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08110093 CITY OF CUPERTINO s ' az � �" 3raaa BUILDING DIVISION PERMIT aCOEdT,R WAPR INI�'C}R.MATION ,A . BUILDING ADDRESS: PERMR NO. 10424 VISTA DR SOUTH BAY ' OWNER'S NAME: PERNITT ISSUE DATE NE: CONTROL NO. (408) 370-3535 . ARCHr1EC/ENGINEER: - BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 C Q 2000 LICENSED CONTRACTORS DECLARATION IOb Description rd nl 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing P U with Section 7M)of Division 3o(Ne Businesses add Professions Code,and my license is u ta in full fineaaweffect. REPLACE WATER HEATER jlaz Uumc Class tic.0 nE,p Dao: Contractor 700 ARCHECTSDECLARATION .0 1 understand my plots shallRW used as mnrt public e.0 c In Licensed Professional 5 OWNER-BUILDER DECLARATION 1 hereby aIrm Net tam exempt from IW Connotes License Law far Ne COO following mason.(Second 7W I.S.Business;and Pmfexakns Cade:Any City lir County $ which mquims a permit to crnafttca after,improve.demolish,nr-Fair my rtmelure _Z< pdwwiuissuncc.akormuims NeapplinntfwsmhNmitmfrleasignW=s ment Natal is licensed pursuant t the pmvisinu of the Comactu'a License Law(Chap=9 Sq.Ft. Floor Area Valuation x�� (commencing with Section 7000)of Division 3 aftW Businessand professions Code)or 400 e`2 that M is concept tbeafsom and the basis for the alleged eacmpdon.My violation of Section 7031.5 by any applicant for a permit subjects to applicants or a civil Peuhy of APN Number Occupancy Type net more than,five hundred dollars($SW). Laadwmrofft yampoy ri 31633130 . 00 ❑ pmpmy,arm I en with wa as tie'v sok mm nastion, wul do to wons Coda,he Core Lsster's endurawd (orss apply 70 N,Badness Required Inspections proparand Professions Cade:The Conoulor's ud.License law don Dote apply 1f rt owrcr is q P mamemwho Wildamlmpmvexthimrovenoha doessackworkh offmdor adeh. own es.the,uilding or thatsuchimpmwmmts erenos eun fcmaRemd for sale B, bowevv.the,buildingorowmms'Ymt de didnot Searofmpruedon.Neowrcr- Wi1dn will law the Rsrdcn of Proving this K did not Wild or improve for purpose of ❑1.as owner of Ne property,am exclusively contracting wit Ilansed mnuamon Is mnstmct Ne project(Sec.7044.Buiuss and Pro(esdou Cade:)The Comracrer's Li- mise law don out apply in m owiiv of property,who Wilds of bound ts Lemon,red. sold,contracts for such p,*m with a comrsnrr(s)licensed pursuant to the consomme- Lice.law. ❑lam aemptunder /SSeen. .B d P C for this rtason Ow., fA/`-sem Date I/- Z(- ` . WORKER'S COMPENSATION DECLARATION 1 hereby affirm ander penalty of perjury aro of one following declarations: I ba.and will mane in a Certificate or Co..to self-imme Los woduce.eompr, Don.u provided for by Sccdon 3700 of the labor Code.for the performance of the work for which this permit is issued. ❑1 haw and will madden Worker's Compensation IuWmce,ss required by Secure, 37W of the,Labor Code.(or the,pcdmmma of the work forwbicit this permit u issued. My Wohe(s Compewoon 4uurana carrier and Policy number me: Carder. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (rhisseetion need not W compked Itme permit Is forone hundmddoRva(SIM) or lox) 1 codify that in tW Performance,of ths work for which Nis postai,is issued.I shall not employ any pefmnin+�y mmrcrmssmbaomn mbjm mtheW Compeervlu - Lawso(Califoma.D-arc Applicant � it � . NOTICE PPIICANT:If.allies making this Cenificau of Eacmpdon,you should become subject in the Worker's Compensation provisions of the Inter Cade.you must �Z forthwith comply with such Provisions or this permit shall W deemed revoked. Z OCONSTRUCTION LENDING AGENCY f~� IWreby affirm most dem isaconstrucdm lending agency for to performance of F4 w�+ the work far which this permit u issued(Sac.3097.Civ,C.) Q Lender's Name Z Lender's Address U O 1 certify that I ban road this application W sou thv tW aWve information is LAE coma agree,m comply with all city and county ordinances and sum laws misting to .0 U^ building construction,and hereby auNodn:repmsenuives of this city to color upon the, >'u7 above-mcntiarcd pmpeny for impectiou purposes „E'0. (We)agree to saw.indcmrify and kap harmless the City of Cupertino against y i,i liabilities. costa and expeuaa which may In my way amue against card City U 2 in conseprcnC.of the 6.ang of this permit. _ ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE gT LATIONS. Signvum of ApplfemUContrucor Date� / Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the,applicants or future Wilding om+pant smrt orhsndle hamdau mvmul as,defined by the Cupertino Municipal Cade.Chapter 9.11 and the Hnith end Safety Coate,Section zssn(gl /a All roofs shall be inspected prior to any roofing material being installed. ❑Yu No Will the applicant or future Wilding occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove it hvadnu dr amumieurts as defined by thr Bay Area Air Quality Mmagomem all new materials for inspection. utricll ❑Yrs I haw mad the hmNau maurids requirenemsudlar Chapurb.95ofte Califor- maFission @ SafetyCode,Sections 25.505,15533 and 15534.1 drummed thalifmhe Wilding . dust not currently haw a moms Um it is my naspauibility to mofy de rccuPant of the rcquirm hkhdonstW=I poor unmmorecofaCerofrauof Signature of Applicant Date Owner m authm oed agent DamAll roof coverings to be Class'%W'or better CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 31633130 . 00 DATE ISSUED. . . . . . . : 11/25/2008 RECEIPT # . . . . . . . . . : BS000006691 REFERENCE ID # . . . : 08110093 SITE ADDRESS . . . . . : 10424 VISTA DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WM. LIU ADDRESS . . . . . . . . . . : 10424 VISTA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : WM. W. LIU CONTRACTOR . . . . . . . : RICK PERKINS LIC # 22605 COMPANY . . . . . . . . . . : SOUTH BAY PLUMBING ADDRESS . . . . . . . . . . : 441 N CENTRAL AVE STE 3A CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 370-3535 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL 1BSEISMICR VALUATION 400 . 00 0 . 50 0 . 00 0 . 50 0 . 00 IPPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1PRWHEATR UNITS 1 . 00 24 . 48 0 . 00 24 . 48 0 . 00 ITRAVDOC FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00 TOTAL PERMIT 106 . 56 0 . 00 106 . 56 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ----------- --- CREDIT CARD 106 . 56 VISA --------------- TOTAL RECEIPT 106 . 56 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ---- ---------------------------- -------- ---- -------------- 518 WATER HEATER CITY OF CUPERTINO �GGd' WATER HEATER CITY•CUPEI�TINO PERMIT APPLICATION FORM APN # ` O 63 Date: Building Address: 0 4 2 y Owner's Name: Phone #: Contractor: Phone #: 3 7a- 35 3 5 Fax #: 370 - 2-, 6 4 Cupertino Business License #: Contractor State License #: zz6b5 858497 / Contact: Phone #: Fax #: Building Permit Info: Bldg ❑ Elect ' Plumb ❑ Mech Residential [A Commercial ❑ Job Description: 2e p1GL,, v,r-�v -4--Zt, Strapped f;�J On Platform © Bonded ❑ New Location ❑ Replacement Valuation (cost of project): -t-4-a Project Size: Express ❑ Standard © Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points achieved: -7 � ? - 3`-Zi- :1, Revised 6/16/08 _ u;ja