Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
04030175
CITY OF CUPERTINO °iu*"* '� 'II^"� � " `a''° BUILDING DIVISION PERMIT �C0NTRAC�"TORJNFORMAT+ION' 3�n :Y 2A , _.3 'aa>xmw7•?'�v � —�2tfit *�, BU ILDING ADDRESS: ,. PERMIT NO. HOT WATER INC 04030175 ' ' OWNER'S NAME: PERMIT I".SUB DATE WA ONE: SANffARY OL NO. ARCHITEC AINGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH l� l! 0 >!O o LICENSED CONTRACTOR'S DECLARATIONirgi Job Desc �t I m7 affirmiA 1antfCmtsml underpmvluO"of chapter my licensing 'I`�ALED A� wlN sec ameb,10)or,that I o 3 licensed a&+MPrsfnsiof Code.and 9(C.rhmments n e is in full forte and effect. REPLACE WATER HEATER bp Z License Class Lk.R Z Dalc Contractor In ARCHITECTS DECLARATION T 2004 Iundersundmyplan.Mvlltensed"public records NOVPIU O L 36 Z ti Llecnsed Pro(usional OWNER-BUILDER DECLARATION BUIL®I N i�E 1 hereby 4Erm N"1 em cmmpt from IW Conlnmofs Liven¢Lew for they00 following maaon.section 703 1.3,Business end Prufe"io"Code:Any city or county 119 which soquires A permit on construct,alter.improve.demolLeh,or repair any structure prior to its issuance.also repuiree the applicant four such Permit to file signed sutermnt < that he is licensed pursuant in the provisions of the Contractor's License Law ChAPICT 9 Sq.Ft.Floor Area Valuatio ae 0 (commencing with Section 7")of Division 3 of the Business and Pro(esslom Cook)or 3$ that he is exempt Ncmfmm and the buss for she alleged esempdon.Any violation of Section 7031.5 by any Applicant for A permit subjects the applicant to a civil Pointy of 3 8 N1 4gr0 0 Occupancy Type not more dun fin hundred dollars($500). ❑I,As owner of the property,or my employe"with wages as lhelr sok compensation. will do the work,end Ne nmctute isnot intended or offered for sale(Sec.7044.Business and Profesalo"Code:The contractor's Liam,Lew don not apply N an Owner of Required Inspections pmpeny who build,or Improves thereon,and who does such work himself or through his own employes,previded Out such Imprevemenu art notinmrded oroRered forsals.It, however,the building or improvement I. to within mu year of completion,the owner- builder will have the burden of proving that he did not build At Improve for purpose of ole.). IM 1,as owner of the property,am exclusively convecting with licensed convectors to co"tract the project(sec.7044.Business end Professions Code)The Convecmr's Li- ce"e Taw docs Tat apply to an owner of propeny who Wilds or improves thereon,and who Contracts for such projects with a comncmr(,)licensed Panamint re the Ommarloe. License law. I am exempt under Sac .B&PP C fm this moon Owner Data`� l WORKER'S COMPENSATION DECLARATIOy I hereby affirm under penalty of perjury one of the foil QJug he �- Iban and will maim+in a Cenificamof Consent to salf-insure for WorkefsCompen- satimn.u provided for by Section 3700 of the Labor Code,for the performance of On work for which this permit is issued. ❑hove and will maintain Worker's Compensation lomnnce,"required by Section 3700 of me 1aWrCOde,for on,perform ace of Oe work fmwhiCh Nis Permit Is Issued. My Worker's Compensation Insurance carrier and Policy number Am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (is section need not Wcompleted If Ne Permit is fmonc hundred dollm(SIgB or lass.) 1 Certify that in the performance of the work for which this Permit is issued.I shall not employ any person in any manner an As m become subject to the Worbox Compe"ation Lawsof California.Date Applicant NOTICE TO APPLICANT:If.after making this CeniO"u of EaemPtion,you should become subject in Ne Worker's Compensation Provisions of the labour Cade,you must Ofornwith romply with such provision.our Nie Permit Mill W domed revoked. Z► CONSTRUCTION LENDING AGENCY [-+ 1Ineby+Erm Nat there isacO"wctinn lendingagancy for one performanceOf C4> the work for which Nu Permit is issued(Sec.3097.Civ.C.) [i1 A Lendcr'a Name =z Lender's Address V Q 1 cer0(y Nu 1 have reed this application and Nm this the above information is 74!' Cmma 1 agree to comply with all city and County on inanCes and shim laws misting m C)Sl^J building eonawnion,and bemby authorize mpmannthivrs of this city in enter upon Ne r +hove-(We)A re pmpeny for emnify An keep bur /y (~ gL (Ws.),gees,saw,indemnify and keep may in An w y.of Against said ego"t y incomaxpacdgmcnu,coming Of this may In any wayancruc againatsild Ciry C)7 in APPLICANT of the Reaming of Nis permit. F� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SOURCE REGULATIONS. Re-roofs �re of AppliCMVCOnnhCtor te HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding aceupanumm or handle harsNo"material "defined by the Cupertino Municipal Code,Ch+pmr 9.11,end the Health and Safety Code,secOOn 15373(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes {$ m Will Nc Applicant or future building uecupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit ha'rallo"air contaminants"defined by the Bay Arca Air Quality Management all new materials for inspection. District? ,+. ❑Yes js''No I have read the han dmu materials requirements under Chapmr 6.95 o(the Califor. Tia Hcalm k SafetyCode,Sections 8505,15533 and15534.I understand Nat ifNe Wilding does not currently ban a moans,that it is my mspomihility N notify the mcuPant Of the requirements which must W mel prior to issuance or a Certificate or Occupancy. Signature Of Applicant Date ermau.Itdaenf z a All roof coverings to be Class"B"or better aClOF Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408) 777-3333 ` UPERTINO ' Buildin Department JOB ADDR $5; PERMIT # O O c h 3 OWNER'S NAW-. TA4)%+2,7 PHONE *N b ¢ - ,o q GENERAL CONTRACTO o1- jj(3 O_t v Gv)o, 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 S:; Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 2oma�cv fi (( P ®3 - tQ - acC- Ownerct Signature Date Y OF .. CIWO c,ATER HEATER CUPEkTINO PERMIT APPLICATION FORM APN# 34 b3 Dater- ( 4 ' d00 Building Address: rl 6 3 2 -FCtAIM. b u) Z . c Owner's Name: Phone#: Contractor: Phone: License#: 1pmG' 71 ©t a S 3 - -S 3 . 116 3 6 1 �j � �L Contact: /o f- - Phone: Cupertino Business License#: 140-'j-In2's'— Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Wc- InCx rro/r� o F coo-j-tf hna4t/0 Residential p Commercial ❑ Cost of Projeq� u 6Da — • Strapped © On Platform 10 Bonded El New Location ❑ Replacement Qty. i li a e Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING