05090176 CITY OF CUPERTINO t �•9� t a t '•^"
BUILDING DIVISION PERMIT C,`OLS`T'CTO"NP'ORVIA'I � 10W%.r
Sul
u LDING ADDRESS: MENACHEM FEIN PERMIT N005090176
171 MIRA VTSTA AV
W HER'S NAME: FE NUT ISSUE DATE
MENACHEM FEIN 09/27/2005
ONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
- BLDG ELECT PLUMB MECH
0 0 0
300 LICENSED CONTRACTORS DECLARATION
i hereby&form that l am beamed under proviatons of Chapter 9(eommeming lob Description
.< with Section WXKH of Division 3 of the Business road Prolmnsons Cadedntl my license is
in full(.Meand effect. REPLACING A 50 G WATER 'HEATER LIKE FOR LIKE
Z License Clan Lh:.0
t- Dau Commemor
`g ARCHITECTS DECLARATION
1 undcnund my pit.shall he usW as public emords
gG Licensed Prufessimal
3 OWNER-BUILDER DECLARATION
y I hereby from that 1 am exempt form the Contractor',License Law for the
O O following mason.(Section 713 1.6,Burnes and Porfessaons Code:My city or county
$ which require a Permit to construct,alar.improve,demolish,or acres,any awmure $750
_Zr prior lex its Issuance.also mquimaduapplieaut for such Permit to file a signed moment
C that he isliavedpuraumltothe prevision ofNeCanuxur'sUmnmiaw(Chapter 9 Sq. Ft. Floor Area Valuation
pyFF (commencing with Section 7000)of Division 3 of the Business and Professions Co&)or
3 that he is exempt therefrom uM the basis for the alleged exemption.Any vloladon of
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penally of
not mom than 0w hundred dollars($500). es' Occupancy Type
❑I,u owner of the pmpeny,or my employma with mgu u their mlc eampemtlon,
wlllao theworlc and the anctute Is notinunded oraQered SmaHe(Sec.7044,Busanew Required Ins ections
.tl property
who
Cade:mThepo msthmmr's License Law deer ms apply lf rt owner of 9 P
propertywhobulldaorireproteath improvements
and who daoamhwoe h(mxeaar through At.
man employees.the
uiprovided pr suchimpmwments vee not year
ded ocaoaeud for ale.IL
however.Ne buildingh at Improvement is cold within am yet of completion,the owmr-
Msilder MB Nw the burden of proving that he did Out delta a improve!a purpose of
sale).
con1,uowerof project
proSec.70y am exclusively Ad contsamiw with:)Tuetlmmexam'n -
mem,Lastruct theesam pplyt am Business propad erty
Catla:)TheC douncen, nd / 5
cense law dao oda apply b.owmr of cramorty who Wilda or im,to u Norton,and
who se Law. for such pojems with s emuxmrtal licensed punu.t m Ne Convactah
License law. /
❑I am exempt under Sec .B @ P C for this mason
13070D
ner /1't.2sa a epi n. Fir 5 Dau
WORKER'S COMPENSATION DECLARATION
/ Ihereby Nim under penalty of perjury mo of the following declarations:
I hive and will maintain a CeNrmu ofComm�t to sal6lnsureferWortar'iCamper-
an,u provided far by Section 7700 of Ne Labor Cade,far Ne perform..o!Ne
rk far which this permit is issued.
1 have rod will maintain Worker's Compensa0n Wur.m,u requimtl by Section
of Ne Labor Code,lar Ne p rfomanm of the work far which this permit is issued.
Worker's Compmeadon hasomenm curia.d Polity number are:
ller. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE.
91d;mcdm need mi lcompleted if the pumit is foram hundred dollar(S 100)
or less.)
I modify that in the performance of the woe for which this permit is Issued.)shell cot
employ any person in any mum ram u b bcmme mbjeet m the Workeri Compensation
Iawaof California.Data ✓Z �bf
Applicant Mme„ G� Cod
NOTICE TO APPLICANT:If.after making Nu Cenarcme of Exemption.you should
become subject u the Workers Compensation previsions of the Labor Code,you muss
vJ z foMwith comply with such provisions or this Permit Shall he ammed revoked.
0
y CONSTRUCTION LENDING AGENCY
Cd I hereby Affirm the Ncrt itscd(Sm..construction7,Ch.agency Ym the pcnumamm of
W.moi the wort for which dela permit V Loved(Sec.7097,Civ.CJ
CLQ Lender's Nemo ,
= z Lcndeis Add^••
V 0 I certify that I haw mad this application and sum that de above InfomNm Is
Iy contact.I agree he comply with,all city and county melasmas and state laws rtlanng N
0 building construction.and hereby audience representsuvu of Nb city u enter upon No
[L7 show-mendoned property for inspection purposes.
0.. (We)agme an saw.indemnify and keep homeless,the City of Cupertino against
f/) Itabilidea.judgmenu,cash ad expenses which may in my way carom against said City
in couequme of the training of this Permit.
APPLICANT UNDERSTANIP AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 27-04-
SOURCE RECUL ONS, Q/t'/�
Re-roofs
St of Applt Dau
vHAZARAEARDOUOUS MATERIALS DISCLOSURE Type of Roof
WIII the a Cupertino
or future building alCaloccupsotChapter
norm or handle Health
material
u defined io No 32(a)?oda Municipal Code.Chapter 9.12,mtl the Health.0 Safely
lowffr.r
e.Section 2ss7z(a>7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes Ly Nu
WIII the applicant or future building byOccupant Sauer s Air Qu or device which
If a roof is installed without first obtaining an inspection,I agree to remove
It India?arardnua elremumiunu u dcfimd by Ne Bry Aro Alr Quality M.agcmcnl all new materials for inspection.
[3 yes [}ifu '
I jc�ml,
mW du huardass aunala nepammentsunder Chapter 6.95 of the Califor.
Helafety Cadc,Sec' 25503,23577arx12333/.Iundcru.d thulfNc belong
e ret haw a ono Nm It u m�y pomibllllY m mtifY tle omup.t of de
uartmwhtch u c ierarl�anceasCertifeMorOceupancy. Signature of Applicant Date
7/z7/u/
authom. igen Data All roof coverings to be Class"B"or better '
• aClOF
Community Development
10300 Tone Avenue
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: I037( ht(4,4 ✓(S v PD PERMIT #
OWNER'S NAME: nM 6"A,4c t a.. F &(r PHONE # 403 2s2 45W
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: 7 9f2 7�pf
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
` R 1z 7(pf
oactor Signature Date
All
Community Development
10300 Torre Avenue
acloF
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: (U31, A09.4 Vo T4 Rq PERMIT #
. . G gR Trt/U C
OWNER'S NAME: SNaCIl6h fcU PHONE # Kug) Zg, 4r f
GENERAL CONTRACTOR: 14v. IJe FAX #
I am not using any subcontractors: 112 765-
,,— ignatthe Date
Please check applicable subcontractors and com lete*"'the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
. Linoleum/ Wood
Glass / Glazing
Heating Hum de f
_ Insulation
Landscaping -
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
4/2 7/0r
Owner/Contractor Signature Date
p50`1 O 1�1v
CITY OF CUPERTINO
WATER HEATER
CUPER� No PERMIT APPLICATION FORM
APN# Date: R /Z 7 /U S
3� - oa- o9�a,
Building Address: t03 71 M
/l/t vis Tse K�� , G VA 6R 7(,r(i C,/ Qrril4
Owner's Name: Phone#: 6.1) 2 5-2 45-f g
Contractor: I-4vluc fl@ aPhone: Na3) 253 34"37 License#:
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect a Plumb ® Mech I&
Job Description: RP /4C ^ a 5o67 4ia der
Residential ® Commercial ❑
Cost of Project:
IR
• Strapped 0 On Platform ElBonded r-1New Location ElReplacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMPI'FEE Plumbing Permit Issuance PLUMBING
tl BENERGY Energy BUILDING
BUSLIC Business License BUILDING