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05060090 CITY OF CUPERTINOtv�av e« xr "t ' �' . BUILDING DIVISION PERMIT CONTRACTQR INk'URMA.TION BUILDING ADDRESS: HOT WATER INC PERMITNOO 5060090 982 NOVEMBER DR OWNER'S NAME: PERMIT ISSUE DATE YVONNE WELSH 2531 GRACELAND AVE QE/14/2005 ONE: SANITARY NO. CONTROL NO. (650) 298-8494 ARCHITECTIENGINEM: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 °00 LICENSED CONTRdunderSDECLARATION JobDescri tion 1 bertby affirm Nsl I am fthe Bu i under and Prisorp of Chapter 9(commencingsis p _Z with Section TO W)o(Diviaion]of NC Business and Profcssium Code.arta my license is < imm11mreanaeffyc ��� Z REPLACE WATER HEATER Liccnu Clasj Lic.S_ ZFp Dam Contractor "+ eeka- rte. SEISMIC RESTRAINTS, T & P TO EXTER. FWj ARCHITECTS DECLARATION w U I understand my plans shall W used as public records 6 3 G vi Licensed Profrssional .�a OWNER-exempt RDECLABATfON 0 0 I hereby.1firm(Sect on I+m exempt from Nc Costas o Liccnu Law for the i.p O which rtamn.(Section 7031.5,Business and w.donnish. Code:Any city or county $ which requites issuance,also re conuirs the sl¢a improve,deermit t fi repair any awment -Z> prior Inslcend puissant ft tWvisiappon of for such Contrasmi'toicersfile ae Li signed m< than W is licensed pursuant to dre provisions of the Contractor's License law(Chaptcr9 Sq.Ft.Floor Area Valuatic$500 yF$ (commencing with Section 7")of Division 3 of the Business and Professions Code)or .. that he is exempt Ncmfrom and the basis for tbe alleged exemption.Any violation of Semon 7031.5 by any appiicmt for a permit subjects the applicant o a civil Penalty of APN Number Occupancy e not mare than live hundred dollars(M). 36213024 . 00 p y TYp 1,u owner of the proputy,m my employees with wage u Noir sole compenmJon, will do Oe work,and the structure is not intended or offered fouale(Sec.700x,Business and Profaadoru Cede:The Cie uactoYs License Law does Out apply tom owner of Required Inspections property who Wilasarimprasss thereon,and who daessuchwork himulfor through his own employees,pmvided that such improvement an,not intended aroRemd bosses.If, however,ones building or improvement is mid within ane year of eompleum,the owner. builder will have the burden of proving that he did not Wild or improve for purpose of sale.). ❑I.as osysmr of the property,am uclusively contracting with licensed conhmtors m connmct the project(Sec.7044,Business and Professions Cade:)The Conumtor's Li- cense Law docs not apply to an owner or property who Wilds or burrows tberton.and who contracts for Such pmfectf with a eontacbr(s)licensed pursuant in the Can r ctors Liccnu Law. O lamasemptuudu See. ,B&PCfar Oismasan ��/3 Owner Dat �� Ah WORKER'S COMPENSATION DECLARATION ,\rel !'� �/f�Y 1 hereby eRnn under Penalty or perjury one of the following declarations: t/D Ih+veand will maintain aCerdfiaeof Coasenttoulf-insure far Wonc�ts Compere 6 /)����� kinum,as pmvided for by Section 3700 of the LaWr Code.for the performance of tbe ` SSK work for which this Permit motion. ❑1 have and will maintain Work,ex Ci mpensatian Insurance,as tequimd by SectionY!) —� 3700 of due labor Code,for Oce performance of the work for which this permit is issued. �.� My Worim`ess C1,ompevad n Inaum1ncetinierand Policynumbeer'are: Cartier. ,7fq'�/ ✓IG+ Policy Na.: CERTIFICATE OF MEMMON FROM WORKERS' COMPENSATION INSURANCE (This section need not becompmad!if ile Permit is foram hundrW dollars(51x0) or lass.) I cenify that in the performance of the work for which this permit is issued.l"I not employ any person in any manner m as in become subject to the Workeri Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Cen rmau of Exemption,you should become subject to the Worker's Compensation previsions of the labor Code.you must .,z forthwith comply with such pravisiom ar this Permit shall be domed revoked. Z O CONSTRUCTION LENDING AGENCY 1 bereby swim that dem is a convection lending agency for the perrormmce of 'Ya,7 the work for which this permit is issued(Sec.3097.Civ.C.) SQ lenders Name 2 Lcmmr,Address U Q I certify that 1 have read this application and state that the above information is (4 E' coned.I agree to comply with all city and county countess and suis laws mlaung to O V Wildingema tion,mdhembyauthoaaemPMMnUlivesofthiscitytoenterupnnthc N CL ahovoms,judgments. udg d PmP out for rail inspection ces puryaua (We)agree to use,indemnify ad Iecp harmless the City of Cupertino against F 'abiliue=nCC a the osis and cutest which may in any way emroc against said City („)z in covegnence of the graining Of this permit L APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU /pIS��� / sign re p onto ter Re-roofs HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof Will the applicant m future Wilding Occupant tom or lundk herardous material xisi�ss ae'-it by the Cup out Micampal Code.Charier 9.12,and the Health and Safety ode,5❑Y a 35532 (x)? 2< All roofs shall be inspected prior to any roofing material being installed. Will thea Applicant future building em ant am If a roof is installed without first obtaining an inspection,I agree to remove PP S p eaAirQuality arta which g P h hasardaus air conuminanu as rkfincd by the Bay Area Air Quality Maaagcmcm all new materials for inspection. 7dua strict? ❑Yes CrNu 1 have read the Ismardousmaerials requirements unear Chaper6.95 of the Califor- Health&Safely Code,Seeumu25505,7553]and 25534.I understand thatifile Wilding not currently hoc a tnant that it u my responsibility to noul'y the Occupant of the u' n artoissaaneanccrupemaram cy. Signature of Applicant Date TcoS o tier car, oriud agent D,e All roof coverings to be Class"B"or better Community Development i 10300 Torre Avenue ( Cupertino CA 95014 Telephone(408)777-3228 CITY 0, Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRES : '^^ PERMTr# doo'� Ove.Wre( ( . © Lf Orcd OWNER'S NAME: V//00 pe, ((, PHONE# O o?rJ- 30? GENERAL CONTRACTOR FAX # 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 n /Tile n� / Owner/Contractor Signature ate CITY OF CUPERTINO o S-' 6 a e) g o �-- WATER HEATER CITY OF CUPEI�TINO PERMIT APPLICATION FORM APN# 3 (d — 3— Oc�2 Date b. S- Building Address: Owner's Name: Phone#: z{o8 -a53-a/S Contr tor: Phone: License#: f c� v �� -(n - 1 / Contact: Phone: Cupertino Business License #: lam( Cr �lJo '�fJ�� Building Permit Info: / Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: ,77 � � / 5/YIiC Kc51%'crin/3 Tr P Residential Commer ial ❑ Cost of Project: 4,5oo • Strapped 11 On Platform ❑ Bonded ❑ New Location ❑ Replacement LJ' Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMTTFEE Plumbing Permit Issuance PLUMBING / BENERGY Energy BUILDING BUSLIC Business License BUILDING