05070187 CITY OF CUPERI'INO
BUILDING DIVISION PERMIT `CONTRACTOR INFORMATION �<,
BUILDING ADDRESS: PERMIT NO.0 5070187
7503 KINGSBURY CT
NER'S NAME: PERMIT ISSUE DATE
MENEZES EUSEBIO AND EUNICE
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I O z LICENSED CONTRACTOR'S DECLARATION with Slob Description
C 1 hereby air,,.that 1 am licensed Om1c,,o vis cox of Chapter 9(commencing p
U waiion)ill of Division 3 of the Business and Promatinru Cole.end my license is
^O or in full fora and effect
yLimnse Class a Lien REPLACE WATER HEATER, �1 NT, T & P
a�z go Dam -7-I IC Contraemn el r.k tat T;e.. TO EXTERIOR.
4 rJe ARCHIECTSDECLARATION
C u q/ I ukmapd my plans shall housed as Public me.,& ('
sod /,muud Professional " 7 2005
5 OWNER-BUILDER DECLARATION
1 hereby affront that 1 am exempt room the Commemea License Law for the
00 fallowing mason.(Section 7031.5,Business and Professions Cole:Any city Or county
ra
$�i which mquia Permit to consumer,alar,improve,dcmulLsh.Of repair any nmmum
°iy priprm its issuana.alw mquira tM apPlicam for such Mrmitmfle asignW suumem
man 500
< he uliansed pursuant¢the poovisiom of the Commcwr's Liana law(Chapmr9 Sq. Ft. Floor Area O¢
x~3 (commencing with Section 7")of Division 3 of the Business and Profcuions Code)or
.. that he is exempt du mfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more man fa hundred dollars(s50(H. 36229025 . 00
Lo tho vorafine pmpcny,o,my cmmmudimwimwagesunts,(S .c044,Boxtlon.
will doer work and destruction,Com is no's nuncio Law does;
Out
apply
t o14,Business
and property
who
Cade:The Canmcmm, nd who law does tort apply lf an owncr of Required Inspections
pmpeny who employees.proorimprovea chicon,and who does oncnworkhimulf ormmugh his
awn er.mebuilding
that such improvements is am not ina:o cd m hared for sale.if.
however,the building o iimprovement is halt a within on year or completion.the oose of
rueder will have m¢burden of proving mel he did not build or improve fm purpose of
salt.).
❑I,as owner of the property,am exclusively conoacting with licensed contractors to
construct the project(Sec.II044.Business and Profession.Cade:)The Conuacmri Li.
cense law does not apply 0 an owna of property who builds or improves therean,and.
who contracts for such projects with a eonuaetor(s)licensed pursuant to the Contormun's
License law.
❑1 oro exempt under Sec. ,B&P C far this mason
Owner Dae
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pemlty of perjury one of the following recursions:
I him and will maintain a Cenifcate of Consent to self--insum for WorkersCOmpcn-
nankin,se provided for by Section 3/00 of the labor Cade,for me pinformation of the
wmk for which this permit is issued.
❑1 have and will maintain Worlmex Compensation Insurance,as mquimd by Section
3700 of me labor Code,for the perfomtana of the work for which this permit is issued.
My WorkersCompensation
bran.,wr1rJ na artier and Policy numb alae:
Cartier: Sknsle FPoll,No.:Il;`L1nk(•200
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(T ussection need nm bceomplemd HIh permit is fm one hundred dollars(5100)
Or Icor.)
1 ani(y mat in to per(mmanec of the work for which this permit is issued.1 shell not
employ any person in any manner an az to become subjmua the Worken'Compemadon
Laws of California.Doc
Applicant
NOTICE TO APPLICANT.IL after making this CenlBcae of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
.,O forthwith comply with such provisions or this permit shall nth demand invoked.
z N CONSTRUCTION TENDING AGENCY
�-. 1 hereby affirm that then is a construction lending agency for the performance of
a the work for which this permit Is issued(Sm.3097.Civ,C.)
Lenders Namc
Z)z Le dens Address
fJ Q 1 certify that 1 have read this application and sate met the above information is
F' correct.I agree to comply with all city and county ordinances and sate laws mlating Or
0U building construction.and hereby authome represenatiwn of this city to enter upon the
4 above-mentioned property for inspection Important.
(We)agree m save,indemnify and keep harmless the City of Cupertino against
F'fA liabilitia,judgments.amts and expenses which may in my way accrue site int mid City
U z in consequence of the granting of this Permit.
^-� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: (2 Date y F'-Or
SO�RsjE REGULATIONS. r u
(%( �( �- Ax oS Re-roofs
Siginum Of Applican/Cconmemt - Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futum wilding Occupant store or handle hvandous material
u darner by the Cupertino Municipal Code.Chapter 9.13,and Be Health and Safety
We.Seey.3ss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes fVNo
Will the applivant or for..building occupant esu cyimportant or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it harardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes t7(No
I have moor the boxamouuss mamrialsrequircmcnis under Chaptcrri.95 of the Califor
niceHalm&SafmyCoem.Secdom25M5.25533 and 35534.1undcsaM thatift ebuilding
dace root currently haw a tenant that it is my mepoaibility to notify the occupant of me
mquimments wpgoo�h most be met not in issuxnee of a cerdrate of Occusiey. Signature of Applicant Date
o rte;amorizedagem Dae All roof coverings to be Class"B" or better
Community Development
' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT # 1��
�3 �n s6u
OWNER'S N u h 2 PHONE b - 7
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin information:
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
lastering
Plumbing LLL• (3l/
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
f
Owner/Contractor Signature Date
CITY OF CUPERTINO 093L ��-
�d WATER HEATER
CUPERTINO PERMIT APPLICATION FORM
API # 3 (0 0 ✓�� _ Date: -7 /
Building Address:
Owner's Na e: hone
Cont ac )�ne: icense#:
lint
Clam Phone: Y Cupertino Business License#:
3/
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech ❑
J Description:
aze )fewLem oSzi��r iLesfra/elf 7i fo �x
Resi ential Commercial ❑
Cost of Project: &,50C—)
Strapped ❑ On Platform ❑ Bonded ❑
New Location ❑ Replacement
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