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04050109CITY OF CUPERTINO°"�" ATI BUILDING DIVISION PERMIT CONkTRACTOR'INFQRMQN BUILDING ADDRESS: HOT WATER INC PERMITNO04050109 0 W NERs NAME: PERMIT ISSUE DATE WILLIAM BE NE: SANITARY NO. CONTROL NO. (650)298-8494 ARCHITECT(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm wi I am limmcd uM r Wovi om of Clupmr v (mmmeneing with section 7") or Division 3 of Ne Business aM Profea imu Cede.and my licevc is in full roaend off «t.G G REPLACE WATER HEATER �'lLry��pq License Ln Dale Cumncat AR HITECTSDECLARA N I undersand my shall W used u records JUN 2/ 2004 plans public Licensed Professional OWNER -BUILDER DECLARATION Lp�r�;p1g1 n� I hereby affirm 1 am exempt License Law for the Ne Csm t� I�� ®80 Code: Any city county s, an ons on : A following mama (Saito 907str Business end on V 0� sae, doom tatemure which mquisa improve, demolish, measrepair s mIUI construct, npmmit e appliatter.cant g ed prioraits issuance. also re to ffic theapplicant far such permit aice ssignedstaamcm thathe of the Contractor'snd itpurstion Sq. FL Floor Area Valuation 7 ) of Division Proclaw(Chap¢rq menciing withof Division) of the Prpfasvi Code) or es egeBusiness inem I Nat he u exempt thcrtfrom and t¢ baso for the alleged exemption. Any violation of Bron exemttS«tion. and 3_'A&N8x01h1Ber00 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant N a civil penalty of not mom Nan Eve hundred dollars ($500). I, as owner a the property, or my employees with wages as their is compensation, Required Inspections will do the work, and the swcmrt is not intended or offered for sale (Sec. 9014. Business and Profession Code: The Conmcunnt License law does not apply he an owner of pro,coy who builds or improves Ummon, and who doessuch work himselfor 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. Ne owner - builder will have is Widen of proving thn he did not build or improve for purporc of sale.). 1, as owner of do property, am exclusively contracting with licensed contactors to comwn the project (Sec. ]Dan, Business and Pmfcamon Cade:) The Canmoote U. cons, law docs not apply to an owner of property who Wilds or improves Hereon, and. who concocts for such projects with a conrecmr(a) licensed pursuant to the Contractor's License law. El 1 am exempt under Sec. B & P C for this reason Owner Date WORKERS COMPENSATION DECLARATION 1 hereby sprints under Penalty of perjury, one of the fallowing declamations: 1 have and will maintain a Certificate of Conentto self -insure for WorkcfaComprt- mone, as provided for by Section JT00 of tae IaW, Code, for the performance of the work for which this permit is issued. B�Jpavc and will maintain Worker's Compensation Insoun¢, a rryuired by Section J200tf the labor Code, for the performance of the work for which this permit is issued. My Worker' Compensation Insurance carrier and Policy number art: 7 Carrier. j I/ �V a'V%� Policy No.: _ , C TIFICATE OFE(EMMON FROM WORKERS' COMPENSATION INSURANCE (This section need not W completed Kthe permit Is for one hundred dollars ($10() or less.) I certify Out in the perfmmancc of the work for which this Permit 0 issued. I most out employ any person in any manner so as to become subject to the WmIsc.' Campemartimt Laws of Catile mice. Date Applicant NOTICE TO APPLICANT: TL after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of Be Labor Code, you mum forthwith comply with such provisions or this form it shall he deemed revoked. 1 CONSTRUCTION LENDING AGENCY 1 hereby that Nene is a col lending agency Int the Performance of Oat ftm ! whichthat (See 3 the work for whim thu permit is vsucd (S«. JWs, Ci, C.) Lendefs Name Lender's Address j I certify that 1 have read Nis application and state that the above information is ' cancer. l agree to comply with all city and county ordinances and some laws relating to building construction, and hereby autborim representatives of this city to enter upon the abovcmcmioncd property for inspecuon purposes. (We) agree I. ave, indemnify and keep ham 1. the City of Cupertino against j liabilities,judgments, costs and expenses which may in any way accrue gainst said City I. consequence of the granting of this pcnniL APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOUR[E REGUynry+�. ' Re -roofs A Type of Roof �I X (3CA-6prjS 1 !qO I Signature ol'A anUCux'ntreaor Dem B PP i �� HAZARDOUS MATERIALS DISCLOSURE Will the applicant toform building occupant store or handleHealuousmaterial u defined by rte Cupertino Municipal [ode. ChapHa1N Chapter 9.12. and the and Safety We. aim, 35572(')? All roofs shall be inspected to any roofing material being installed. prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or fu building occupant use equipment or devices which hazardous air contaminants as defined by the Bay Area Air Quality Managcmcm all new materials for inspection. District? ❑Yes o 1 have mad the hvaNmsmaterials requiremous under Chaporb 95 of Ne Cab or- piaHealth&Safc,,Cade.Scetimu 25505, 25577 and 25534.1 undersand Natifft Wilding d. not etummly have a tenon. Nat it u my.,cribilo, In noury th, occupant of the rcquirtmcnts tanpt,j; atone tr,ccrdneal,nro, cy Signature of Applicant Date 0S�% All roof coverings to be Class "B" or better Owner or auNo D �L WCITY OF UPEkTINO O a Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 Building Department JOB ADDRESS- a ISBb f Z� PERMIT #pz- loroloq OWNER'S NAME: W 1 t l_,t M I PHONE # 6o31 -6(j ' GENERAL CONTRACTOR: cj I FAX # G31- I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature 10/28/03 6S o Date 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 10/28/03 6S o Date t f aftdov�]% CITY OF CUPERTINO CITY OF CUPERTINO WATER HEATER PERMIT.APPLICATION FORM 6 � os --D t 6 ( APN # Z) 5(_a / Date: I 6 Building Address: / PPERMITFEE Owner'�s,��yy V I VA Phone o Contractor: Phone:,,,,_,,,_ pI/ HOT WATER, INC. a T�1 License#: Contact: SAN CARLOS, CALIFORNIA 94070 Phone: Cupertino Business License #: Building Permit Info: Bldg ❑ Elect ❑ Plumb I!d Mech ❑ Job Description: vzz � Residential Commercial ❑ Cost of Project: C /V Strapped ❑ On Platform ❑ Bonded ❑ ❑ New Location Replacement Qty. if Annlicable Fee ID Fee Description Fee Group BPWHEATER Water Heater / Vent BUILDING / PPERMITFEE Plumbing Permit Issuance PLUMBING / BENERGY Energy BUILDING BUSLIC Business License BUILDING