The URL can be used to link to this page

04050112 CITY OF CUPERTINO ✓ ; hwn pa: ase, '. BUILDING DIVISION PERMIT 'GeONTRACTtIRINk'ORMATION BDILDINGADDRESS: HOT WATER INC P"""04050112 -I-,q 17-01,124PITS A17 OWNER'S NAME: PERMIT ISSUE DATE JNE: SANITARY NO. CONTROL NO. (650298-8494 4 ARCHFEC MNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MPRH 0 0 0 Op LICENSED CONTRACTOR'S DECLARATION 4.C I Wmby affirm that I am licensed under provisions of Chapter 9(commencing Job Description $Uto with Section 7MrI'Division3ofNCBusimusandProfessionsCode,andmylicenseis 22p��pp �3 in ran ore anaerm` REPLACE WATER HEATER. kr604�i�LMED pz Lice of I tiew O Da¢ Commerce j f UI AfItCHITEC7S rea DECLARATION JUN lip 2004 1 understand my plansshell he used public records DECLARATION 3 u.t; Licensed Prokoximard .�O Oat I am OWNER-BUILDER DECLARATION BUILDING <f 1 hcrthy affim that 1 am exempt!rein the Convenor's License Law far rise 00 following rexaon.(Section 7031.5,Business and Proassiov Code:Any city or county 5 g is which mquiress a Permit to construct.ale!,improve,demolish,or repair any structure _ai prior m its issuance.also requires the applicant for such Permit m file a signed susemcnt t that he is licensed pursuant 10dwprovisions ofthe,ContracbisLicense Law Charm,9 Sq. Ft. Floor Area Valuation xl-0 (commencing with Section 70M)of Division 3 of the Business and Professions Code)or y 9 that he u exempt therefrom and Ne huts for Ne alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicants to a civil penalty,of 3 6QRN1TQ A93er0 0 Occupancy Type not mom than five hundred dollars(5500). P Y YP Q I,as owner of the property,or my employees with wages as their sole compensation, will do she work,and the swcturt is not intended of offered for sale(Sec.7044,Business and Professimss Cade:The Communes tines License Law des onot apply to an owner of Required Inspections property who builds ar i m prow thereon,a nd who don such work toreador through his own employees.provided that such improvements are not intended or offered for sole.If. however the building of impmvement is sold within one year of completion,the owuer- buildcr will have she Wooden of proving dust W did not Wild or improve for purpose of sato.). ❑I,u owner of use property,am nclusivcly contracting with licensed contractors to convect the psnject(Sec.71N4,Business and Professions Code:)The Contractor's Li. term Law dors not apply in an owner of property who Wilds or improv Wemon,and who common for such projects with a eantnnoga)licensed pursoam to the Contractors License law. O two exempt under Sea .B k P C fm this mason Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury ore of the following declarations: I have and will maintain is Cenificme dreamed to self-insure far Worker's Compen- aatian,ss provided for by Section 3700 of dee Labor Code.for the au romunce of the work for which his permit is issue& 40ave and will maintain Works/s Compensation Insurance,as required by Section 1,IsWr Code.for the perfasmucc of the work for which this permit is issued. My CamWeo,..rke(Ys CPerwdon lnsunrra Policy oldicyPoNlioc.y:numSber4 art9 : -3��A�ATEO�%EMP LGN , FROM WORKERS' COMPENSATION INSURANCE Thesection need not becompleed if she permit Isforone hundred dollars(5100) Or Ins.) 1 comfy Nat in the performance of she work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workors'Comperostion Laws of California.Date Applicata NOTICE TO APPLICANT:IL after making this CeniDcam of Exemption,you should become subject of fie Worker's Confrontation provisions of the Labor Code,you must .J O forthwith comply wish such provisions or Nu Permit shall W rimmed mated. Z � f1 CONSIRUC0N LENDING AGENCY 'rw I hereby affirm Nat dere is a cmtswctinn lending agency for the performance of (Y the work,for which th¢p.if is issued sin.VD.Civ C) (y Q Landon Names Z) Z Lender's Address U 0 1 certify that I have read Nis application and sure than Ne above infmmatiun is entreat 1 agree to comply with all city and county ordinances and state laws relating to 0 Wilding construction,and hereby anuria mpossenutiw of this city to enter upon the fS3 above-mentioned property for inspection performs. (Wes).,me Io save,indemnify and keep harmless the City of Cupertino against Fliabilities,judgments.costs and expenses which may in any way accrue against said City U aZ in consequenec of Ne granting of this Permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REG�y'��+S. I TL_,N"P C 1 I/Otl Re-roofs Sipromme of Ap licanr/Coiruactor I I Dat( HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant of future building occupant nom or handle hazardous material .% as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety otic.Section 23532(a)? All roofs shall be inspected prior to an roofing material being❑Yea I-]No P P Y g g installed. Will Ne applicant or!severe building occupam vu equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Di vin? C3 Yes ❑Nu 1 have mad he hazardous materials requimmenls under Chaper 6.95 of the Califor- niaHeslthASafety Codes,Sections IM5.25533 and 25534.1 urdersusW that if be Wilding Jac nowarrently hast a enant that it is my mpomibilily to W61Y IN,oceupant of be, mquircmcnts h atW atpriortoivuxnceafaCcmfeamrrocepane Signature of Applicant Dale `r� a�� F All roof coverings to be Class "B" or better Owner ser atahorixed agent . Community Development 10300 Torre Avenue s Cupertino CA 95014 Telephone(408) 777-3228 ICITY OF Fax(408)777-3333 CUPEkTINO Building De artment JOB ADDRESS: PERMIT # Qz )IK130 fi (0 _007 2- OWNER'S NAME: N til PHONE # �$d G -�I� GENERAL CONTRACTOR: FAX # p G -gam I am not using any subcontractors: Signature Da e Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting eLinoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile caner/Contractor Signature Date 10/28/03 1 CITY OF CUPERTINO d" WATER HEATER CUPEkTINO PERMIT APPLICATION FORM APN # G o-� _ b� — b Date: Building Address: lJ � 3�1 �ol �mbus fie . Owner's Name: II_ 1 Phone #: �) " I Cc �Cc Vl l GC i'1 d� —� Contractor: Phone: { 9� License#:� HOT WATER, INC.963 MEMS" Contact: SAN CARLOS, CALIFORNIA 94070 Phone: Cupertino Business License#: Building Permit Info: / BldgEl Elect El Plumb al- Mech ❑ Job Description: \ ccte_ � r I r Residential Z Commercial ❑ Cost of Project: �O�\ Strapped El On Platform ❑ Bonded New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING / PPERMTI'FEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING