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B-2016-2385CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10183 DENISON AVE CUPERTINO, CA 95014-2426 28 023) CONTRACTOR: PERMIT NO: B-2016-2385 (316 PLUMBING TECH INC SAN JOSE, CA 95173 OWNER'S NAME: WALTER WILSER DATE ISSUED: 07/26/2016 OWNER'S PHONE: 408-996-1450 PHONE NO: (408) 347-0000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C36 Lic. #933572 Contractor PLUMBING TECH INCDate 07/31/2017 X BLDG —ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH X RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: RE -PIPE SFD (COPPER) - FULL; REPLACE MAIN WATER LINE 1. I have and will maintain a certificate of consent to self -insure for Worker's FROM METER TO FOUNDATION Compensation, as provided for by Section 3700 of the Labor Code, for the REVISION #1 - REPLACE 40 GALLON WATER HEATER IN GARAGE performance of the work for which this permit is issued. - ISSUED 7/27/2016 C. 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. Sq. Ft Floor Area:, Valuation: $7300.00' APPLICANT CERTIFICATION certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 316 28 023 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said. City in consequence the granting this permit. Additionally, the applicant erstands and willl comply with all non -point all WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per upertino Municipal Code, Section 9.18. 180- DAYS FROM LAST CALLED INSPECTION. Signature Date 07/27/2016 Issued by:'• 1�-s�_4 Date: 07/267 616 OWNER -BUILDER DE LARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: I All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered.for inspection. sale (Sec.7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Scc.7044, Business & Professions Code). Date: 07/27/2016 I hereby affirm under penalty of perjury one of the following three declarations; 1. 1 have and will'maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code,?Sections3 5, 25533,, 4. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 07/27/2016 I certify that l have read this application and state that the above information is CONSTRUCTION LENDING AEN Y correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 07/27/2016 Licensed Professional • GENERAL PERMIT APPLICATION R�lwp% M E P COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION .11a MISC 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - _building(a)cupertino.org MEPMIiscApp_2011.doc revised 03116111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2385 10183 DENISON AVE CUPERTINO, CA 95014-2426 (316 28 023) PLUMBING TECH INC SAN JOSE, CA 95173 OWNER'S NAME: WALTER WILSER DATE ISSUED: 07/26/2016 OWNER'S PHONE: 408-996-1450 PHONE NO: (408) 347-0000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class SANITATION SYSTEM Lic. #933572 Contractor PLUMBING TECH INC Date 07/31/2017 X BLDG — ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH X RESII)ENTIAL COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: RE-PIPE SFD (COPPER) - FULL; REPLACE MAIN WATER LINE I hereby affirm under penalty of perjury one of the following two declarations: FROM METER TO FOUNDATION 1. I have and will maintain a certificate of consent to self-insure for 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. j 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 vv permit is issued. Sq. Ft Floor Area: Valuation: $7300.00 APPLICANT NT RTIFi ATION 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 APN Number: Occupancy Type: and state laws relating; to building construction, and hereby authorize 316 28 023 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City ' consequence of the granting of this permit. Additionally, the applicant derstands and will comply ith all non-point WITHIN, 180 DAYS OF PERMIT ISSUANCE OR source regulations per Cupertino Municipal C action 9.18. 180 DAYS FROM LA + CTION. i / Signatu Date 07/26/2016 Issued by; NMI SSANAMES Date: 07/26/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS- following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 07/26/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. I have and will maintain a Certificate of Consent to self-insure for 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. , HAZARDOUS MATERIALS DISCLOSURE 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3, I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino M ipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Section 605,25533,and Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 07/26/2016 u I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the ,performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-poi source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed SignatLWI _T_ _ ---ate 07/26/2016 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a�cupertino.orgCUPER MISC ,, INO �PLUMBINGEl l 2, 0),E - 2 3 8- MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS / UWSZ APN # (o� C) -z �� -/� OWNER NAME q y . �/� PHONEAq WK JJ/ f f STREET ADDRESS CITY, ATE, ZIP FAX CON,TAC NAME 4.1 NOW PHO ® E-MAIL STREET ADDRESS ZX A CITY, STATE, FAX ❑ OWNER ❑. OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ 11 DEVELOPER El TENANT ONTRACTOR NAME LICENSE NUMBER �7ENGG�INIEER LICENSE TYPE/�� ` V/ BUS. LIC # 3rIQ, 5 COMPANY NAME t E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP ya4.Zea vj/-z PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SED or Duplex ❑ Multi -Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK / �s7ZI7 TOTAL VALUATION: RECEIVEDBi " ,.. By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information i have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building con ion. I authorize representatives of Cupertino to enter the above-identiVicd pr werty for inspection purposes. Signature of Applican ent: PLEMENT INFORMATIONREOUI i` nFFr�-raFtaNY'v MEPMiscApp_201 1. doc revised 03/16111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2385 10183 DENISON AVE CUPERTINO, CA 95014-2426 (316 28 023) PLUMBING TECH INC SAN JOSE, CA 95173 OWNER'S NAME: WALTER WILSER DATE ISSUED: 07/26/2016 OWNER'S PHONE: 408-996-1450 PHONE NO: (408) 347-0000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C36 Lic. #933572 Contractor PLUMBING TECH INCDate 07/31/2017 X BLDG _ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ MECH X RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: RE-PIPE SFD (COPPER) - FULL; REPLACE MAIN WATER LINE I hereby affirm under penalty of perjury one of the following two declarations: FROM METER TO FOUNDATION s. I have and will maintain a certificate of consent to self-insure for Worker's REVISION #1 - REPLACE 40 GALLON WATER HEATER IN GARAGE Compensation, as provided for by Section 3700 of the Labor Code, for the - ISSUED 7/27/2016 / performance of the work for which this permit is issued. C�. 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. Sq. Ft Floor Area: Valuation: $7300.00 APPLICANT NT ERTIFI ATION 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 316 28 023 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant erstands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source reg21at.ions per upertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 07/27/2016 Issued by: -— Date: 07/26 016– OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: I All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 07/27/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. I have and will maintain a Certificate of Consent to self-insure for 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous, materials requirements under Chapter 6.95of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections Si15, 2553�4. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 07/27/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct, I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name - to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 07/27/2016 Professional s GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION MISC 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a.cupertino.org PROJECT ADDRESS Wpi-sen Ail e, APN 11 OWNER NAME ( J ¢' PHONE rr� E-MAIL STREET ADDRESSCITY, STATE, ZIP Almo /Spa FAX CONTACT NAME40Oh P PHONE , ®y f � (�joe- E-MAIL STREET ADDRESS ? CITY, STATE, ZIP qqz FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT UE3 ARCHITECT ❑ ENGEVEER. ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME¢ < LICENSE NUMBER LICENSE TYP) BUS. LIC # COMPANY NAME p �f E-MAIL FAX STREET ADDRES� IVJ CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX i STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACEAREA❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provid d is correct. I have read the Des ption of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bui g construction. I autho ' esentatives of Cupertino to enter the above -identified erty for�spec on purposes. Signature of Applicant/Age Date: SUPPLEMENTAL a MEPMiscApp_2011.doc revised 03116111