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06010156 (2)CITY OF COPERTINO t ,=, zve ;"W BUILDING DIVISION PERMIT CONTRACT'TOR�TN'(5R1�1TtC1V; BUILDING ADDRESS: PERMIT NO. 0 6 01015 6 11597 CEDAR SPRING CT OWNER'S NAME: PERMIT ISSUE DATE ALBERT TENG 01/27/2006 NE: SANITARY NO. CONTROL NO, BUILDING PERMIT INFO ILI BLDG PLUMB MECH LICENSED CONTRACTOR'S DECLARATIONlob Descri tion pSection I hereby afRsm th&I 1 are IEansed under pmNions of Chapter 9 (commencin{ 70(0)) ufDivifor 3ofthe BueiMu aM professions Codo.md my license is nro=anderfea 'fell©�g REPLACE WATER HEATERe. .,, La.• Debi f ca trance e a RCHITELRS DECLARATION CONTRACTOR: METRO MECHANI AI I undersand my pans shall mused! a public record, 1' /F C. -L / Licensed Professional OWNER -BUILDER DECLARATION I hereby affrm that I am exempt from the Contractor's License law for the following mason. (Section 703 1.5, Business and Professions Cada: Any city or county /1g�, which requite m a permit construct, sler. improve. demolish, or repair my structure s n., prior an its issuance. also requires the applicant for such permit to fle a sigrod comment Nat he is licensed pursuant to the previsions of the Contractor', Uccnm Law (Chapter 9 Sq. Ft. Floor Area U� aluatio 500 (commencing with Section 7000) of Division 3 of the Business and recreations Code)or �'�lV!Q'yyyyy�l b that he is exempt WertfroW and the baa for the alleged exemption. Any violation of /JV �p,jp.7 65 4 066. c p e� pe Section 703 LS by any applicant for a permit subjects the applicant in a civil penalty of not cothan raw hundred dolan ($5Wx me 3 6 0 0 - ❑ I, as owner of the property, ar my employees with wgu as theirhae compensation, Required Inspections will dothewmk. and the LMede aw 7044, c , notweer Of cads: The conmmar, ware law doe, and he Cortie �ms apply to as rouser ter work himselfter through his arty wh ban or property who buildster ed Demon,and who mm,ut caws improvements are oat IeaMec mplercd ferule awn a uiprovaetl than a vett r. wait er, the terIWprowmemishand wiWnoroyear of mprove(,the owner- Nebuil Wle.) wall haw the Emden of proving than he did not amid M improv far purpose of Wilda the seta.). ❑ I. as Owner of the property am exclusively co snacung with licensed mnttecmri u construct the pro cat (Sec. 70", Business and Processions Code:) The Consomme, Li - muse law Ones not apply to an owner of property who builds or improve theteon, and, who contracts for such pm)eets with s eanuacur(O licensed pum ant at the Commune, License law. 01me aemplundu See. ,B d P C for this mare 0. Dale WORKERS COMPENSATION DECLARATION 1 hereby &Man under penalty of perjury, arc of the following dectanllons: 1 hswond will m dream a Cenlficauar Covent toself-Insure forWorker'aCompen- u Ion, as pmvldcd for by Section 3700 of the Latter Cade, for the performance of de watA for which this permit is ianeC. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section J]DO of the labor Code. for the performance of the wart for which this permit Is Issued. My Waraces Comparadan Insuranceemia and Policy numberart: Casrier.G'rQNA-( 5+aa� Poliry No,:ie2���6 ' CERTIFICATE OF EKEMPnON FROM WORKERS COMPENSATION INSURANCE (Tha,cctim need not W completed If the pereall is form= hemmed dollmsell( )) masa) 1 certify that In the perfnmtsme of the work for which this permit is tested. I shall not employ any person In any manner an a m haome,ubject to the Workers' COnpewtion I. of Calita rls. Dae Applicant NOTICE TO APPLICANT: If, afar making this Certificate of Exemption, you should became Subject a Nc Worker', CrrRnatiOlt PMV160M of the IaMr Came, you West foMwith mply with such provisioM or this parank hall be dcerMd ranked. . CONSTRUCTION LENDING AGENCY I Maxey afrtren that thees is a construction lending agency for time performance of the work for which this permit is broad (Sea. 3097, Civ. C.) Lender's Name , 1 certify that i ban mad this application and me this the &how information Is correct. I agree he comply with all city and county Ordinances and sea aw matin{ to Wilding construction, and hereby authorize repasmatiwa of this city to enter upon the above-mentioned property for la mation pulpaQL (Wc) agree to sew, indemnify and keep hanmnea the City of Cupertino against liabilities, Judgments, cru and expeMes which may in any my amus against said City In consequence of the {renting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date (,� -z) e RCE REGULA S. © /2 Re -roofs R ' Type Of ROOF stimulate of AppncaneConlrham, Dam HAZARDOUS MATERIALS DISCLOSURE Will the applicant or futwv building occupant oma or handle haardous material defrd by the Cuperdno Municipal Code, Cbapar 9.12, and time Harlinand Safety ce. Sued. 25332(a)7 No All roofs shall be inspected prior to any roofing material being installed. ❑Yes y611 ia If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupnt ua equipment or device which IIt hava loos air contaminantsu dcOncd by this Bay Area Air Quality Management all new materials for inspection. CL? .II Q Ye, yNu I have mW the haardous materials requirements underChspaer 6,93 of the Califor. naHMIth BSafetyCode.ScLU M23505.25333 and 25334.1 understand the Ode building dace not currady haw a anal this it is my tespoodhllity to natify the manual of the myuimnents which muub�tet reamanman cesinMeIf O�m 2r.7 Signature of Applicant Dale -. All roof coverings to be Class "B" or better Owner or authorized agent Dam Community Development 10300 Torre Avenue 11* . Cupertino CA 95014 Telephone (408) 777-3228 CI F Fax (408) 777-3333 I UPEkTINO Building Department JOB ADDRESS: 115 -1 7 Gu9C<- S C Cu c 'wo 4501q I PERMIT # 66 0�d/ f'� OWNER'S NAME: apt 1 Q Q ,c S PHONE # I (0(o '-QR-,� -3,0 31 GENERAL CONTRACTOR: FAX # i gcp(o -1 (o 494(5- g4S I am not using any subcontractors: +'l 7 D I / >7 Signature Date Please check applicable subcontractors and complete the following information LJ Owner/ Contractor Signature Date 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 Tile LJ Owner/ Contractor Signature Date E f CITY OF CUPERTINO WATER HEATER CUP kTINO PERMIT APPLICATION FORM A N# 3 C� S�f o �6 PPERMITFEE Date: / I lI /06 Building Address - Ener UILDING (u of n � 96'O 1� Owne 's Name: /�l�eet Te" Phone #: pt -50 775a Contr ctor: O T ec// a/) d 01140- (yQ� G License #: n II 6,FO 6615 Conta t: %764 Cupertino Business License #: Buildi ig Permit Info: Bldg ❑ Elect Ltl' Plumb Mech Job Description: _ �O / Resid tial Commercial ❑ Cost of Project: d O"r) Strapp d On Platform Bonded New cation ❑ Re lacement Qty. if Aimli able Fee ID / BPWHEATER Vv Water Heater / Vent BVIULTNQ PPERMITFEE Plumbing-Re—nnit Issuance PLUMBIN BENERGY Ener UILDING BUSLIC Business License BUILDING a" L� t3v, 86 3�