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00100202 CITY OF CUPERTINO EIUILDINGDIVISION PERMIT ;• r R s, . a.,vi .edaHk •�aSTN�uz PERMIT NO. BUILDING ADDRESS: WATER HEATERS & MORE PLBG. 00100202 PERMIT ISSUE DATE OWNER'S NAME: RSTNr SANITARY OL NO. NE: (6550) 522-998-7 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLOO ELECT PLUMB MECH 0 0 0 0 loo LICENSED CONTRACTORS DECLARATION Job Description I MmbY afliw Nal I w lumnsed uMer Pravidou of CMpur 9(commrrein{ ��� MWscoMm]ODU)of Dlvldon3ofWc BudmuaM Prafessiom Code.aM mY litems" In full f«=Add Affect. REPLACE WATER HEATER DAM Clue Codm IIS � u9 DAM ARCHITECTS DECLARATION ty7 I untleraand my piano a1Wl M used An public r««ds =� Licensed Professional OW NPA-BUILDER DECLARATION S 1 hereby affirm that 1 Am emmpt from the Cenumtans Liters.law for We p C fallowing mann.(section 7071.5.Business W Professions Code:MY city«county $ which reliance a permit to tunemcl,Aller,Improv,denmliab.o mPW any"bathe 'his^ pd. Ft.g Ft.Floor Area Valuatio k1F< (,.,,llmnaedpurmmtmNepmvie 1003omCenuacu/elicemmlaw(Chap«9 tl' a (cmmmenring Mth Stolon]ODO)NDivslan7 of the Busineu,nd Pn(wlom Code)er out M u emmpt thctef em and Me bad,for We alleged exemption.MY vielatlon of .... Occupancy Type Section 7071.5 by any applicant f«A Permit mbjeeu the apm plicam A civil Penalty of 3.r lMii, Occu anv m 0 t e not roam than Ow hundred delves 1$501). " ❑1,u aero of W proprny,«mY wployem with aegh u Me'vmle mnpenwiw. Ann Bothe wart.end We he Contranx's Lt ed MA Ener of Required Inspections uW property wh obu Cede:The Canuacuts ndwho 4w doh rot apply m rt rover of q P Property"rhobulbs ided m A Muamn,andwho AM Intended amenlf«Wmu{b his own..me Wipmviar Wm such ImO�d wit in not lean ofc«ortmed fnssaln E. �• howler.We bui:teL Mean Mat Mali set Year ofimprownon.for Weow«Of Miller ME haw the sullen of proving that M did rot sMld or improv f«puryaa of ` (/ ale.). I jl j ❑1.a owner of We Property.w emlunwly comitant wed bcuued conuamrs he t a• comumt the project(See 7044.Besinh"and Profcsam Cade:)The Cmtracnefa W- t ..•"•-law does not apply An an owner of property who Mild,or improwa Women.and who contracts far Ach projeeo with aeentr.,AAM)Iicemed pursuant An hM Cmuunf, License law. IwexwPlundm See ,Bh PCf«wsromn Dam WORKERS COMPENSATION DECLARATION I heathy 0111.rode,penalty of PM1uY oro ar the following declwdn s: ,-]I Mw am will maintain a Can lcmem.Comm",An If-ares for Wo A's Cooper- - satim,.pro 1 for by Section 37M of de IaMr Cade.for the Perron".a the A(or whits this Permit Is issued. ❑1 Ww atM will microbio W aures Compensation loavuhm.u minimal by Section _ ]700==,i. 00 of the Inbar Cade,far We pedartmwe of We work For which Mis pewit 1a issued. My Workefs CMP—Wan lawn-.,..arra«and Policy number w: Carder. Policy No.: , CEnFICAT RE OF—EXEMPTION FROM WORKERS COMPENSATION INSURANCE finds needed weed rot becanplowd irate pewit is foramhundtNdollua(SIOD) Or RaJ 1 certify Wal W We p«fowmce of the won for which this permit is issued I shall am employ any person in any mune,au he bamme abject to Me W dare Compensation Law,of California.Dau Applkut NOTICE TO APPLICANT.If,afar making Wu CeniOwm of Eumption.you shmid be mme mbj«h At are,Work='s Compensation ptmisions or the lab«Code,You mune �z feMMhh cedeply wine s«h provisions w this Permit shall W deonN reeked. Z yCONSTRUCTION LENDING AGENCY F. There ,Ebro Wat neem l,aconsuuctim lendin{agency for de Pcdonnuwe of lYi am wrk for,which Ws permit u issued(See.315].Civ.C.) W QLsrdens Nee raj z Lenders mama U I maty that 1 saw mad this R plic doa and wen Wu the above infowNon i, cows 1 agree m comply with all city ad=Only ordimreo add awe laws relWng m W Open 0 building construction,a ,rode uNodd mpmenuowa Of this df uenwo Aga the W above-m=oaned pmpenY fo inspection Purposes gy (We)agree m ssw,indemnify and luep humless We City of Cupertino agdmt y liabilities.jm1jdam%cow and expemmn which MAY In Any nYaceroe agdnusva Ny in consequence of We grarting of this Permit. Date ww APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Simatw of AppllwnbConuenmr Di1C m. Of Roof HAZARDOUS MATERIALS DISCLOSURE ')pe Will Me applicant or fuwm Wilding«cupentsmm or handle hasa ima matMd se defined by the Cupertino Municipal Cade.Chapter 9.13,and dm Health and Safely Ads.Section M5324)? All roofs shall be inspected prior to any roofing material being installed. ❑Yea ONO If a roof is installed without first obtaining an inspection,I agree to remove Will the applicmt or future building occupant mm equipment«devices which emit haraNnw err mmaminaru As defined by Me Bay Area Air Quality Management all new materials for inspection. Diarc,7 ❑Yen 0 N I hen read is,husrdWA remodels mmuimmenu under Chapter 6.95 of f Califor- ranHealW A SafelYCode.Sections 255M,25577 aW 25534.l undemem!Wat if We Wilding does not cunendy Mw A wum.and It's my mal a othility At ratify the Acte at of Me Date nequimmcnu ss M w wc m which mumet prior uamof a Ccninaof OccupamY. Signature Of Applicant All roof coverings to be Class"B"or better Ower or aoNOdmd a v.i Dam CITY OF CUPERTINOIN aFn "f�y7"?/� h "y� ' �r BUILDING DIVISION PERMIT `yWL� ,; r` „'' g'•±'. BUILDING ADDRESS: PERMIT NO, WATER HEATERS & MORE PLBG. 00100202 OWNER'S NAME: PERMIT ISSUE DATE ONE:VIJ-T.TNr RRTNr4 62 =F,22 s SUITE SANITARY �99OL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u00 LICENSED CONTRACTORS DECLARATION IOW D0SC1'I IIOn �zs 1 hemby affirm Nat 1 am licensed under provisions of Chapter 9(commencing P < wife Section 7")of Division Sof the Business and professions Code,and my license is < in full fome and effect. Z License Class Contractor. REPLACE WATER HEATER Dan. . y�q ARCHITECTS DECLARATION i understand my plans stall W used as public racoma 3:U '1 s, Licensed Pmfesslmml 3 OWNER-BUILDER DECLARATION 1 hereby amrm feel 1 em cxcmpt Inc.de,Comracmes License Law for the O D following mason.(Section 7031.5,Business and Professions Code:My city or county k @ ff which requires a permit to mmen m,alk,,improve,demolish,or repur any auu=um mea prior in its laWMe,also requires the applicant for such permit to file a signed statement < Nat he is licensed pursuant to the provision of the Connectorsla aLicensew(Chamer9 Sq.Ft.Floor Area Valuatio as (commencing with Section 7")of Division of the Businessand Profession,Colo)or .. Nat he is exempt therefrom and Ne basis for We ulcgad esempllon.Any violation of Section 7031.5 by any applicant f=a permit subjects the applicant to a civil penalty of 3 5031-V�g10 0 Occupancy Type not mom Nan live hundred dollen(5500). - ❑1.u ower of lite property.mmy employees wife wages u dkeir sole compenution. will do lhewcakmd Neawcwm is not intended oroRared formle(Sec.7044,Bninas Required Inspections and Profeauons Code:The Committees License Law does not apply m e an owner of q P properly w ho Wi Ids m improves thereon.and who does such work himself or through his Own employees.provided Nat such improvements arc not intended= ffemd formic.IL however,the building or improvement is sold within one yeti ofcompletion,the owner- builder will have the human of proving feat he did not Wild or Improve for pulp.of sale). ❑1,as owner of the property,am exclusively contracting with licensed centruccrs to I 6iI, construct the project(Sec.70",Business and Professions Code)The Convectors Li- l cane law does not apply in in owner of property,who Wilds or improves demon,and who contracts for such pmjecw with a communist limnsed pumuant to lite Convectors - - License Law. ❑I are eamept unit=Sec. .B Al P C for this moon Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have atm will maintain a Certificate of Consent m calf-intim f=Workers Compon- 7cm, tion,u provided for by Section 3700 of the labor Code.for rho performance of the W for which this permit is ismed. 1 have and will maintain Workers Compensation Insurance,as required by Section 00 of the Labor Code.for the p rforruance of the work for which this permit is issued. y Worees Compensation insurance carrier and Policy number am: rrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Till,section need not W completed if fee p=mil isfnrm,hundred dollars($100) or leu.) I cenify,th=in the performance of the work for which this permit is issued,I shall not employ anypermn in any mannerm as to become subject to the Workers Compensation Laws of California Dam Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subject in fee Worker's Compensation provisions of the Labor Code.you most ,J O forthwith comply with such provision or this perm)shall be deemed mroked. .ZiCONSTRUCTION LENDING AGENCY E.t 14 (hereby affirm that them is a construction lending agency for fee performance of LYI> the work for which this permit is issued(Sec.3097.Civ.C.) W Q lender's Name ice. z Lender's Address U 0 I cenify that 1 have read%is application and sato that dm above informman is W correct.I agree to comply with all city and county mdinances and sale laws relating to 0Ubuilding construction,and hereby sutherim represenatives of this city to env upon dm :4 above-mendoned property For inspection purposes Ly, .(We)agree to ave,indemnify and keep habeas the City of Cupertino against y liabilities,judgments,costs and expenses which may in anyway same against said City U consequence UNDERSTANDS eRof due IANing of tAND his permit, APPLICAWILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of ApplicaDem HAZARDOUS US MATERIALS DISCLOSURE Type of Roof WIII Lha applicant or future building e.Chains, 9.1 or handle hazardous materiel as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety - Code.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. 0Y ❑No Will the applicant or future building occupant use equipment or devices whichnmu dmIf a roof is installed without first obtaining an inspection,I agree to remove mit haom air contaminants defined by the Bay Area Air Quality Management all new materials for Inspection, istri=7 ❑Yes I-]No I have mad the heurdons materials requirements under Chapter 6.95 of the Califor- niaHealth&Safety Code,Sccdon,25505,25533 and 8534.1 undersand Nm if like Wilding dues not currently haw a write,that it o my rospenibiliry m notify the,occupant of the requimmcnts which must Wm at pour w issuance or a Carifcate of Occupancy. Signature Of Applicant Date O Dwnerr or authorized agent Date All roof coverings to be Class"BI'or better CITY OF CUPERTINO EIUILDINGDIVISION PERMIT ;• r R s, . a.,vi .edaHk •�aSTN�uz PERMIT NO. BUILDING ADDRESS: WATER HEATERS & MORE PLBG. 00100202 PERMIT ISSUE DATE OWNER'S NAME: RSTNr SANITARY OL NO. NE: (6550) 522-998-7 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLOO ELECT PLUMB MECH 0 0 0 0 loo LICENSED CONTRACTORS DECLARATION Job Description I MmbY afliw Nal I w lumnsed uMer Pravidou of CMpur 9(commrrein{ ��� MWscoMm]ODU)of Dlvldon3ofWc BudmuaM Prafessiom Code.aM mY litems" In full f«=Add Affect. REPLACE WATER HEATER DAM Clue Codm IIS � u9 DAM ARCHITECTS DECLARATION ty7 I untleraand my piano a1Wl M used An public r««ds =� Licensed Professional OW NPA-BUILDER DECLARATION S 1 hereby affirm that 1 Am emmpt from the Cenumtans Liters.law for We p C fallowing mann.(section 7071.5.Business W Professions Code:MY city«county $ which reliance a permit to tunemcl,Aller,Improv,denmliab.o mPW any"bathe 'his^ pd. Ft.g Ft.Floor Area Valuatio k1F< (,.,,llmnaedpurmmtmNepmvie 1003omCenuacu/elicemmlaw(Chap«9 tl' a (cmmmenring Mth Stolon]ODO)NDivslan7 of the Busineu,nd Pn(wlom Code)er out M u emmpt thctef em and Me bad,for We alleged exemption.MY vielatlon of .... Occupancy Type Section 7071.5 by any applicant f«A Permit mbjeeu the apm plicam A civil Penalty of 3.r lMii, Occu anv m 0 t e not roam than Ow hundred delves 1$501). " ❑1,u aero of W proprny,«mY wployem with aegh u Me'vmle mnpenwiw. Ann Bothe wart.end We he Contranx's Lt ed MA Ener of Required Inspections uW property wh obu Cede:The Canuacuts ndwho 4w doh rot apply m rt rover of q P Property"rhobulbs ided m A Muamn,andwho AM Intended amenlf«Wmu{b his own..me Wipmviar Wm such ImO�d wit in not lean ofc«ortmed fnssaln E. �• howler.We bui:teL Mean Mat Mali set Year ofimprownon.for Weow«Of Miller ME haw the sullen of proving that M did rot sMld or improv f«puryaa of ` (/ ale.). I jl j ❑1.a owner of We Property.w emlunwly comitant wed bcuued conuamrs he t a• comumt the project(See 7044.Besinh"and Profcsam Cade:)The Cmtracnefa W- t ..•"•-law does not apply An an owner of property who Mild,or improwa Women.and who contracts far Ach projeeo with aeentr.,AAM)Iicemed pursuant An hM Cmuunf, License law. IwexwPlundm See ,Bh PCf«wsromn Dam WORKERS COMPENSATION DECLARATION I heathy 0111.rode,penalty of PM1uY oro ar the following declwdn s: ,-]I Mw am will maintain a Can lcmem.Comm",An If-ares for Wo A's Cooper- - satim,.pro 1 for by Section 37M of de IaMr Cade.for the Perron".a the A(or whits this Permit Is issued. ❑1 Ww atM will microbio W aures Compensation loavuhm.u minimal by Section _ ]700==,i. 00 of the Inbar Cade,far We pedartmwe of We work For which Mis pewit 1a issued. My Workefs CMP—Wan lawn-.,..arra«and Policy number w: Carder. Policy No.: , CEnFICAT RE OF—EXEMPTION FROM WORKERS COMPENSATION INSURANCE finds needed weed rot becanplowd irate pewit is foramhundtNdollua(SIOD) Or RaJ 1 certify Wal W We p«fowmce of the won for which this permit is issued I shall am employ any person in any mune,au he bamme abject to Me W dare Compensation Law,of California.Dau Applkut NOTICE TO APPLICANT.If,afar making Wu CeniOwm of Eumption.you shmid be mme mbj«h At are,Work='s Compensation ptmisions or the lab«Code,You mune �z feMMhh cedeply wine s«h provisions w this Permit shall W deonN reeked. Z yCONSTRUCTION LENDING AGENCY F. There ,Ebro Wat neem l,aconsuuctim lendin{agency for de Pcdonnuwe of lYi am wrk for,which Ws permit u issued(See.315].Civ.C.) W QLsrdens Nee raj z Lenders mama U I maty that 1 saw mad this R plic doa and wen Wu the above infowNon i, cows 1 agree m comply with all city ad=Only ordimreo add awe laws relWng m W Open 0 building construction,a ,rode uNodd mpmenuowa Of this df uenwo Aga the W above-m=oaned pmpenY fo inspection Purposes gy (We)agree m ssw,indemnify and luep humless We City of Cupertino agdmt y liabilities.jm1jdam%cow and expemmn which MAY In Any nYaceroe agdnusva Ny in consequence of We grarting of this Permit. Date ww APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Simatw of AppllwnbConuenmr Di1C m. Of Roof HAZARDOUS MATERIALS DISCLOSURE ')pe Will Me applicant or fuwm Wilding«cupentsmm or handle hasa ima matMd se defined by the Cupertino Municipal Cade.Chapter 9.13,and dm Health and Safely Ads.Section M5324)? All roofs shall be inspected prior to any roofing material being installed. ❑Yea ONO If a roof is installed without first obtaining an inspection,I agree to remove Will the applicmt or future building occupant mm equipment«devices which emit haraNnw err mmaminaru As defined by Me Bay Area Air Quality Management all new materials for inspection. Diarc,7 ❑Yen 0 N I hen read is,husrdWA remodels mmuimmenu under Chapter 6.95 of f Califor- ranHealW A SafelYCode.Sections 255M,25577 aW 25534.l undemem!Wat if We Wilding does not cunendy Mw A wum.and It's my mal a othility At ratify the Acte at of Me Date nequimmcnu ss M w wc m which mumet prior uamof a Ccninaof OccupamY. Signature Of Applicant All roof coverings to be Class"B"or better Ower or aoNOdmd a v.i Dam CITY OF CUPERTINOIN aFn "f�y7"?/� h "y� ' �r BUILDING DIVISION PERMIT `yWL� ,; r` „'' g'•±'. BUILDING ADDRESS: PERMIT NO, WATER HEATERS & MORE PLBG. 00100202 OWNER'S NAME: PERMIT ISSUE DATE ONE:VIJ-T.TNr RRTNr4 62 =F,22 s SUITE SANITARY �99OL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u00 LICENSED CONTRACTORS DECLARATION IOW D0SC1'I IIOn �zs 1 hemby affirm Nat 1 am licensed under provisions of Chapter 9(commencing P < wife Section 7")of Division Sof the Business and professions Code,and my license is < in full fome and effect. Z License Class Contractor. REPLACE WATER HEATER Dan. . y�q ARCHITECTS DECLARATION i understand my plans stall W used as public racoma 3:U '1 s, Licensed Pmfesslmml 3 OWNER-BUILDER DECLARATION 1 hereby amrm feel 1 em cxcmpt Inc.de,Comracmes License Law for the O D following mason.(Section 7031.5,Business and Professions Code:My city or county k @ ff which requires a permit to mmen m,alk,,improve,demolish,or repur any auu=um mea prior in its laWMe,also requires the applicant for such permit to file a signed statement < Nat he is licensed pursuant to the provision of the Connectorsla aLicensew(Chamer9 Sq.Ft.Floor Area Valuatio as (commencing with Section 7")of Division of the Businessand Profession,Colo)or .. Nat he is exempt therefrom and Ne basis for We ulcgad esempllon.Any violation of Section 7031.5 by any applicant f=a permit subjects the applicant to a civil penalty of 3 5031-V�g10 0 Occupancy Type not mom Nan live hundred dollen(5500). - ❑1.u ower of lite property.mmy employees wife wages u dkeir sole compenution. will do lhewcakmd Neawcwm is not intended oroRared formle(Sec.7044,Bninas Required Inspections and Profeauons Code:The Committees License Law does not apply m e an owner of q P properly w ho Wi Ids m improves thereon.and who does such work himself or through his Own employees.provided Nat such improvements arc not intended= ffemd formic.IL however,the building or improvement is sold within one yeti ofcompletion,the owner- builder will have the human of proving feat he did not Wild or Improve for pulp.of sale). ❑1,as owner of the property,am exclusively contracting with licensed centruccrs to I 6iI, construct the project(Sec.70",Business and Professions Code)The Convectors Li- l cane law does not apply in in owner of property,who Wilds or improves demon,and who contracts for such pmjecw with a communist limnsed pumuant to lite Convectors - - License Law. ❑I are eamept unit=Sec. .B Al P C for this moon Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have atm will maintain a Certificate of Consent m calf-intim f=Workers Compon- 7cm, tion,u provided for by Section 3700 of the labor Code.for rho performance of the W for which this permit is ismed. 1 have and will maintain Workers Compensation Insurance,as required by Section 00 of the Labor Code.for the p rforruance of the work for which this permit is issued. y Worees Compensation insurance carrier and Policy number am: rrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Till,section need not W completed if fee p=mil isfnrm,hundred dollars($100) or leu.) I cenify,th=in the performance of the work for which this permit is issued,I shall not employ anypermn in any mannerm as to become subject to the Workers Compensation Laws of California Dam Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subject in fee Worker's Compensation provisions of the Labor Code.you most ,J O forthwith comply with such provision or this perm)shall be deemed mroked. .ZiCONSTRUCTION LENDING AGENCY E.t 14 (hereby affirm that them is a construction lending agency for fee performance of LYI> the work for which this permit is issued(Sec.3097.Civ.C.) W Q lender's Name ice. z Lender's Address U 0 I cenify that 1 have read%is application and sato that dm above informman is W correct.I agree to comply with all city and county mdinances and sale laws relating to 0Ubuilding construction,and hereby sutherim represenatives of this city to env upon dm :4 above-mendoned property For inspection purposes Ly, .(We)agree to ave,indemnify and keep habeas the City of Cupertino against y liabilities,judgments,costs and expenses which may in anyway same against said City U consequence UNDERSTANDS eRof due IANing of tAND his permit, APPLICAWILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of ApplicaDem HAZARDOUS US MATERIALS DISCLOSURE Type of Roof WIII Lha applicant or future building e.Chains, 9.1 or handle hazardous materiel as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety - Code.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. 0Y ❑No Will the applicant or future building occupant use equipment or devices whichnmu dmIf a roof is installed without first obtaining an inspection,I agree to remove mit haom air contaminants defined by the Bay Area Air Quality Management all new materials for Inspection, istri=7 ❑Yes I-]No I have mad the heurdons materials requirements under Chapter 6.95 of the Califor- niaHealth&Safety Code,Sccdon,25505,25533 and 8534.1 undersand Nm if like Wilding dues not currently haw a write,that it o my rospenibiliry m notify the,occupant of the requimmcnts which must Wm at pour w issuance or a Carifcate of Occupancy. Signature Of Applicant Date O Dwnerr or authorized agent Date All roof coverings to be Class"BI'or better