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04110089 CITY OF CUPERTINO �tn� n'" BUILDING DIVISION PERMIT P3CQt�+y l�ACTOEI1�� 11 BUILDING ADDRESS: HOT WATER INC PERMIT"'54110089 -- - 10164 MANN DR OWNER'S NAME: PERMIT ISSUE DATE Adh SHEN YE 2531—GRACELAND AVE 1111612004 11 ONE: SANITARY NO. CONTROL NO. 650) 298-8494 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB ..MECH epe0o LICENSED CONTRACTOR'S DECLARATION JobDescri IIOn F 1 Mreby affirm Nal 1 son luxnud undo provivars of Chapter 9(commencing p _ ---- - `uf iO Secrica.70M)uf Diviam Sof Oe Butinusa dProfaaahma Code.and myliccnuis mmneClass eReec REPLACE WATER HEATER. jyj? License Class Lic.Y ° n-� DauContraao ,S, - -.. f AR HnEC1'g DECLARATION _ -- - - -----— ?W V I understand my plans shell be used as public=orda 6 G Licensed Pmfesional OWNER-BUILDER DECLARATION 0 S I bunchy.(Erre that 1 1. exempt from d¢Canlns;Co Licenu Law for the p p fallowing¢aeon. Paneth to 7(u on Business and improve, der tau COM:Any oily of county K$ which requires a Permit re enngron,plan improv,h Permit t fie pair any,Ifaetum Tie Our hepoor ins iensedpalso uant10 ata preisio of for such Penni'tOicense ned Law(Chapter fxxp that hoeing wit pursuant10of Division of NC Conusiness nd Podlsw(CMPur9 Sq.Ft. Floor Area Valuation - - -' saw, Ou(cohe examithselfrn7and basisofroflMeed Business pion.Anynvi Code)or - that k u eumpl Oemfrom and tK hair for sire alleged eumpuon.Any violation of Sax,on 7031.5 by any applicant for a permit subjects the applicant m a civil penalty ofane et0 0 Occupancy Type not mom than five hundred dollars(S50y. p y yp ❑1,u owner of the propcny,army employee wish wages ns their eats,compena0on, will do the work and the swaure is ofirmded«offend forsale(Sec.11161,Business and Professions Cods,The Conmemes Licen law doe,not apply to an owner of Required Inspections - property who builds«improve thtereen,and wha doessuch w«k hi muf f or tMugb his - own employee,provided that each improwmenu au not inmnded orolrcmd fur sals,If, however.the building or improvement is old within one veer ofoompledon.the owner- - builder will have the burden of proving that he did not build or improve for purpose of - - - - - - ale.). ❑1,a owner of the propenY•am exclusively concocting with licensed comments or conga a the pmjaet(Sec. r an Business and property who Code:)M Cs,thumon. rad «sec Taw doe n«apply m an owner of protons who builds or improvrs Contractor's oma c and / whence contracts projects with aconuaMor(x)Iiunudpursuant to the,Conmaah - ' License Law. - 01ameaemptunder See. ,B k P C far Oil maam Ou Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury aro of the following declggions: I have and will maintain a Cadfevu of Conant he self-iuun for Worker's Co nKa. radon,a Provide4 f«by Session 3700 of the Labor Code,for the pcnmma«c of the _ work for which this permit is issued. 1 have and will maintain Worker's ComPonsadon Insurance,u required by Section 37 film Labor Cade.far the peRormanee of the work for which Nis permit is issued. My Worker',GcronPeaOminswumcconaland Polirynurnkrare: Cartier, ty/K.(.0 rU A!r~ Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed little Permit is for one hundred dollars(5100) or Ices.) 1 canify that in the performance of one work for which this Permit is taued,I shall nm ..Ploy any parson in any manner an u to become subject o the Workcts Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making Nis Cenifica a of Exemption,you should become subject in the Worker's Corepcuation provisions of the Labor Code,you mug 0zMfowrm ith comply wit such Provisions or Nis peit shall he deemed revoked. Zy CONSTRUCTION LENDING AGENCY F I hcrebY oRrm to ten is a eonsovainn lending agency for the Performance of C' the work fur which this permit is issued(Sec.3097,Civ,C.) A lender's Name D z Under's Address U 0 1 certify that 1 have read this application and state than the above information is D. eorcce I ague m comply with all city and county ordinances and rum laws raging m 0 V building conwuction,and hereby authmim reocunutives of this city to enter upon too r W abovcmemidgm psoRnY far impaction purpose: t„�G (Ws,)agree m ave.indemnify and keep harmless Ota City of Cupcnion ageing, y ince ses.quenc of ts.the uan of expenses;which may in any way accroc against aid City V z in consequence of the grwdng of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date his SOU E gg,EGULATIO . ,/ NI�Air�,l/dc^... 0 Re-roofs Signgure of A,,1icW OCanlrsma1 Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material u defined by the Cupenino Munidpal Cods,,Chapter 9.12,and the Health and Safcty 11-Macoda.0Y�zss3zap �No - All roofs shall be inspected prior to any roofing material being installed. _ Will the applicant or future building occupant tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mil hanrdous air conumicams as defied by tc Bay Ana Air Quality Managealenl all new materials for inspection. "I istrict' a� 0Yu LLNo �I have toad the hvartmsresunals requirements under Chapter 6.95 of the Califon-aid ^ / - oesnothkrentlyhamaSccdonsindit 3MY rsnd25534.1 un domed that if the building ors not currently haw a the t thg it h my rcsponrihility m notily the scup t of nth mug be met p o w iuuantt of a Cef4fcau of Occupanq. � � I(/ SlgnatureofApplicant Date Owneru autorondagent "'i— All roof coverings to be Class"B"or better x y Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 fUPERTINO ByRding Department JOB ADDRESS: r l PERMrr# �I 0oS OWNER'S NAME: PHONE # OS ,52 -aS 2Z GENERAL CONTRACTOR FAX # I am not using any subcontractors: Signature Date 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/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing ��f e� 11f C, Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date Sam CITY OF CUPERTINO U a WATER HEATER d PER T cu RINO PERMIT APPLICATION FORM , APN# Date: Building Address: 10 I/ _� Owner's Name: (f/ u Phone #: q , I�rn o a5/_Z -Z�ZZ Contr o� V�/Gt (/ PUDJ( Li d —S1 c.�CI y cs&3&/,,)— Contact Phone: 1 t 1 Cupertino Business License#: r6 (c< ala Building Permit Info: / BldgEl Elect El Plumb 2_ Mech ❑ Job Description: Residential Commercial ❑ Cost of Project: 47 50U • Strapped ❑ On Platform LJ Bonded ❑ New Location ❑ Replacement ,ty. if Xppljcable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMII'FEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING o Zi � OT �