >Sl =� I am not using any subcontractors: w.. ----716 - Sigmature DA Please check applicable subcontractors and coml)lete the following information: Owner/ Contractor Signature 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 Owner/ Contractor Signature Date 5 ITEMS OF 5 CITY OF CUPERTINO PERMIT' RECEIPT Sec: Twp: Rng: Sub: Bl}:. Lot: APN ........: 36928008.00 DATE ISSUED.......: 07'08/2009 RECEIPT #......... BS000008158 REFERENCE ID # ...: 09070091 SITE ADDRESS .....: 20:-15 SUISUN DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER JEhN WITT ADDRESS ..........: 20:-15 SUISUN DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: JE2N YIH OPERATOR: SylviaM COPY # : 1 CONTRACTOR .......: TBI) - TO BE DETERMINED LIC # 00096 COMPANY TBI) - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: , TELEPHONE ........ FEE ID UNIT QUANTITY !MOUNT PD -TO -DT THIS REC NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 3,000.00 ----------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BSEISMICR VALUATION 3,000.00 0.50 0.00 0.50 0.00 1PPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1PRWHEATR UNITS 1.00 24.48 0.00 24.48 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 0.00 ---------- TOTAL PERMIT ----------- 109.98 ---------- 0.00 ---------- 109.98 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 109.98 --------------- 109.98 REFERENCE NUMBER -------------------- master card VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER } CITY Of CUPEI�TINO CITY OF CUPERTINO WATER HEATER PERMIT APPIJCATION FORM l9 ?v7OO1?/ APN # uq 2_S 6 0 r -o Date: . /s Building Address: -i l /. 5_uiSu n / Owner's Name: Phone #: Y-, k, Contractor: Phone #: (L{ct3 )-Z -Zit `1 S .0. b GC_>ti+S C.->. Fax #: Cupertino Business License #: Contractor State License #: ®'Zo o '41 L4' -> Contact: Phone #: C4o31 2-2-G - 2r1 i `i S©ASF ���.GrrE� Fax #: Building Permit Info: Bldg [ Elect Plumbo Mech ❑— Residential 21 Commercial ❑ Job Description: T4Kkless114 Strapped ❑ On Platform ❑ Bonded Eq --New Location Replacement Valuation (cost of project): �_ Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points achieved: 4y Revised 01/07/09 CITY OF CXPERTINO mclwtWATER. HEATER CUkTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group Permit Type ° 1 PCWHEATR Commercial Water HeaterNent B PCWHEATR 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICOM Seismic Commercial B � 1 PRWHEATR Residential V'later HeaterNent B PRWHEATR 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICRE Seismic Residential B 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel & Documentation B 1BUSLIC Business License B