04110088 CITY OF CUPERTINO 6heCy x0rax�Ntyt2�4�'uRty-wA,CT01:Y R0�^AIxNLsI' 9*'1R'W1'rA.�A`_'W-T,•W1%a,9
:aDILDINc DIVISION PERMIT
.$
BUILDING ADDRESS: . HOT WATER INC Pr" "N'b4110088 --
19937 PEAR TREE L
( OWNER'S NAME: PBRMTr ISSUE DATE
BRIAN HEANEY 2531 GRACELAND AVE4
ONE: SANITARY NO. CONTROL NO.
(650) 298-8494
ARCHITECr(ENGINBER: BUILDING PERMIT INFO
BLDGELECT PLUMB MBCH
�O ZO LICENSED CONTRACTOR'S DECLARATION JOb DesGn nGn
u 1 beuby affirm Net 1 am licensed under provisions lir Chapter 9(commercial, p
with Sa Jan TOMB of Division 3 of the Business aha Pmfc W ons Cade.and my I icemen is
infull roceaadeIT REPLACE WATER HEATER.
5�Z Luenu Clw
u� DauIL _-
A CHIrECTS DECLARATION
3�y 1 understand my pita shall W used u public recaNs
i Licensed Profasiunel /
OWNER-BUILDER DECLARATION
5 I heathy affirm Beal 1 am(attempt from Be OMBACIars License Ice �orthe,
y
00 following mason.(Section 703 1.5,Business and Pmfasslons Code:Any city resiu ny-
Whichconnotes, 1 - .
%S LL RgYIRs a Permit In CmtANe6R
ahm.Wpm. of Rpull Ny momm
WI,Zsn poor m its issuance.aim requires se applicant forsuch permit W file aaigned sutemcm _ ��+
££ < Nat he is licensed pursuant ted ft proviLimu of the ContracaKs License Law(Chapter9 Sq.FI.FIOO�Area . .-._. 'J - Valuation
K $
(commencing with Section 700M of Division 3 of Ne Busineuand Psufauions Code)w --`
3 out he is exempt thmfrom and the basis for ft alleged exemptian.Any violation of
Section
ore dim, ive anyhuna pplicued alW or a Permit
e it subjects the Applicant te a civil penalty of a Occupancy Type _ --
0l,uawrdraftWpmpwy.mmyempl y=wiNmMuOe4wle mpemdon. - -
willdo thework,and W awclu[e tanaRer
imended oraed forsale(Sm.7041.Business -—
and Pa reaelam Cade:no commemers License Law das not appy to so amer of - Required Inspections
property who bu Ilds car impemvs semen,end who dates such work himself or through his
oro employees.provided that such Improvements am our Intended or onered for sale.If.
however.are Wilding or improvement is mid within arc year ofcompleuoa,the owner. .__ ._ ._.._ _. ..__...__r_..
Wilder will have BR burden or proving that he did not build or improve far purpose of
uicd.
❑1,As owner of the property,am eadusWely,contracting with licensed conoacun to -
==I rte project(Sec.7044.Business and Professions Code:)The Comruues U,
=am law deck not apply u an owner or property who Wilds at Improves Beeman,and
who coummusfor such projects with a conoecu(s)licensed punwnl la the Contractor's
Ltrenss law. _ - .•..
❑1 are eumpt under Sec. .B&P C for this reason
weer Data
. WORKER'S COMPENSATION DECLARATION
1 hereby affirm under p lie ty of perjury one of the following declarations:
1 Mw and will maintain a Certificate of Consent a ul6insure fra Worin'sCompen-
aation,As provided for by Section 3700 of the labor Cade,for the perf sm rem of Ne
wwkf whkh Nis permit is inand.
haw and will maintain Workers Compensation Insurance,an required by Section
3700 of the laWr Code,for the perfomance of the work ferwhich this permit is hissed.
My Workes Co In"It. n hjavaue amicr and Policy number are: p
Geier: ori/'gfit.L �'f4�t(.� Polity No.: /53
y0 �
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This whom need not uncompleted If the permit Is fnronc hundroddollan($100)
or less.)
1 our ify that in the performance of the work for which this Permit is issm,d.I shell raw
employ any person in try memersn As m became subject to the Workers Compevation -
LamofCalifamia.Date -
Applicant
NOTICE TO APPLICANT.If,afar making this Cm10cau or Exemption,you shark!
become subject to rte Worker's Compensation provisions of the labor Cade,you must
,JO Tarantella comply with such provisions W this permit tall W decmed.wked.
Z i CONSfRUCT10NLENDINGA0ENCY
(+ Iarobyfiffire,that the.isamosructinn lendingagerey for Beeperfurmatemaf
!� the work fur which this permit is Asad(Sec.3077.Cin Q
Q Landers Nunes
z Lender's Address
U0 I certify Nat 1 haw read shit application and sue Bear the above infomaden 4
Gs.U correct.1 agree u comply with all city and county ordinances sed suss laws misting m
O Wilding contraction.end hereby auNoriR representatives of Nu ft
city crater upon
LSj abort-mentioned Property for inspection purposes.
IY (We)Igrea m um,indemnify and kap harmless the City of Cupertino against
y liabilities,judgmenu.case,and expenses which may in any my warm,again[said City
t)`J in containment of the treating of this Permit,
r+ APPLICANT UNDERSTAAAN/�D�S�ANDpWIIL�L COMPLY WITH ALL NON-(POINT Issued by: Date
5(:4 REGIiLATfOr leaf z �Cl'�wtti. I t I�((/0 7
1��l Re-roofs
Sitntw.or AppllapnDau
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
IdeasWIR the a Cupertino
or future Wilding eauput atom or and t e Health a material
defined o the Cupeuno Municipal Cade.Chapter 9.12,and the NcatN sed Safety
cede, 0 VAId zss3zaPVA. . All roofs shall be inspected prior to any roofing material being installed. -
Will the applicant or fuum Wilding occupant use equlpmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Mit hazardous air contaminants u defined by tle Bay Area Air Quality Management all new materials for inspection.
gUim7
OYn l2�
new nead the bazudtwsmau0alsreg3And 2uunderCapter Bud Ba a Wilding
-in Health Safety Code,Satia,BanItism 33uJ157b.I undeNand lhulfNc Wilding
rot curRnOy haw a.rug Nu It u my mepanaihility m notify Uo ccupanr of seyul mcnawh' hmusIbe Lprior uisauucaraCenigcaum a nry. Signature of Applicant Date
J l r'0
W.,car Nthorl]Lda Cm Data roof coverings to be Class"B"or better -
/I
Community Development
OCIF
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRSS: PERMIT#
I C1 T
9 -7 'P axrfneo kaoe, 0 (41/ 068
OWNER'S NAME: 13r1&- 0 IjLfane. PHONE its 1
GENERAL CONTRACTOR FAX # qO oz 5 7-
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 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 h6t PV&* r In C—
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Ah Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
6c?k)
WATER HEATER "
CUPEkTINO PERMIT APPLICATION FORM
APN# —3Uyb(a Date: /S/a
Building Address: (� 7
1993-7
Per. �T� Cie V1
Owner's Name: 6r•lav) ` � „ e Phone Llt)8 X5 -7—=,
57_7 2Q 0
Contractor: � / �l }��(I•'^G hone: J8(/� License#• /� / ,aX,
Contact: U T � ul / I �. Phon t I Cupertino R�BBuJ si e(ss License#:
Building Permit Info: — /
BldgEl Elect El Plumb LY Mech ❑
Job Description: &-/r 1 , )0771v/� i�
Residential Commercial E] C� U
Cost of Project: i—M .
Strapped 0 On Platform LJ oQded
New Location ❑ Replacement
Qt if
A ,cable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
1LV PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING