The URL can be used to link to this page

07080154cez oa W� z .z v�Z a )WU :CIA � �p0 CITY OF CUPEK-UINU BUILDING DIVISION PERMIT ow D KESS: ns SWEET OAK ST OWNER'S NAME: KLING JOANN V TRUSTEE qE: ARCHITECr/ENGINEER: I hereby affirm that I am licensed under provisions of( with Section 7000) of Division 3 of the Business and Professions in full force and cff License 1 s Lic. # Date — — Contractor Q ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to concoct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 1, 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 sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale- If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contraaors Li- cense Law docs not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. ❑ 1 am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations " 11- PERMIT NO. FAST WATER HEATER 07080154 PERMIT ISSUE DATE 12601 :_32 AVE NE 08/16/20 SANITARY NO. Co j I have and will maintain a Certificate of Consent to self -insure for WorkeesCompen- ation, as provided for by Section 3700 of the Labor Code, for the performance of the vork for which this permit is issued. -1 I have and will maintain Worker's Compensation Insurance, as required by Section 5700 of the Labor Code, for the performance of the work for which this permit is issued. Ay Workers om ensa'on Insuranc artier d Polity number are: Zanier.I olicy No.. ro CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred doUars(5100) or less.) 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 Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address 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 state 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 in any way accrue against said City in consequence.of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE ;1E sSig u pplicam./Conttactor Date L HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle haiardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yes t�No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑Yes JN. 1 have read the hazardous materials requirements under Chapter 6.95 of thc Califor- nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building does not ��yyrently have a tenant, that it is my responsibility to notify the occupant of do requirr�tigk¢�iyhich must be met prior to issuance of a Certificate of Occupancy. or authormed Date REMOVE/REPLACE GAS WATER Issued b, Re -roofs Ft. Floor N Job Description CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Required Inspections Valuation occupancy Type of:Zoof All roof:: shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. 4�u3 of Applicant Date All roof coverings to be Class "B" or better Pei CITY OF O-UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Buildin De are- tment JOB ADDRESS: PERMIT) A �, OWNER'S NAME: PHONE#,y GENERAL CONTRACT _ a FAX # I am not using any subcontractors: ('s� Sig nature Date .. ,] .,..le+e 4-1kn Ff%llnzerina infnTmAfinfl_ . lease cnecx-- 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 Owner/ Contractor Signature Date 3 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32651017.00 DATE ISSUED.......: 08/L6/2007 RECEIPT #......... BSO)0002401 REFERENCE ID # ...: 07030154 SITE ADDRESS 10923 SWEET OAK ST SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER KLING JOANN V TRUSTEE ADDRESS .......... CITY/STATE/ZIP ...: CUPERTINO CA, 95014-0123 RECEIVED FROM FWH ACQUSTN CO. CONTRACTOR JEFF JORDAN LIC # 29100 COMPANY FAST WATER HEATER ADDRESS 12601 132 AVE NE CITY/STATE/ZIP KIFKLAND, WA 98034 TELEPHONE (8CO) 454-8955 FEE ID UNIT QUANTITY FMOUNT PD -TO -DT THIS REC NEW BAL -- BENERGY PERMIT FEE ---------- 1.00 ---------- 34.86 ------ 0.00 34.86 0.00 BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 ---------- 38.37 ---------- 0.00 ---------- TOTAL PERMIT ---------- 84.02 0.00 84.02 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 168.04 --------------- 168.04 VOICE ID DESCRIPTION -------- ---------------------------- 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING REFERENCE NUMBER -------------------- #3180 VOICE ID DESCRIPTION -------- ---------------------------- 506 GAS TEST From: 08/13/2007 14:33 CITY OF CUPERTINO WATER HEATER CUPEK O PERMIT APPLIC kTION FORM #314 P. 002/005 375687 070?0/5Y APN # Date: Building Address: Pluml iing Permit Issuance PLUMBING 10923 SWEET OAK ST BUILDING Owner's Name: Phone #: KLING, JOANN (408)736-4604 Contractor: License #: FAST WATER HEATER COMPANY 877489 Contact:ertino Business License M upCarol T-29100 Randall 800-454-8955 Building Permit info: Bldg Q Elect Cg— Plumb ® Mech Job Description: Remove/Replace Gas Water Heater Residential [I Commercial Q Cost of Project 9.00 Strapped On Platform 0 Bonded New Location Q Replacement IN Qty. if V. TUgw v4nt;r%n Fre Cvroun 1 BPWHEATER ✓ Water Healer / Vent BUILDING PPERMT17EE ✓ Pluml iing Permit Issuance PLUMBING BENERGY ✓ BUILDING BUSLIC Business License BUILDING