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CITY OF CUPER'I'INO
BUILDING DIVISION PERMIT CONTRACTOR I�NFORMATION;s
BU ILDINGADDRMS: HOT WATER INC PERM�NO05060088
7848 E
OW,
W NER'S NAME: PERMIT LSUE DATE
GEORGE MATTINGER 2531 GRACEL
NE: SANITARY NO. CONTROL NO.
(650)298-8494
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION Job Description
I Wr.by affirm that I am licensed under provisions of Chapter 9 (commencing p
with Seetion ]0!111) of Division 3 of IW Buvne s and Professions Code,and my license is
in full Ed �Yn Lie.e J`_ REPLACE WATER HEATER
,am C, //W C s Contractor SEISMIC RESTRAINTS, T & P TO EXTER.
ARCHITECTS DECLi RAT10 f
T understand my plans shall be used as public meet&
Licensed PmOssional -
OWNER -BUILDER DECLARATION
I hereby 21Drm that 1 am exempt from Nc Comnam's License Law for the
fallowing reason. (Section 703 L.S. Business and Professimu Code: Any city or county
which ¢quires a permit us construct. alter, improve, demolu R m repoen any Structure // (/i1 17
prior to its issuance, also requires the applicant for such permit to file a signed statement /
that he is licensed pursuant Ne provisions of the Comomer's hcoa. Law (Chapter 9 Sq. Ft. Floor Area V�[��f Valuati0500
(commencing with section 1000)of Division 3 of the Business and Professions Crum)or �cUq // `\
that he u exempt themfmm and Ile hesis for the alleged exemption. Any violation of
Section 7031.5 by arty applicant for a permit Subjects the applicarano a civil penalty of V
not mom than Ove hundred Cellars(3500). APNumber n yn Occt7pancyType
❑ 1. a mite, of Me property. m my employee with wages as Men to comparators. 36217033. 0 0 //
will do the work. and the stmmure is not intended or offered for sale (Sec. 71144, Business r /"
and Pmfmsiom Code: Tim Contractor's License Law does not apply to an owner of `tRegiiiied In'spections*'
pmpenywho buiprovi id t1misslhercon,anti inuamessuchwmk bimsdforthrough hisowm
however,
e,ping or iNmsuchcatis,em within
ne(you fcomplBerW forsale0.
huilder the Wilding ofimprovementissoldwithinone year ofimprovfor theowner.
builder will have the burden of proving that he did not build or improve for purpose of
sic.).
❑ 1, a owner of the propany am exclusively conteting with licensed contractors to
construct die project (Sec, 7044, Business and Professions Code:) The Contractor's LI.
maim law doe not apply in an Owner of property who Wilds or improves therson, and
who contracts for such projects with a con eactor(s) litineed pursam to de Conuacto's
License law,
O l am ea crept under Sec. - . B h P C for Nis mason
Owner Dale
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury are of due following declarations:
I Banc and will maintain a Certificate of Consent to self -insure for Worker's Compcn-
1031,"1
ion, a provided for by Section JT00 of the labor Code, for IW Performance of the
for which this permit is issued.
Bassa and will maintain Worker's Compensation Insurance, a required by Section
of due Labor Code. far Ne performance of Ne work far which this permit is issued.
yWorker's tomperwuon IgLW,rn_a�carrier and Policy numberrtier. "y'^'f� Ir
L* rA Polity No.: f�
CERTIFlCATE OF EXEMPnON FROM 0 K�l
COMPENSATION INSURANCE
from motion need not be completed if the permit is intone hundred dollars (51!X)
or less.)
1 mory that in the Performance of Ne work for which this permit is issued. I shall not
employ any person in any manner So a to become subjmt to the Workers' Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to Me Worker's Compensation provisions of de tabor CMc, you must
Oforthwith comply with Such provisions or Nis permit shall the deemed revoked.
CONSTRUCTION LENDING AGENCY
I W nny afli m Nat dem is a construction lending agme, for tW perfurnance of
Me work for which this Permit is issued (Sec. 3091. Civ. C.) -
QLi,ndcr's Nam. .
z L<nder's Address
Q 1 certify that 1 Baan mad this application and sum Nn the above information is '
corcet 1 agree to comply with all city and county oNinances and sum laws relating to
V building construction, and hereby authorise mpresomatives of this city to enter upon the
CSl above mentioned pmpeny for inspection purposes.
py (We) agme to ave, interact fy and keep hmmleaf the City of Cupertino against
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liabilities judgments, costs and estimates which may in any way accrue against said City
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in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date 6—N -j' Qrlj.Tyl
So L
cc
cam-- Q(y�Z S
Re -roofs
Type of Roof
Sig Ap anUContracmr Dam
HAZARDOUS MATERIALS DISCLOSURE
Will IW applicant or future Wilding occupant stare or handle bamdous material
a defined by the Cupertino Municipal Code. Chapter 9.13, and the Health and Safety
tock, Sectionz553z(a)l /
All roofs shall be inspected prior to any roofing material being installed.
C3 Yes fl
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building .;,tim m use cytii,unr t or devices which
it haxardnus air contaminants dcOncd by the Bay Arca Air Quality Management
all new materials for inspection.
isuial
❑Ycs Nu
I have real Ne W shdtms row criaB requirements under Chma,1695 .(the Calif.,.
nice Heal" Safety Cade. Sections 25305.15573 and 25534.1 u deemod dutif the Wilding
dos w urtcn I have a tenant Nat it u my responsibility, to houfy Me occupant of the
re Ipriarm issuancoofa CertiRcauy of panty.
/Y�_
Signature of Applicant Dale
All roof coverings to be Class "B" or better
nc r aux v<J agcm Dam
L
aw
CITY OF
UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
73Y,? 0 effe-
PERMrr #
O -50 6 IS O <?e -
OWNER'S d�/
PHONE # SOB - 777- S
GENERAL CONTRACTOR.- u
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
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
f
/
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Date
CITY OF
CUPEtt;TINO
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
APN # L _ / _
2
BUILDING
Date:
Building Address:
PLUMBING
BENERGY
Energy
BUILDING
BUSLIC
Owner' Name:
r
Phone #:
-7 7 -Sas
Con act r:
Phone:
&50-GO(-00y96,
License #-
•&50
Contact-
Phone:
Cupertino Business License #:
Vs
Building Permit Info:
/
BldgEl Elect El
—
Plumb L�
Mech ❑
Jo Description:
Residential Er Commercial ❑
Cost of Project Sop
Strapped ❑ On Platform ❑
Bonded ❑
New Location ❑ Re lacement
Qty. if
Annlicable Fee ID
Fee Description
Fee GrouD
BPWHEATER
Water Heater / Vent
BUILDING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BENERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING
'A 9 � 7 �
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