04060026 (2) CITY OF CUPERTINO rr { v'^^ ✓ k'- '°`��`*'1 r " '
• BUILDING DIVISION PERMIT ,,CONTRACTQR INFORMATIION
BUILDING ADDRESS: AQUATEK PLUMBING INC ......04'O6OO26
OWNER'S NAME: PERMIT MU DATE
LAM NGUYEN
IF E: SANITARY NO. CONTROL NO.
(408) 295-7767
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 t 0 0
u O p LICENSED CONTRACTOR'S DECLARATION
=� 1 hereby affirm ton I am licensed under pmvisions of Chapel 9(commencing Job Description
a� with tion? lot Division 3efthe Budnea+jhd Prorevsmax Code,andm licevcis p
a inrull o d �(�`(r� St 'T7 WATER HEATER UN�thUZ®
^ z oxl'7 Inas Conlsmmr
A CHRECT REPIPE/WATER MAIN JULp[a
0 sand my PunselWlWusetluP J 6 2004
JyU
$u. Lkcmcd Pmfcssi0nal
OWNER-BUILDER OECLARATIO BUILDING
f I herchy affirm Nm that I am exempt train the Contractors License Law for the 6i
a n C follnwing Tenon.(Section E131.5,Banner;and Professions Code:Any city of county
,2� which mquims a permit to cnnm re,alter.impm m,demoldsh,or repair any atracem
Pay prior to its issuance.also whom:the applicant for such permit to file a signed suemcm
<
that he is licensed punuanuo the previsions of the Coormons License Law(Chapter 9 Sq.Ft. Floor Area Valuat#]83 O0
y�B (commencing with Section 7")of Division 3 of the Busines+and Prolessiam Code)or
duo he is exempt therefrom and th,buds for on,alleged exemption.My violation of
Section 7031.3 by any applicant for a permit subjects the applicmu0 a Civil penalty Of APN Number Occupancy Type
Out mare dun five hundred dollars(M). 3 6610069 . 00
❑1,an w.of the pmpeny,or my employees with wages as their so to corimm on,
will do the work.and the structure Is aotintended«offered for safe(Sce.]Ua4,nosiness Required Inspections
and Projections Cade:The Co nsuctora Liame Law does at apply m e an Owner of q P
prop.ny who Wildsor improve thceon,and whodmssmh work himselfor through his
Own employee:,provided dimench improvements are not amended oroRaed forssle.if.
however.Ne building or improvement is mid within one year of completion,Ne"ner-
builder win axe toe burden of proving that he did not build or improve Ira puryore of
sal..).
❑1,as owrcf of Irk P oNn,am exclusively contracting with licensed ran o dors to
consumes the project(Sec.7004.Business and professions Cade:)The Comfmmta Li
ceme law dors not apply be an owner of property who Wilds or imprown dancer,and,
who contracts for such projects with acomnaor(q licensed purawnt td the Contractors
License law.
❑lamexemptunder See. ,Bh PCfcrduswon
Owner Dain
WORKERS COMPENSATION DECLARATION
1 Wrtby affirm under penalty of perjury oro of Ne following decimations:
.ave and will maintain a CcNficae of Consent m self-insure for Wo lonesCompen-
mdon,u provided for by Section 3700 of the aWr Code.far the pafarmarce of the
work for which this Permit is issued.
❑I have and will maintain Worker's Compeuation Insurance u required by Section
3700of the aWr Code.tar the pcdormanec of the work for which this permit is owned.
My Work e s Compcmation l senna cart:.and policy number _
Cant
'ter Pat No.: \q, \Ca1_q�
IFICATEOFF' 0 OM WOR ERS'
COMPE SA RANCE
O bissection recd nm W cora lend if the permit is foram:hundred dollars($100)
or lust
1 certify that in the perfmmarcc of the work for which this Permit u issued.l shall nm
employ any person in any manner an as to Wcome subject o the Workou'Compensation
Laws of California.one
Applicant
NOTICE TO APPLICANT:If,after making the Cenincom of Exemption,you should
Wcome subject to to Worker's Compcnaadon pmvisions Of the Lean'Codc,you must
�O forthwith comply with such powboom or this permit shall W deemed revoked.
z CONSTRUCTION LENDING AGENCY
E1Wreby aRrm that Nen iso mmeuctinn lending ageay far led P.rfonnamx of
D:> the walk for which this permit is issued(See.3091,Civ.C.)
a0 Lenders Name
7 z Landers AdNeas
()z I anify that 1 hast read this application and sue that ted move information is
LL (•-' conal.l agree to comply with all city and county ordinances and nue laws relating to
0U building construction. thm
ction.and hereby mohmprcsenuoionS of this City to enter upon Ne
VU aWvo-mcnf. property for impecdon purpose.
(W e in neve,indemnify and keep hornless the City of Cupertino against
Fh Ilabilitica,u .coauaM eapcm.which may in any way acrncagaimt and City
V z in conseq c f the granting of this it.
r-" AP ICA NDERSTANDS AN ILL COMPLY W TH ALL NON-POINT Issued by:94 Date
SOUR TIONS. �LC)1 '
�'1' Re-roofs
Sig o VC 16, Dae
A2ARDOUS MATERIA DISCLOSURE Type of Roof
the bean Deco mstortmaedlc harardem material
u defined b Cupertino Municipal Code,Caper 9.12,and fa Health and Safety
Cade.Section 25532(.)7 All r S shall be inspected prior to any roofing material being installed.
❑Yes ON.
ZrisIled without firs[obtaining an inspection,I agree[o remove
Will the applicant or future Wilding occupnt use equipment or devices whichhe arm mants u defined by Ne Bay Area Air Quality Managementals f0 Ins tion.
in icr❑ c ❑No
Iha ardmasmae els quimments nderChpmrli.95ofNCCalifor-nulkalth C .Scctime 25 5.�S533mdUS ,lundermndimanow Wilding
does cwt u a¢nam.Nat my tc m nail,de=a,.,of doens h them r ce0 aC maeof e.prmy. pp Date
owner eiaath sent D,0 All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�=- WATER HEATER
OCUPEkTINO PERMIT APPLICATION FORM
APN # _3� C
Building Address:
15 q 8 �UmeSTo�.�r, flr
Owner's Name: Phone#:
urs n 40i5. S S1.- U O�
Contractor: GPhone: aGq License#: -7 c 36
Contact: Imo' Phone• Cupertino Business License #:
hlerriC�. S\VY�p`t� - 4OX.
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech ❑
Job Description: 1 1 1 1
(<'<
Residenti Comme ial ❑
Cos of Pro ct: �0�30CD
Strapped ❑ On Platform Bonded ❑
New Locatr ❑ Re la ent ❑
ab a Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLI Business License BUILDING
Community Development
10300 Torre Avenue
• i [ i Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
OPPEkTINO
Building De artment
JOB ADDR&CtS, 'S clg PERMIT #6 d
OWNER'SN GY, N v er, • PH # 5%1- 46(o- 131.
GENERAL CO CTOR: 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
Adilk Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing Ina
Septic Tank
Sheet Metal
She ock
Ask
Date