04110093 i'
CITY OF CUPERTINO 7 7a`�7"�.s ++ �/'
BUILDING DIVISION PERMITR11TQIZII�I'vRAIO
BUILDING ADDRESS: HOT WATER INC PERMIThAN 110093
8015 RAINBOW D
OWNER'S NAME: ' PERMIT ISSIR DAM
STEVE HARTING 2531 GRACELAND AVE11/16/2004
ONE: I --- —. - SANRARYNO. CONTROLNO.
(650) 298-8494
ARCHITECT/ENGINEER: - BUILDING PERMITINFO
- _ __ BLDG EIECr PLUMB�MECH__
LICENSED CONTRACTOR'S DECLARATION'
I bemby alum that l em licenced under pmWtlom of CNpur 9lcommeneing _ _ .IObDescription/` -
� withSection 7IXD)of DIY1JOn3nfdVIBUlIMd4and ProfuJnN CndC.and my license is •. �(_/--
'in fill fares and effect - - - REPLACE WATER HEATER. - d�� r,�-_
S rt? License Chis
L-p De¢ Conlnclar \
ruARCHITECTS DEC O /r• �\ ____
I undeand my plmulWutnd l be a public menrtls
it
u
Licensed RafessianJ
Die OWNER-BUILDER DECLARATION
"a� y 1 hereby aRrm that 1 em exempt fmm.Ne Committees License Law for the /VVV {, �CPs
O o fallowing moon.(Section 7031.5.Business and Profession Cade:Any city or county
500
$On which mquira•permit in contract,slur.Improve•demolish,or must,my structuretustructure
k,ic Prior m its issuance.1190 infor quires Me Applicant fouch permit to file asigned ltsumm
c _ v • _
ggg < Roche islimnadpumanslothepmvisiomofda Con=wr',Uwnselsw(Chapur9 --- Sq.Ft. Floor Area �i ,Valuation_'
$ (commencing with Section 7")of Division 3 of the Busineaand Profeuian Cade)or' -
th al M I.remain thertsom and the basis for the alleged exemptimt Any violNon of 1\'•
Section 7031.5 by any applicant for•permit subjects the applicant to a civil penally of
not mom than five hundred doles!DISM. 6 Occupancy Type
❑-L a owner of the property,m my employees with wages As dub sets ewepetiation,
will de the wort,and the srumum 11 not intended or offered fes ale(Sm 7010,Business
and Prosessions Code:The Communes License law dam!Out Apply to an owner of - _ Required Inspections ..-.._ .. -
propeny who bui lds or im proves Neuron,end who dna such work hi mseif or through his
own employ.,provided Ousuch improvements Am eat intended uroRenW fwala ff,
however,the Wilding or improvement it sold within one year afcompkdon.Ne owner- --.- -builder will will have the burden of proving that hm did not Wild or Improve fes putpme Of - `- - - -'---- --' - -
sele.).
❑1.a owner of the property,am exclusively convecting with licensed conractma to
construct the project(Sec.7044,Business And Profesiom Cade:)The Conrecur's Li•
came taw it.not appy in an Owner of property who wilds or improve Memos,And, -
whocontracts for such projects with A contractor(,)licensed pursuant n the Contrsourl -
Lice.LA..
❑I un exempt under Sec. .B&P C for this mason
Owner OAu
WORKER'S COMPENSATION DECLARATION
1 hereby ARtm under family of perjury,am of the fallowing declallons:
I haw and will maintain a Cenifteamaf Conant a self-Wwe for Warku's Coupes•
adan,a provided for by Section 3700 of the labor Cade,fes Rhe performance or the
wink for which this pcnnit is issued. -
I have And will maintain Workers CompemNon Ineuuoce,u required by Section -
OfoftheLaborCode.for the performance of ds:work for which th19perml,IsWOOL
MY WorkeYsfAfl rhe.on k nit snd�icy n�/;/33 ,
Conder. �I'gL(� Policy No.: JY �s
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissicdm need not W completed 11the permit Is(mane hundred dollars($IW)
or less.)
1 certify thin in the performance of Me work for which this permit 19 issued,11111111 nm
employ any person in any mannmrm As u became abject to Ne WorYcrs'Compcnudon
Laws of CAlifomlL Data
Appllunl
NOTICE TO APPLICANT.If.Jur making this Cautious,of Exemption.you Ihnuld
become subject o Ne Worker's Compensation provisions of the labor Code,you must
.,O forOwith comply with such provitlnm w this pecontractll mail becontractremind.
Z" CONSTRUCTION LENDING AGENCY
[••t rNw Ihereby aRim Nat them is A construction lending agency for the perimmAnee of
CYitit work for which this permit u leaned(Sea.3097.Civ.C.)
OWi Q Lenders None
Z)
z lenders Address
U0 1 cenify that I have reed this application and sou that the Above Information U
L4 H correct.1 agme to comply with all city Wcounty onlinances and luta laws misting to
0 C.1 building construction.ad hereby Authorize mpmamatives of this city to enter upon the
W Ahove•mcntioned pmpcny for inspection purposes.
pL (We)egme u ace,indemnify and keep harmless the City of Cupeoim Against
rn Ilebiliticajudgmenu.emu and expense which may in any soy accuse sit mid Gly
In consequence of the grmdng of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITHAL NON-POINT Issued by: Date
SOLIVEGUTATIONS.,,A
— AS Jar c � (( �(o�d� Re-roofs
Signuum of ApplienrConuamw Data
HAZARDO) ATERIALS DISCLOSURE Type of Roof
Will the applicau (arum ilding oavpsot uommhandlebaudoa materiAl
u dcfinod by the Cupertino Muni pal Code.Chapter 9.13,and the Health And Safety i
ndo.semen 25532/,)7 - _ All roofs shall be inspected prior to any roofing material being installed.
❑Ye No -___. _
Will the applicant or Tutu building mcuponR vu cyvipmcni or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hsardna air cantuminAnu deBncd by the Bay Ams Air Quality Management all new materials for inspection.
District?
❑Yes No
I haw mW the hius dous materials mqulmments under Chapter 6.95 or the Cslifor.
nia Health&Safety Cade.Sections 25505.25533 and 35534.1 undcrsund On ifthe Wilding
Own not Immty be.A to m,that It b my Wil ty u wdly M oeculi m M Nc I V /�.r� v)�e'`/2'�i •' l _
mm c� w,,ichnmutbemR aruissoaao e�m�of�ccupa� Signature of Applicant Date
q�` - "74 ' p r U ta--t' 07b't' All roof coverings to be Class"B" or better
wneronut� hoAredA ens
Data
Community Development
10300 Tone Avenue
OCOF
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT # 0- c I I ` 73
OWNER'S NAME: Jf— r `J PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
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 e,
Roofing
Septic Tank
Sheet Metal
Sheet Rock
�Tile
��
Owner/Contractor Signature Date
CITY OF CUPERTINO
WATER HEATER U 3
CUPEkTINO PERMIT APPLICATION FORM
APN# / Date:
Building Address:
bbl S
Owner's Name: / Phone#:
v oRIR 57-
Con actor: 74, Ph e: License#:
Contact: n Phone: Cupertino Business License#:
(, `l/1 S �(� Gt v1 (� Ci✓n-L 1
Building Permit Info:
Bldg ❑ Elect ❑ Plumb D--� Mech ❑
Job Description:
Residential ET ICommercial ❑
Cost of Project: G�
• Strapped 11 On Platform 0 Bonded
New Location ❑ Replacement
if
4PW416ird Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMTI'FEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING
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0 1