The URL can be used to link to this page

04050113 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT co •,, . BUILDING ADDRESS: HOT WATER INC PERMITNcb4050113 10456 STQKFR AV OWNER'S NAME: PERMIT ISSUE DATE EUGENE LEE 2531 GRACELAND AVE, QS/19/2004 ryE; SANITARY NO. CONTROL NO. (650) 298-8494 ARCHITECT]ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u00 LICENSED CONTRACTOR'S DECLARATION OF 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description 7")of Division 3 of NC rip rofessin s Co de.end mylicenseia � with Section mmuto=and_ Leeerre REPLACE WATER HEATER O Damn Contractor (may` s W A Hf1ECT5 DECLARATIO �� / Y < 1 understand my plans shell W used as public Needle ItWyUIt / u. Licensed Professional G OWNER-BUILDER DECLARATION Contractor's ON aI I hereby.farm that 1 1. exempt from the ftsums Co License Law for the n Kp O following uisten. erten I ]03 L&Business and ova,de rote Code:Any city or county $Yi which requires a e,a h.ac cores the alwm Improve,demolish,or repair any ammo¢ `a�xln poor In its ienenm,alsu a t1.the pre inion of fors.cthe Contractor's Tensele Law(Cha mem 259 that W(commencing ccgwithSrsuant7")ofDivisionfof cBuiness ndPrselaw(CWPtcr9 Sq.Ft. Floor Area Valuation 1- (cam eis exempt Section Rand)or Diaiiiofr the alleged Codc)or y that he is exempt pmmfrom and dw beers for the alleged exemption.Any it Penalty of Section die five any applicant fora permit subjects the applicant m a civil pemhy of (gr0 0 Occupancy Type not mom Nm Ove hundretl dollars(5500). ❑1;as owner of)he property,or my employees with wages as their sole compensation, will do the work and Rte sumta m,is not intended or offered far sale(Sec.7046,Business and Professions Code:The Contracture Licems Law does not apply to an owner of Required Inspections property who bui Ida or improves Nanton,and who does suc h work himself or through his own employees,provided rhmauch Improvements.notlnwnded.eoffered percale.if, however.the building or improvement is mid within one year of completion,the owner. builder will haus the burden of proving Net be did not Wild or imprave for purpose of sale.). ❑1.as owner of the property,am exclusively compressing with licensed mnuacmm to consumer the project(Sec.7044,Business and professions Code:)The Contrecmrh LF cense law does not apply to an owner of property who Wilds or improves thereon.and. who contracts for each projecss with a conuacter(D licensed pursuant in the Contractor's License law. ❑I and exempt undo Sec. ,B&P C for this renown nes Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 have end will maintain a CeniOcam ofComent in se f-inmm for Wodmr'sCompen- motor,as provided for by Section 37M of the Later Cods,fm tW Performance or the work for which this Permit is issued. ' he.and will muntain Worker's Compensation Insurance,as required by Section 00 of the labor Code,for the performance of the work for which this permit is Issued My Wmkees ore enation Insurance car ire and Policy numk,.- - eram:CPolicy No.: S(I/L E FICATE OFE AMON FROM ORKERS' COMPENSATION INSURANCE iMbissecoion need not W completed if lW permitisforonc hundred de lays($100) or ices.) 1 certify that in the performance of the work for which this permit is issued.I shall not employ any person in any mmacrm as to become subject to the Workers''Compensadan Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation previsions of the Labor Code,you must ',7.. forthwith comply with such provisions m this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY I hereby aMon Nat Nem is a contraction lending agency for thoperformance of Ne work for which this permit is issued(See.3097.Civ.C.) Q lender's None z Lender's Address U 0 I comfy that I have read this application and saw that tlw aWvc information Is "Pcorrect.1 agree to comply with all city and county ordinances and state laws misting In CV Wilding construction,and hereby amorire represenatives of this city to enter open the LSI abevomentioned property for inspection purposes. C (We)agree to save,indemnify and neap homeless the City of Cupertino against N liabilities,judgments.costs and expanses which may in my way Beane against mid City U`L in consequence of the Heade,of this Permit. r+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:3 Date ' SOURCE RE I S iZCt,eO way Re-roofs SignaturroofApplicartio'ComflZior I DW HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will dm applicant or run=building occupant store or handl.hamdma material saj as dcM.d by 1,c CupeNno Municipal Code.Chapter 9.12,and the Health and Safety ode,Section 25532(q? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or I'm e building occupant taw equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hal'y',"c air conbminants as d tined by the Bay Area Air Quality Management all new materials for inspection. DisuictT k..,., ❑Yes two I have mad the huxsamusmawnalsrequirements tracer Cha swr 6.95 of the Califon ria Health&Safety Code,5.6.25505,75533 and 8534.1 undcrsmnd NetifNa building does not currently have a mount,that it is my responsibility to notify the occupmt of the mquimmmttwhmn al cep wissaane. facemticamnr �Stae m / Signature of Applicant Date foN Ownm ter atrmor<d agent �D6 c1�" All roof coverings to be Class "B" or better Community Development "�. 10300 ToiTe Avenue Cupertino CA 95014 Telephone(408)777-3228 ICITY Of Fax(408)777-3333 CUPEkTINO Building De artment JOB ADDRESS: PERMIT # Jol�z S-ro M AL)f, 0000113 OWNER'S NAME: Vj0(yj4Wj L&6 PHONE # GENERAL CONTRACTOR: c Nc. FAX # - G 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile s- Owner/Contract-or Signature Daie 10/28/03 CITY OF CUPERTINO / WATER HEATER CUPEkINO PERMIT APPLICATION FORM APN# 3A( — q j _ O-,�-3 Date b Building Address: b 5 u-e— Owner's Name: Phone#: Lc. vu f o - 7 7 3 -6Za g Co ractor Phone: —aY67 License ��/� Contact: Phone: Cupertino Business License#: Building Permit Info: / Bldg ❑ Elect ❑ Plumb 2'- Mech ❑ Job Description: � cL+e-v- Residential Commercial ❑ Cost of Project: Strapped On Platform ❑ Bonded El • New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEA'I'ER Water Heater/Vent BUILDING PPERMTTFEE Plumbing Permit Issuance PLUMBING / BENERGY Energy BUILDING BUSLIC Business License BUILDING vS�S� -Z