04050107 CITY OF COPEATINO . tea: 7 ' �'''^f&= T "'
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' � ,�®R�INFI'JRMATIQN
BUILDING DIVISION PERMIT - -1D,;N''u,
BUILDING ADDRESS: HOT WATER INC PERMIT"°.04050107
11 6 4 4 PERMIT LGne DATB
OWNER'S NAME:
JOHN LIOU 2531 GRACEIAND AVE
SANITARY'N0. CONTROL NO.
NE:
(650) 298-8494
BUPERMLT INFO
ARCHiTECfyENGINEER: BLDG ELECT
PLUMB MECH
t� t--1 l---I f�
app LICE NSEDCONnR -nDRunderS DECLARATION Job Description
hereby a1Bam her 1 em ONTRlicensed under provisions of n0 Chapter Y(commencing
Z wjNSmuos70`Af Of DiA.lm of Nc Buainrsr end Profcasinru Code,end mylicemcia Q
A infall fmaaadoffset.n_ (p Z, REPLACE WATER HEATER /
��p� fix
Lice. s LIc.M
a.
Data A CNr1ECTS DE LAR TIO
1 understand my plans shell W used u Public records O `
,60
T C 1 Licensed Professional
OWNER-BUILDER DECLARATION
0I 1 hcnby afOrm.a I a1.exempt from the losmns Co License Lew for the
i
02 following meson.(Soden 703 mo Business and see.de oli Cade:Any anity I morin
ounty
$ which its
issi n permit re ars dm alum,impmw,demolish,s nr e a sig any twmum
M I, prior mitscensnce,also unyodue thovisios 0 foe such Pcrmelaecruse signed statement Sq,Ft.Floor Area Valuation
< That me ccensM pursuant 7")provisions of dueCommitteesLicenselaw(Chodms9
(ret he is
{commencing with Section7")and of hands n 3for of too
eged exemnd ption.
Any
Code)or
that hent 31.5 b timy.p li and du boar for Ibe alleged esemam to Any violation of
aSerum..,.. cast by hanapplicantfonpermitmbjoutheapplicanuoanvilpenaltyof Gt$u00 Occupancy Type
not mort Nen five hundred dollars(5500).
Lo ownoof the Pmpm&a not
hmyea withwagsoIMir role vompensaiess
will damewmea end thesoComisur'sLMede Law it mret apply an 44,AnO nerof Required Inspections
And Professions Code:The ConuacmYa License Lew tl h net apply lf en owner is q P
property dsnrimpravathenogand who dmsemhendhlmseee though his - -however.
Mera,provided N rovemimprosemenu armor ear ofoded m at sed for 941.It.
bull&' me building atimprovement is said within one year of cpm.on,far Ne owner
builder will have the burden of proving mo he did mer Wild or improve for Purpose of
sale.l.
❑1,M owner of the property,em exclusively convecting with licensed ronuamon m
construct the pamper(Sec.7014,Business and Profes ion$Com:)The Contractors Li.
cense law dos not apply m an owner of property who builds or impmw meRO .and.
who comsacts for such projects with a convacur(s)licensed punoant In the CO"Imchars
Lkensa Law.
❑1 am exempt under Sec. .B&P C for this mason
Owner Dale
WORKERS COMPENSATION DECLARATION
I hereby sham under mostly of perjury am of the following declarations:
I hew and will mainum a Cer ifiau of Consent in selfdnsure fm Wadon's Console
sono.,As provided fur by Section 3700 of the Labor Code,for Ne pedormmce of Ne
We
for which this permit is issued.
ave and will maintain Worker,Compensation Insurance,ss m4uimd by Section . .
'of the labor Cade.for the performance of the work for which this permit is named.
My Warkcf,Com asnation insurance amu and Policy number Am::..[�Jl�–
Gamier. CT �e—F F1. MOlr N FROM WORKERS'
COMPENSATION INSURANCE
rfMs=One mail not lw completed if the remit lsforanc hundred dollars(5100)
or las.)
1 certify that in the tufa marec of the work for which this permit is Issued,1 shall not
employ any Nixon in any mmmrm AS In Womac subject w the Wadeef Commnee bon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:It,after making,dent Cenifceu of Exemption,you should
bacome suhjoct to to Wo tan'.Compensation Pmvisiom of the Lehrer Cade,you mum
0 O forthwith comply with such provisions M this permiuhall o domed revoked.
ZN CONSTRUCTION LENDING AGENCY
(~ Ihereby Aran Nat dart is a construction lending gency or the performance of
CC> me ward for which this permit u issmd IS..3097,Civ.C.)
W 0 Lender's Name
z Lender's Address
V O 1 certify that 1 ham mad this application no sum met the anew information is
W F Cmmcel.I agree to comply with all city and county ordinances and sun laws relating to
V building cm)agree n.andhenbymthorim mpremntadwse this Of toeteno ago the
W ahwe-mentioned property ror impectian NrP0mL
{', 1 (We)agree m cons antic expenses
and hi c0 hannleM the y Se of against against
r^N) li emcaa,judgmcntincauang Of this awhich may in any way eccruv against Wit Cly
(�Z inconsequence of thegranting of misDWI
Fr APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RE A NS.
(L(Q Q� 'll D� Re-roofs r
Signaturcofic HAZARDOUS MATERIALS DISCLOSURE ate Type of Roof ((
Will the appliam or future building mourner nom orhandlc handout material
as dented by the Common Municipal Code,Chapmr 9.13,and the Health and Safety
IDmirict?
de,Section 73532(x)? All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant or(utum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it henrdnus air contaminants M defined by the Bay Area Air Quality Management all new materials for inspection.
IYu r�1 have mail mehanmousmaurislsrcquiremcnts underChapurb.95of thcCalifon
Ha)m&SafetyCode.&&.. M5,25533and25534.IMAkoumnJthatifthu building
cs mol curtently how a tcnenL Net it is my respoMibility m notifyOeoccupantoftheuirements which be norm mann ofa Certificate mf13ce cY Signature of Applicant Date
�X �7wo----�� 5/O I All roof coverings to be Class"B"or better
Owner r authdrin, Dim
Community Development
4 10300 Tone Avenue
� Cupertino CA 95014
Telephone(408)777-3228
CI OF
Fax(408)777-3333
ICUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
619kS 0 I 0
OWNER'S NAME: Q pL�) PHONE # - q9
GENERAL CONTRACTOR: 140r (.jPn-T Z,-Xt f FAX # -8 Y F6
I am not using any subcontractors: ��'l�n::fQ
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/Contractor Signature Date
10/28/03
I
CITY OF CUPERTINO �7
WATER HEATER `' �U /
CUPERTINO PERMIT APPLICATION FORM
APN# � �� _ _ b / - Date
Building Address: ( �
Owner' e: �( Pho�
uiL,
Contractor: Phone: License#:
HOT WATFR INC. J -ff`%
Contact: 963 INDUSTRIAL ROADUNIJI Phone: Cupertino Business License#:
SAN CARLOS, CALIFORNIA 94070
Building Permit Info:
Bldg ❑ Elect ❑ Plumb LJ' Mech ❑
Job Description:
Residential Commercial ❑
Cost of Project:
�
Strapped ❑ On Platform El Bonded ❑
New Location ❑ Replacement
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
�6P 2-