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05030227 a CITY OF CUPERTINO -- BUILDING DIVISION PERMIT ,CONTRACT�UR INE�RMATIQN' BUILDING ADDRESS: PERMIT N WATER HEATERS ONLY 05030227 OWNER'S NAME: PERMIT LSUE DATE ONE: SANITARY OL NO. ARCHf1ECr/ENCINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH _00 LICENSED CONTRACTOR'S DECLARATION Job Description mF I Washy affirm then 1 am liecved under provisions of Chapter 9(commencing p Zto with Section 7")ofDivision Sof the Business and Professions Conc.and my licenser ^tea in fullfncea deffe $Ljz unenw �° 3(. uc,g REPLACE WATER HEATER ' n DI¢ Comnxwr ARCHITECTS DECLARATION 1 understand my plans shall be used as public meet& it 01n Licensed Professional 5 OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the cc following reason.(Section 7031.5.Imaine6 and Professions Cole:Any city or county y m which.quires a permit to..,L alms,improve,dcmulish,or.,it any structure prior 4)its ia3uaM4 Iran marmots the applicant forsuch permit to rile asigned9amment / iia that he is licensed pursuantmthepmvisiomorNeConuacmr'sLicenselaw(Chap¢r9 � Sq.F[. FloonArea Valu anon C,x ` �� t-$ (commencing with Section 70)0)of Division 3 of the Business aM Professions Cade)Or Net io u exempt1.5 bthaefmm and Vise aper for the alleged exemption.to Any violation of Seton 7031.5 five my applicant fora(omit subjects the applicant a civil penalty of .�A.p}�y,Tv� 'f not mom Nanfim hundmd dollars($SB07. ) 3 LlEs4`PlI`�1betpO f :.y Occupancy Type ❑I.ssawncrof tlieproprny,armycmplemieswithered ssthe"uict.7 .B.sinces willdo the work.and theswaure is notintendcd oroffcmd forsNe(SecA04a,Buxiness and Pmfessimu Cade:The Contractors License Law dcs onot apply to an owner of 4t bV/ Requiied•Inspec[ions " property who builds orimprove i thereon.and who douauch wart himsefor through his ownemployeu,provided Nat such improvements aremn intended ar offered for sale.It. however,the Wilding or improvement is sold within ane year of complcdon,the owner- ��a///JJJJJJ builder will have the burden of proving that he did not Wild or improve for purpose of - sae.). ❑1,as awmer of the property,am exclusively emoracing with licensed tun..to construct the project(Sec.7044,Business and Professions Cedc)The Conuaenn's Li. ve law does not apply to an owner of property who hullos or improve thereon,and. who concocts for such projects with a contractor(s)licensed pursuant m the Contractors License law. I am exempt under Sea ,B&PC for this reason Owncr Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain aCeadricate of Consent to self-insure for WortrrsCompen- sation,as provided for by Section 3700 of the labor Code,for dm performance of the we k for which this permit is issued. I have and will maintain Worker',Campatution Insuran,s,as myvired by Section 7 ofd.laWr Code.for the perfamunce,of the work for which this permit is issued. My Workers C�mgpensation Insumam carier and Policy number am: Carrier. S •T ss�� policy No.:-.S4Jd'r�y X87 CERTIFICATE OF E%EMPTION FROM WORKERS' COMPENSATION INSURANCE ('Dry section need not W eomplemd if the permit is farm=hundred dollars($1001 or lcsz) 1 eenify that in the performance of the work for which this permit r issued.1 shall at employ any person in any mannerso Is in become subject o the Workcri Compensation taws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compenstion provisions or the labor Code,you must .,O forthwith comply with such provisions or this permit shall W deemed revoked. Z y CONSTRUCTION LENDING AGENCY 'rr Ihereby anion that there its cotsuuction lending agency for date performance of C' the work for which this permit r issued(Sec.3(197,Co.C.) WL Q Lenders Name Z Lenders Address U Q 1 certify ton 1 have tend this application and state that the aWve information is Uy E-' correct.l agree to comply with all city and county on inoses and sum laws reining to O U building Conswction,and hereby authorim represcnutive,of this city to enter upon the H.1 soove-amminced propcay for impcnion puryaaes. (~ G (We)agree to save.indemnify and kcep harmless the City of Cupertino against to Ii.1,11Wu,judgments,costs andexponses which may in any way scans against to City U Z, his Permit. APPLICANT UNDEnsuenof the RSTANDSooding of IAND WILL COMPLY WITH ALL NO POINT Issued by: Date SOURCE RE 3 ✓ Re-roofs Signature of Ap icanUCOn wr Date 112 DOUS MATERIALS DISCLOSURE Type of Roof Willapplicant tutuni Wilding Occupant store or handle havardous material ss defined byy the Cupertinmo Municipal Codc.Chapter 9.13,and she Mcalth and Safety Cudc,Seton35532(,)? Yes e d�-. All roofs shall be inspected prior to any roofing material being installed. Will the applicant or fawn building occupant esu cyviPmem or devices;which If a roof is installed without first obtaining an inspection,I agree to remove it havardom air contaminants n dc0ncd by the Bay Area Air Quality Managcmcnl all new materials for inspection. is"ict? ❑Y C� 1 have read the hanobous materials requircmcnus under Chapter6.95 of the Calirno nice Hwith&Safety Code,Setons 7 505.25533 and 25534.1 urdcrsmM that ifthe Wilding docs not currently hams a tenant that it r my ma,mearility m unify ser Occupant of the myuiremcnuw' ,priorwissu ecofaCenificateorOc5 er' Signature of Applicant Date 3 4 All roof coverings to be Class"B" or better Owner or au omsd agcm Dam Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building Department JOB ADDRESS: 5 c�ta-- PERMIT # 0 r.7-� 3 J ZZ OWNER'S NAME: PHONE # 2S 3 —303 GENERAL CONTRACTOR: A),&„ FAX # I am not using any subcontractors: 4,14 7V•c�r2,, - -3/;5JdLS Signature Date Please check applicable subcontractors and complete the following information: 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 ' 1 Tile Owner/Contractor Signa a Date CITY OF CUPERTINO WATER HEATER j�-b 3 o 2- z7 CUPERTINO PERMIT APPLICATION FORM APN # Date: 3 z Co - '-f � - 0 3 1 3/2-s /o s Building Address: Z 18. 2 S� CSP Owner's Name: ate., A Phone#: 2 Contractor: Phow: License #: 60a2tu �,le X400 135 -59 L/ a 7 Les 73 Contact: Phone: � � Cupertino Business License#: l8 �� Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description:/��, Residential Commercial) ❑ Cost of Project: Strapped ❑ On Platform ElBonded El New Location ElReplacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING / BENERGY Ener BUILDING BUSLIC Business License BUILDING o,2—, U T