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05020112 CITY OF CUPERTINO � BUILDING DIVISION PERMIT t,ICONTRACTOR �INFOIRMATION : BU ILDINC ADDRESS: MACKEY CONSTRUCTION PERMIT NIb5020112 023 BAXLEY CT OWNER'S NAME: PERMIT ISSUE DATE SABA SATHYA 2593 HEBR 05 ONE: SANITARY NO. CONTROL NO. (408) 274-6799 ARCHITECTIENGINEER: BUILDING PERMIT INFO ELECT' PLUMB MECH 0 0 0 +oo LICENSED CONTRACH3R'S DECLARATION - C lob Description 1 hereby affirm that 1 am Bcome d under provisions of Chapter 9 Comm fitting or id,msection 7000)Of Division ofthe Buslnesx and Professions Code,and my license is imm�mreeand etrea. REPLACE WATER HEATER ccmin full Come s � Lic.N Sr4 o`/� =r p Dam 7/( Q Cirrome r AikutFl Plly kF— ca,`,E- —T ARCHITECTS DECLARATION C H< t understand my plans shall W used as public records JyU e s' Licensed Pmreisim it `Og OWNER-BUILDER DECLARATION <$ 1 hereby affirm that 1 ser exempt from the Contractor's License Law for the o o following pension.(Section 7031.5.Business and Professions Cork:Any city or county 5 m which requires a permit to construct,alter,improve,demolish,or repair any structure S500 prior to its issuance,also mquims the applicant for such permit to file a signed statement �Z< that he is liecowd pursuant to the provisions of the Contractors License Law(Chapser 9 Sq. Ft. Floor Area Valuation til—$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or x — mat M is exempt mciefrom and the bash for me alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of 3 5'aVE,0g fO 0 Occupancy Type not mon man fire hundred dollars(M). P Y YP 1,as own.of the property,or my employees with we,.as mcir sol.compensation, will do the work,and the twctun is not intended or offered for sale(Sec.70x4,Business I>" and Professions Code:The Contractors License raw does not apply to an owner of Required Inspections property who builds or improves thereon,and who doessuch work himselfor through his AF Jf(j3/f"� Own employees,provided Chat improvements are not intended mothered torture.If. however,me building or improvement is sold within one year or completion.the owner. builder will lave the burden of pmving that he did not build or improve for purpose of 14b sale,). ❑1, r owner of project property,.B exclusively contreniner with licensed conuecmrs i. /a., cenconse La the esonot appl(Secy to o0n Business and Profession Co on) pro Contractor's red ^////aV/I71,rg 9n cens.Lawdtsforsch p r loan with aontropeny who sedprsds or improves th.mon,antl "p�f/a/�� who coronets for projects wim a contractor(s)leaned pursuant to d¢Contractors ,yxs� ucens.Law. pq�{JII ❑1 vet exempt under Sec. .B h P C for this reason � Owner Date (J (V1' WORKER'S COMPENSATION DECLARATION V ttC�9 I hereby affirm under Penalty of perjury one of the following declarations: I have and will maintain a Cenifcam of Consent ta sett-insure fur Wurkeri Compcn- eation,as Provided for by genion 3700 of the labor Code,for the performance of the work for which this permit is issued. '1 have and will maintain Workers Compensation insurance,sts required by Section 37 ofthe Labor Com.for the perihormena ofthe work forwhich this peroolis issued. My Workers Cm.,ro um.Immianee carrier add Policy number am: Cartier.(/i AOI&dS Y Policy N...,C)CG O0O246173 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE abet imeian need not Mcomplcwd if tie permit is fm ow hundred dollars($100) - or less.) 1 certify that in the performance of the work for which this Permit is issued,I shall not employ any person inany manner to me subject to the Workers''Compensation Laws ofC lila Da/1Z Applicant NOTICE TO APPLICANT:IL aper making this Certificate of the Exemption.ImoCadyou should become subject m the Workers Compensation or thin provisions of the Labor Code.you roux �O forthwith comply with such prnvisinnsatbis permit shall ba deemed revoked. L.yN. CONSTRUCTION LENDING AGENCY 1 hereby aftrte mat mere is•controninn lending agency for the performance of Z the work for which this Permit is issued(Sec.YN7,Civ.C.) ]] Q Lenders Name Z Lender's Address J Q I wrofy Out 1 have read this application and those that the alum information is y correct.l agree to comply with all city and county ordinances and sate laws relaing10 �U building construction,and hereby authorim represcmatims or this city to enter upon the shove-mentioned pmNrty for inspection purposes. y (We)agree I.ave,indemnify and keep harmless the City of Cupertino against Vy Imbi lities.judgments,costs and expenses which may in any way accrue against said City C7 Z inc......le of me grants ng of this Permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCEREGUL ONS. shs ureofApplhcanUCon --form Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle loOardous malarial as def reeby the Cup.nino Municipal Cate.Chapter 9.12.and the Health and Safety CnJe.SDy. cd V tion 25532(a)? 01Nn All roofs shall be inspected prior to any roofing material being installed. Will mea leant or future building t ala equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove applicant gby then it ha'ramnus air contaminants as JCMCJ by me Bay Arca Air Quality Management all new materials for inspection. D'svin7 u El Ycs 1 have mad the hmardous materials ox,imments under Chapter 6.95 of the Calif., nix Health A Safety Cale,Scetion 255115.25533 and 25534.1 undersand Noir lM Wilding , Jess not currently hate a tenant that it is my responsibility to and fy the occultism of the req/iy5�,eats/w�hp+mutlxme,priormiazuanecoraccodrealaof/a.upNa. Signature of Applicant ' Date or ` 2( —�j All roof coverings to be Class"B"or better Owner or authuriud agent � Date Community Development 10300 Torre Avenue (� Cupertino CA 95014 Telephone(408) 777-3228 CITY 0, Fax(408)777-3333 I UPEkTINO Building De artment JOB ADDRESS: PERMIT # ZZo23 )WLff ef,- t�,66 2C) IZ OWNER'S NAME: 5A -),,.-I 56-jNYq PHONE # Z7t-946 GENERAL CONTRACTOR /nNfl e6. s-ce✓Cr/o ti FAX # 274 -,vW j I am not using any subcontractors: Z 14�L !/ f5 Signature ate Please check applicable subcontractors and complete the following information: 66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting - Linoleum/ Woyd Glass / G g eatin Insulati L Handscaping gLathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing/ Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date h 1 • :� e Community Development 10300 Torre Avenue Cupertino„t C-A 95014- pZ Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 UPERTINO Building Department JOB ADDRESS: PERMIT # 22o?'2 fir Lc-y cr- C- 20lIZ OWNER'S NAME: 5A F-+1 5/i r6-t) \ PHONE# 7/r - EOba 1 GENERAL CONTRACTOR: /++l?IAiFY Co. STR-✓q'/oti FAX # 774 CTI9 7 j; j. I am not using subcontractors: H `any SAT 1/ 1-4 Signature 6ate Please.check,a "licable subcontractors and complete the following information: SUBCONTRACTORI RucBUSINESS NAME,:i _ BUSINESS`LICENSE`#- Cabinets &Millwork ¢. Cement Finishing _ _ ir.. rL� Electrical 4 Excavation y� Fencing Flooring: Carpeting -5 Linoleum/ Woyd— ® � Glass / Glazz`mg / Heating lnsulation� a Landscaping n Ir Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper ,Paving Plastering Plumbing ' Roofing/ Septic Tank 1 Sheet Metal Sheet Rock w Tile - Owner/Contractor Signature Date CITY OF CUPERTINO oS Z �-' WATER HEATER • CUPEkTINO PERMIT APPLICATION FORM APN # Date: . Building Address: Z Zo Z -3 #)(L,6?r CT- Owner's TOwner's Name: Phone #: Contractor: Phone: / License #: i�}CY-E-� CGN STRLLTI ON 27y" - f0�66 S/'f6c1 Contact: Phone: Cupertino Business License#: 94ti 0-?Oc.-Ey ate- �v,o Building Permit Info: Bldg ❑ Elect . ©. Plumb Mech Igl Job Description: F-0 wr�Tit� � w T9�C ra rE� /fERT�2 Residential Commercial ❑ Cost of Project: S.5 vo Strapped ❑ On Platform ❑ Bonded New Location ❑ Replacement 81 Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/ Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING 2g6