06010112 ;— OWNER'S
TY OF CUPERTINO %r � _-�' '''
BUILDING DIVISION PERMIT CCI' 1')iT1GCIRIN1`q 'A.TZU1�"-,
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DING ADDRESS: PEKMIT NO.0 6 010112
NAME: PERMIT ISSUE DATE
EILEEN PENG 01 20 2006
E: SANITARY NO. CONTROL NO.
ARCHITEMENGINEER: BUILDING PERMIT INFO
BOELECT PLUMB MEOCH
3Oj
LICENSED CON'TRACTOR'S DECLARATION Job
1 herby a1Rrm that 1 em licensed under provision,of Chapter 9(commencing ®L�Description
U with Section 70M)of Division Sof the,Business and Prufauiuu Cmlo.md my license is
^ In full forte and effeet. REPLACE WATER HEATER QjY
AJ Litems Claes Lit.N
na- Dau ContractorDELI [J ®
q ARCHITECTS DECLSRATION
l{ILy.
W u 1 understand my plans shill he used u public record Jq7/y'I
20 Licensed Pmfcisionel � O
Oat I"m exempt
form
DECLARATION
t a C 1 hereby mucco .(Sure that 11. exempt from me Contractor's o :Any c Law cor the
unty
i O O followhich re mu0n.(Section 7 omoss Bonito and Proare.de esu Code:Any city or county (J]� ')
yt$ which its requires a permit re cnr s the aloe improve,h Permit t ri repair and oname , U f $475
Zi primmsliauancpursuaugo the the inion o for mchpermi'micenserile a LawJuatemcm �,
< Nat heir 11 tensed purmantt0thc provision of the Buumr Ind Proflaw(Chapser9 Sq.FL Floor Area a� u anon
yF$ (common cemempt kmSccfmm andth Division,the
the Busman andon.Anynns Cnde)err
.. mu he b emmpt tiere(mm and me bub for me allegro exemption.Any violation of
Section 7031.5 by any applicant fora permit objects the applicant to a civil penalty of
nor mom than fin hundred dollars(5300). of Occupancy Type
C]L u ownu of the pmpeny,a my employees wim wage u Meir mk c^mpeuadon,
will do the work and the someone is notinunded aro@red for We(Sec.TON,Business
and Pmfeuiou Code:The Conaxmrs License law does so,apply b an owner of Required Inspections
property who bei Id or Improves thereon,end who does such work himself or through his .
Own employees,provided that such improvements are mtinunded oroRerrd for We.If,
however,the building or improvement Is mid within one Year of compkuon,he owner-
builder will have the burden of proving that be did ret build or improve fur purpose of
l
L u owner of the Se^peny.B simui and contracting with I)The Cconuacmrs m
coutmct me es not (Bey.706x,guinea and property who
Code:)Them the tors nd
cave Taw does not apply m an ownu of pmpeny.who build at improves Norton,and
who contracts for such pmjeN with eonlncmr(a)licensed puuum to du CContrContravenesac
License
nx LLaw.
❑I om csompt under Se. B&P C or rob museum
Dots 1 u 6
5 0 1 S COM EN TION 0LARATION
I hereby affirm under peealty of perjury ax a the following decimations: -
IC317:00
have and will maintain aCenifrcase oloouenl m self-insure for Workers Compco-
,a provided for by Section 3700 of the Labor Code.for the peeformmte of the
for which this permit is isoed
aw and will mainWn Workers Campenution Insurance,u required by Sidon
of the laborCode.fm the performance of me wah forwhich this peemit is bsoed.
orkers Compeuauon Insurance curio and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPITON FROM WORKERS'
COMPENSATION INSURANCE
(This sermon seed notbccompleud If the permit Isforax hundred dollars(5100)
or leu)
I crnify that in the performance of do, k f^ which this permit is issued,I shall ma .
employ any'person in my manners Icer tnbeco e} he me Work"'Comparable.Lawaof Califamia.Dx �O V
Applicant
NOTICE TO APPLJCATML afar maki g Nit ti0ute of Exemption,you mould
become subject a dm War Campenarion pmv iota of me labor Code,you most
.J O forthwith comply with such provisions u this perm shall W dtemed revoked.
55 CONSTRUCTION LENDING AGENCY
E^vN. 1 booby strum that mem is a mnNanimr le h.S agency for the pufamnexe of
a
the work for which this permit is Wood(Sec.3097,Civ.C.)
Q Landers Name
z Lenders Address
U0 I terrify that I Mn read this applkadon and wu that the above information b
D.F corms,I agree in comply with all city and county ordinates and sou laws relating as
DU building construction,and hereby authority repmentatives of this city to enter upon du
f•SI ahow-mentioned property for impaction purposes
gy (We)ague to un,indemnify and loop harmless the City of Cupertino against
In liabilities,Judgments,costs and eaprues which may in my way amuse against said City
U Z inconsequence of the granting of this pennil.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date i Lo-ve"
SOURCE REGULATIONS.
421 Ive Re-roofs
Signature,of Apples mUCon I Dam
HA 0US MATERIALS DI CLOSURE Type of Roof
Will the applicant or Town Wilding ottupan re m handle havallous material
u&.I d by the Cupertino Municipal Cade.Ila 9.12,and the Hashish and Safety
.Sudors 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes yJ No
Will Nc applicant or furore Wilding acoupam tie equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haurdnu air cmtamiunts u dcfracd by the Bay Area Air Quality Management all new materials for Inspection.
7d=
sulmt
Oyu XNo
I ban read the haraedms meanials requirements under Chapter 6.95 of the Califor.
Health&Safety Cade,Sections,25505,25533 and 2553/.l undeeswrd that ifde Wilding
net currently ban a berm,the it b my mapnmihility a antify me oteupanI of the
uimments whit metpnor les' vote ofaccrurk •e,of so ! Signature of Applicant Date
Owner ar,atharisdagcm I AD m6 All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
3J' Cupertino CA 95014
Telephone(408)777-3228 '
CITY OF Fax(408)777-3333
JUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
8,31 i Ilei 1 Ve, e iiw V/ O
OWNER'S N PHONE # ¢08- 2-k -X60
GENERAL CONTRACTOR FAX #
-4o9--31 y- — Z
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following 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
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contracto ignature Date
WITOFCITY OF CUPERTINO
WATER HEATER
CUPERTINO PERMIT APPLICATION FORM
APN# 3 91903 Dater-20 —06
Building Address:
83 A llel� AtAe-,I , e 50
Owner's Name: Phone#:
Contractor: p Phone: License#:
o
Contact: G' �� Phone: S 3_ G ps Cupertino Business License#:
Building Permit Info:
Bldg O Elect t[ �Vj 4 Plumb tj� Mech L
Job Description:
Residential Commerciafl ❑
Cost of Project: $2 7,�-- +
Strapped AY On Platform LJ Bonded
• New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
/ BENERGY Ener BUILDING
BUSLIC Business License BUILDING
i