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12030098CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRPISS: 8085 11YANNISPORTDR OWNER'S NAME: OLIVER KAO OWNER'S PHONE: 4082556286 ❑ LICENSED CON I'R,\CI'OR'S DI?CLARA'I'ION License Class Lie. N Contractor Date I hereby affirm that I am licensed under the proyisinns of Chapter 9 (commencing with Section 7000) of Division 3 of Ilio Itusincss S Professions Code and that my license is in full force and effect. hereby affirm trader• penally of perjury one of the following Isco declarations: I have and will maintain a certificate of consent to sell=insure lir Worker's Compensation, is provided I'or by Section 3700 of the Labor Code, for the performance of the work fur which this permit is issued. I have and will maintain Worker's Compensation Insurance, its provided for by Section 3700 of the. Labor Code, for the perfomumce of do work for which this permit is issued. APPLICANT CER'HFICATIO,N I certify that I have read this application mid state that the above information is correct. I agree to comply with all city and C011my ordinances and suite laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities. judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Mnmicipal Code, Section 9.18. Date ❑ OWNER-RUILDER DECLARATION hereby offarnn that I run exempt from the Contractor's License Lass for one of the fallowing two reasons: I, as owner of the properly, or my employees o ith wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sce.7044, Business R professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See.7044, Business K Professions Code), hereby affirm wider penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent m sell' insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, I'or the performance of die work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of Elie Labor Code, for the performance of due work for which this permit is issued. I cenily that in the performance of the work for which this pemnit is issued, 1 shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of Califmmia. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with suchprovisions or this permit shall be decried revoked. APPLICANI'CERTI FICATION I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and comity ordinances mrd state laws relating to building construction, mad hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date CONfRACfOR: PAST WATER HEATER PERMITNO: 12030098 12601132 AVE, NII DATE ISSIJFD: 03/192012 KIRKLAND, WA 98034 PRONE NO: (800) 4V-8955 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB ( 1 MECH RESIDENTIAL - COMMERCIAL - JOB DESCRIPTION: REMOVE/REPLACE GAS WATER BEATER Sy. Ft Fluor Aren:0 1 Valuation: $785 APN Number: 35011011.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RI ROOFS: All tools shall he inspected prior to any roofing material being installed. If a roof is installed withoo first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Appli©ne Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BE'I-ITR HAZARDOUS MATERIALS DISCLOSURE have read the hazardous materials requirements under Chaplet 6.95 of the California I leahk S Safely Code, Sections 25505, 25533, and 25534. I will maintain cum phis rice with the Cupertino Municipal Code, Chu Iter 9.12 and the Ilealth S Safely Code. Section 25532(a) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the Ilculth J Safety Code. Sections 25505, 25533, and 25534. Owner or authorized agent: Date: CONSTRI1C1ION LENDING AGENCY I hereby aff ani that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097. Civ C.) Lender's Name Lender's ARCIII'ITC l"S DECLARATION I understand my plans shall be used as public records. Licensed CITY OF CUPERTINO BUILDING PERMIT BUILDIN'C ADDRESS: 8085 If YANNISPORT DR I CON'ITACTOW FASTWATHR IiliA'I'IiR PEA MIT NO: 12030098 ON'N'Elt'S NAME: OLIVER KAO 12601 132 AVL; IVE DATE ISSUED: 03/19/7012 OW'NER'S PHONE: 4082556286 KIRKLAN'D.WA 98034 pt ONE NO:(Sam) 454-8955 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lia tJ Mr•,cnr RESIDENTIAL F- MNImnERCIAI, Contractor Date I hereby :dlirm that 1 :un licensed under tire provisions ulChapter 9 (commencing with Section 7000) of Division 3 of Ile Moiness & Professions Corte and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have air(] will maintain it certificate of consent to self -insure for Worker's Compensation, :is provided for by Section 3700 of the Labor Code, Ibr the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for die performance or the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and slate laws relating to building construction, and hereby authorize representatives at* this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indenni Iy and keep harmless the City of Cupertino against l iabilitics, judgments,. costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally. the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18, Date ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt front the Contractor's License Lav foroneof the follaving two reasons: L as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for stile (Sce.7044, Business R Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to constrict the project (Sec.7043, Business R Professions Code). I hereby affirm under penalty of perjury one of the following thi cc declarations-. I have and will maintain a Certificate of Consent to self -insure fol -Worker's Compensation, as provided for by Section 3700 of the Labor Code. for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation Imus of California. If, after making this certificate of ezennption, I become subject to the Worker's Compensation provisions of the Labor Code, I trust forthwith comply with such provisions or this pernin shall be deemed revoked. APPLICAN r ClItTIFIC TION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and stale Imes relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned properly for inspection purposes. (We) agree to save indemnifyand keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of This pennil. Additionally, the applicant understands and will comply with all non -point source regulations per lire Cupertino Municipal Code, Section 9.18. Date JOB DESCRIPTION: RLMOVI%RI?PI.AC6 GAS WA'T'ER IMATER Sq. Ft Floor Arca: 0 1 Valuation: $785 APS Number: 35611011.00 1 Occupa ncy'1'ype: PERMIT EXPIRES IF WORK IS NOT S-rARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued Its: Date: RL: ROOFS: All roofs shall be inspected prior to any roaring material being installed. Ira roof is installed without first obtaining an inspection, I.agree to remove all new materials for inspection. Signature of Appl ALL ROOF COVERINGS '10 BE CLASS "A" OR BE ITER HAZARDOUS MAT1IRIA1S DISCLOSURE 1 have read [be hazy dous materials requirements under Chaplcr 6.95 of the California Health S Safc•N• Code, Sections 25505, 25533, and 25$34. 1 will maintain compliance with the Cupertino Municipal Code, Chaplcr 9.12 :rid the I lcahh Safely Code, Section 25532(x) should I more or handle hazardous material. Additionally, should I use equipment or devices which call[ hazardous air cunlantinanis as defined by the Bay Arca Air Quality Managemmnt District I will maintain compliance with the Cupertino ,Municipal Code, Chapter 9.12 and the Health & Safely Code. Sec(inns 25505, 25533, and 25534. Owner or authorized agent: Date: CONSPRUM10N LENDING AGENCY I hereby alf cin that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ Q Lender's Name Lender's ARCI1ITEICI" S DECLARATION I understand my plans shall be used as public records. Licensed