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04050105 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONT.RW TOR'INFORMATTOl e- - b.,� BUILDING ADDRESS: HOT WATER INC v..,r N004'050105 :10019 OAKLEAF PL OW NER'S NAME: PERMIT L'SUBDATE FAY CHONG 2531 GRACELAND AVE 05/19/2004 ZONE: SANITARY NO. CONTROL NO. (650) 298-8494 ARCHITECnENGINEER: BUILDING PERMIT INFO ELECT PLUMB MECH e O il 0ep LICENSED CONTRACTOR'S DECLARATION Z lob Descri m UW I hereby affirm Nns at I am licensed under provision of Chapter 9(commencing with Section 701111).f DivisionSoftheBeat.and Pofuest...Code,arldmylim.sno, << mfmllbmeanderf .��6 Lie.x REPLACE WATER HEATER L z� oar° Came.' ft. 8" 2004 ARCHITECTS DECLAR( TIO I understand my plans shall be wed as public records It°6u BUILDING G� Licensed Professional 3 OWNER-BUILDER DECLARATION Commences E<� 1 herohy.(firm that 1 1. exempt(,tired r Cssions os e:Any Law for the OO which mgmason. ermitt 7,e 1.5,Business and Professions kowli Ca le:Anycity mouthy E$ which ayuira a Peril m cnnswct,alar,improve,demPlixh,or repair ay structure $500 prior m its issuance,aim require f applicant for such permit to fate a signed statement FF < that he is licensed pursuant to the previsions of the Common's License Law(Chapter 9 Sq.Ft. Floor Area Valuation Y�Q (commencing with Section 70110)of Division 3 of dm Business and ProRexions Codee)or y that he is exempt therefrom and the buffs fm the alleged exemption.Any violation of Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penally of a Occupancy Type not more then five hundred dollars(5500). ❑I,u owner of the pmpeny,m my employcm with wages u their sole compensation, will d.the work,and the mucture is not intended or offered for sea(Sec.7044,Business and Freebooters Code:The Commences License Law does not apply m an owner of Required Inspections Property who builds.,Improves thereon,and whodmssuch work himself.,Borough his own employees.provided thalauch Improvements are notheended mortared forest.if, hownwr,to.building or improvement la said within con,year of complains,Ne owner- bullder will have the burden of proving that he did not Wild or improve for purpose of ale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's LF cense law does not apply to an ownm of properly who Wilda or improves uemon.and. who contracts for such projects with a comnetor(s)licensed pursuant o tis Contractor's License Law. ❑1 am exempt nder Sm. .B&P C for this mason Dwmr Dae WORKER'S COMPENSATION DECLARATION / I hereby affirm under Knotty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self-insum for Worker's Compcm anion,as provided for by Section 3700 of the labor Code,fm tie performance of the work for which this permit is issued. �f I have and will maintain Worker's Compensation Insurance.as required by Section 3700 of the labor Code,for the performance of the woh forwhich this permit is issued. My Work(cerr's Compensation Insurance amm and Policy number are: Cartier.JT� �tiNn Policy No.: � CERTIFICATE OF EXEMPTION FROM WO KERS' COMPENSATION INSURANCE (This we ren recd not W completed iflhe permitisforonc hundred dollar(SIM) or less.) I cenify that in the performance of the work for which this Permit is Issued,I shall not employ any person in any manner an of he become subject to the Workers''Compensation Laws of Califomia Dau Applicant NOTICE TO APPLICANT:It,after making this Certificate of Exemption,you should become subject to lie Worker's Compensation previsions.(the Labor Code,you mut 0 forthwith comply with such provisions or this Permit shall W rimmed revoked. z ^' CONSTRUCTION LENDING AGENCY Fs� IWreby.Rren Baal there is a construction lending agency for tis Performance of p$> the wank for which this peril is issued(Sec.309?,Ci,C.) QLender:Name =z Lender's Address U 0 1 certify that 1 have mad this application and sum Beal the above information is D.P correct.1 agree to comply with all city and county ordinances and sum lave totaling to 0 U building construction,and hereby authorirs reproweadves of this city to enter upon tis L57 eWw-memioned property for iupecti.n purposes. (Wo)agree to ave,indemnify and keep harmless the City of Cupertino against „y y Itebilides,Judgments,costs and expenses which may in any way same against said City V Z in consequence of the starling of this permit. a.r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date SOURCE R ATION — 4 �r / QS IgjQ Re-roofs Signature Pp c to HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding occupant stow or handle Woodcut material u tlefined by tie Cupertino Municipal Cade.Chapter 9.17.and tic Hcalu and Safely .de,soY�25537(.)'7 'FN - - All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mil h1'raNnus air canumItems u defined by Bac Bay Area Air Quality Management all new materials for inspection. District? ❑Yes le. Ihawmad theh,&cis smaan ,255utmdc 534.derdce d.95ofthe Calding nits Health&SafetyCodeseetiom 25815.75533 and 25514.1 undersand thatifthc huilJing lyl) does nal vurnlly haw a terns,that it is my reme mobility Ire notify the mcuPenl of the royuireocnuW elpnorto;anccofe CeNficaa.fOlwancy Signature of Applicant Date 1. " "rxe ��'I5jty All roof coverings to be Class"B"or better Owner or auhonrcd agent Date ' auldiffle Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 ICITY OF Fax(408)777-3333 CUPEkTINO Building De artment JOB ADDRESS: PERMIT # /00/2 COs'©/ O3� OWNER'S NAME: r -to" PHONE GENERAL CONTRACTOR: ljo I n7Z,y�C, FAX # I am not using any subcontractors: ��-�C/� e, 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/Contra' br Signature bate. 10/28/03 CITY OF CUPERTINO �� l WATER HEATER l CUPEf �TINO PERMIT APPLICATION FORM APN# 2(;) r ? J Date: /6 Building Address: Owner's Name: Phone#: G� o,-6 - 4�-os�9 Contractor: Phone: . A License#: / HOT WATER, INC. (Q5�6 �(Q��_8 `'7 �U T/ ( 5 CD Contact: SAN CARLOS, CALIFORNIA 94070 Phone: Cupertino Business License#: Building Permit Info: — / BldgEl Elect E3 Plumb Cid' Mech ❑ Job Description: Residential Commercial ❑ Cost of Project: 0O Strapped ❑ On Platform ❑ B9nded El New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING 6 61