04030191 CITY OF CUPERTINO ^`
BUILDING DIVISION PERMIT $(CONTRA TOR INFORMATf6N
BUILDING ADDRESS: HOT WATER INC PERMIT N'04030191
7577 HEATHERWnnn UR
OWNER'S NAME: PERMIT ISSUE DAMJIM YU 2531 GRA
ONE: SANITARY NO. CONTROL NO.
(650) 298-8494
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� 0 t�
Zoe,
LICENSED CONTRACTOR'S DECLARATION Job Descri �!A
O
WU C Iion7 affirmthat lam Ilecmcdunder ed profasmof shaper9(rommense is P�f•`'CI AIS
b with Section lllfl(1)of Dlviaian3a(Ihe Buaimss tape Profeesiniu Cade.and mylicemeu 9a fl��
e& in full fame andcRccl. _ 3 Z REPLACE WATER HEATER
S Z
Lie
I a Lic.sY
Z�� Dam Conmcon s _£ APR 142004
AR 1'IECTS DECLARA ION
Ky 1 understand my plans still W used as public record
BQt; Licensed Pmfcisionel BUILDING
OWNER-BUILDER DECLARATION
�y1 1 hitch,aBhm that 1 am emorpt from the Cantnerors License law for the
i
00 following natio.(Section 70 I.S.Business and Prokeamos Cade:Any city or county
$ which rtyvims a permit to mnawct,aiuc improve,demolish.or repair any slruetuu
r Z< prior to its issuance.also requires the applicant for such Permit o file a signed statement
that he is licensed pursuant W she previsioosnf the Comractori License Law(Chapter 9 Sq. Ft.Floor Area Valuation
(commencing with Section 10110)ofDivision3 of the Business and Prefeasions Code)or
$
that he is exempt therefrom and the haste for the alleged exemption.My violation of
Seeder 1031.5 by any applicant for a permit subjects the applicut tu a civil penalty of $I4qifn8er00 Occupancy Type
not mom Nan Eve hundred dollars(5500).
❑i.ms nernrNepmperty.armyernplo wi0wguastheb Solemmpcnsadon,
willdo thcwork.and thesuuerure meminmndedsralfesed feraale(Sce.1014,Business Required Inspections
and Pmfessiom Cerk:The connector's Limme law docs w1 apply m an owner of q P
pmpery who builds or improeaa thereon,and who does such work himself or though his
own employes,provided Nat such improvements are,not intended or offered for sale.It.
however.Ne Wilding or improvement is Sold within asm year of mmpleuon.Ne owner
builder will have the burden of proving that he did WE build or improve for purpose of
sok.).
❑1,as Owner of the property,am exclusively contracting with licensed con"Cims to
construct the project(Sea 1044,Business and professions Cod:)The Coneumrs LL
terve Taw does not apply in an owner of property who build or improves Merton.and
who contracts for such pmjccts with a conuacmr(s)licensed pursuant m the Contncmfa
LicenseLaw.
❑1 ser exempt under Sec. B&P C for this Mason
DAM
WORKER'S
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury arc of the following declarations:
I hale and will maintain a Certificate of consent to self-insert for Worketa compeer
union,as provided for by Sesuon 3100 of the Labor Code.for the performaree of tic
work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as me tined by Section
of the Labor Code,for Ne performance of the work for which this permit is Issued.
my Workers C maIt ac numr
C.
Carter. Policy No.: /
CERTIFICA OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Innis aeetim reed not he completed if the Ierunk Is foram hundred dollars(SIM)
or less.)
1 mildly that in the performance of the work for which this permit is issued,I shall not
employ any person in any manocran as to become Subject o the Woftor Compensation
Laws of Ca11romia.Dau
Applin.
NOTICE TO APPLICANT:If,after making this Cmdriicam of Exemption,you should
become subject in the Worker's Compensation provisions of the Iabnr Code,you must
Z foMwith comply with such provisions or this permit shall Im deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
I hereby affirm Nat them its consuuminn lending agency for the perfurmane of
a> thc work for which this permit is issued(Sea 3091,Civ.C.)
fLt Lender's Name
Lenubm's Addovs
U Q 1 certify Nat 1 have read this application and sou that Ne above infamtadan u
lL - minect.l agree to comply with all city and county ordinances and state laws relating to
p building eonswnion,and hereby authmixe tepreuntatiwns of this city to enter upon the
aWye-mentiond property for inspection purposes.
(We)agree m rave,indemnify and keep harmless tie City of Cupertino against'
NLiabilities,judgments,costs and expenses which may in any way acetic against sad City
V Z in conuyucncc of the granting of this permit.
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLN N-POINT Issued by: Date
y$.- �%
��
SOURCE REGULATIO
/ r 0 dOc/ Re-roofs AP
Signewrc of ApphnHAZARDDOO
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant at future building occupant ram ors H
e rda
eaus maudai
ss dfitted by the Cupertino Municipal SM
l C .Chapter 9.11.ape the ca1N and Safety
.Seen.255314)1 All roofs shall be inspected prior to any roofing material being installed.
❑Yes 0N
W01 the applicant or future building Occupant tee equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants as defined by the Bay Arta Air Quality Mamgemmt all new materials for inspection.
Disviatl
❑Yes [I No
1 have real the hus dous materials mquirtmcnu under Chaplin 6.95 of the Califon
.is Health&Safaycodc,Sem.15505.M533 and 25534.1 understand thate bu
if One
docs trot currently have a trnan.that it 4 my responsibility 0 notify the=upset of the
requimmcnts which musatc,metgderlu ssuanrccofaccmflcae or c ry/ Signature of Applicant Date
�(. All roof coverings to be Class"B"or better
Owner or amhori.d agent Da
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS5 ? -2 e T 'Zl, x � PERMIT # '-' C�6
OWNER'S NAME: Ja 6 [S r, PHONE '
GENERAL CONTRACTOR �L(- lz,G FAX !Co /-
I am not using any subcontractors: 3 2 0
Signature Date",
Please check applicable subcontractors and complete the followinginformation:
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. j;,x
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Contractor Signature Date
CITY OF CUPERTINO
WATER HEATER
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
5 _Z60 -059
Building Address:
7577
Owner's e: Phone#:
Ifo$ -
Contractor: Phone: License#:
HOTWATER,ROAD INC.961 INDI ,50_(C)a1-6 ,c/Cl -7& ( �
Contact: SAN CARLOS, CALIFORNIA 94070 Phone: 7 Cupertino Business License#:
� I
Building Permit Info: /
Bldg1:1 Elect El Plumb Me Mech ❑
Job Description:
Ince. uJ ct_,ter
Residential Commercial ❑
Cost of Project:
Strapped Lid On Platform Bonded
New Location ❑ Replacement
Qty. if
ARplicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
I BENERGY Energy BUILDING
BUSLIC Business License BUILDING