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06040026 CITY OF GV PERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION;. ,. _n MRaHUN A. 'TT!yFl "NbCK SPRING CT PERMIT NO. 0604002-6 PERMrP ISSUE WNEI'�l" DA fCE JANG 1000 N RAND RD, #112 . 04'705/2006 PHONE (866) 293-3031 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 i00 LICENSED CONTRACTOR'S DECLARATION IOb w V w 1 hereby affirm that 1 am licemead under provisions of Chapter 9(commencing S ithScclion]MU)afDivision]ofNCB.O.,andProfc inns Co@.andmylicaurcis REPLACE HOT WATER HEA ? � TALL 12YR ; o, in full fora and affect. q= License Class �L .a 7?�ROCf%e�' Date�!'/r_ Ln/'_ Conuacwr�{<<c.�. LJ PR ARCHI=S SOECLARATION MrK (7 I < I understand my plans shall IIT used u Public records lUl i 1 )yU B U 40 Licensed Professional U/�� 3 OWNER-exempt rum the ommun �I ty I Mmhy affirm that I am exempt from the Contrazmfa License law for the tl O o following mason.(SCNun AA 1.5,Business and Professions Cock:Any city or county 5 Q 5_6! which roquou a Peril to cataract.alter,improve,demolish,or repair any structure poor w its issmerm.alsu mquiro Ilse applicant for such Permit to file a signed statement EE` NalhcisHeamedrandom,rodepmvisionsofdeConmcwriLicarvelaw(Chaper9 Sq.FL Floor Area 'alua[ion e� (commercial,with Section 7")of Division 3 of the Business and Professions Code)Lir i R 3 Out he is exempt Therefrom and the basis fee the alleged exemption.Any violation of 36651033 . 00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type not mom than RK hundred d.IWm(M). ❑1.0 awrcr of NC Propeny,wmy rmploywa with wagess their sole wmpcwtion, will do Ne worltand theawctun is not intendedordlferod for Sale(See.7W.Business Required Inspections and Professions Code:The Conmcwr's License Law doee ns;not apply to in owner of q P propeny who build;or improves Neuron,and who does¢whwwk himself orthrough his Own employees,Provided that such imporworents are not intended oro@rect forsale.If. however,the building or improvement is sold within one year of complcdon.the owner- Wilder will have the burden of proving Net W did not build or improw for purpose of sale.). I,as owner of the property,am exclusively contncung with licensed conitaewrs an covwcr the pmjecl(Sec.7044,Business and Professions Code:)The Cmaracwr's Li. cove Law dwa not apply m an owner of property who builds or improv Nemo.and who eontmcu for such projects with a conuocmr(s)licensed pursuant to the Convenor's License Law. ❑1 am exempt under Sec. .B&P C for this round caner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declensions: lha.e and will maintains Certificate ofConscnt coxal!-insurtfwWodohCampen- sation.as provided far by Section 3700 of Ne Labor Code,for the pedo...of the work for which this perosis is issued. Q 1 have and will maintain Worker's Compensation Insurance,ss required by Section 3700 of Ne labor Code,for the performance of Ne were fa which thii parmil is issued. My Worka's Compensationnsunna Icarrier and Policy number are `'t 0 : Cartier: l� 3 C. Polley No.: �G -211 I L(QG CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This inion road noE W complcwd if be Permit is for one hundreddollars(SIM) Lir Mss.) I artily Nat in thc perfom arca of duce work for which this Permit is issued.I shall not employ any person in any mammr an as w become subject to the,Worked'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should ' became subject on Oc Worker's Compensation provisions of Ne labor Code.you must .J O forthwith comply with Such pmvisiov w Nis Permit shall M deemed revoked. z CONSTRUCTION LENDING AGENCY I hereby affirm that Nem H a construction lending aFcne for the Performance of fYithe work for which this perosis i;issued(See.3097,Co,C.) aA Iandcr's Namc r7 z LaZa's Add= V O 1 entity that 1 have rod this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating to O V building construction,and hereby authonw represenutives of this city to enter upon the, ahow-nna tinned NeFcrty for ivperat or,osea (We)agree to aaw,indemnify and keep harmless the City of Cupertino against y IiabllideS,jidgmenu,eosu and expenses which may in any way acemc againstsaid City U z in consequence of the Starting of this Permit. r^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT SOURCE REGUL.$TIONS. Issued by: Date t� �,f 6 —'fY4';^-cJ� ti (Q 016 Re-roofs Signature of ApplicanVConuector Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the,applicant ser future building occupant swrt or handle ha ordous material ss defined by the Cupertino Municipal Cade.Chapter 9.12.and the Health and Safety Calc,Section 25532(a)? ❑Yes KIN. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining inspection,I agree to remove Will the applicant or future building Occupant um equipment or dcvioa which g an ection P g emit havardous air commm(vnv as dcftned by Ne Bay Area Air Quality Management all new materials for inspection. District? ❑Ycs kNu 1 have nad the hvammn materials mquimmcnu under Chapter 6.95 ofthe Califon out Health&SafetyCu le,Sand.75505.25533 and 25531.1 understand Net ifthe building docs not currently hoe a mount,that it is my responsibility m may Use occupant or the roquiramcnu which mast to mel prior m issvnce of a ccmraaw of RcopancY. Signature of Applicant Date gent ���D©� All roof coverings to be Class "B" or better Owner w authooaJ;gem Date Community Development �j 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 WUPEkTINO Building De artment JOB ADDRESS: PERMIT # �Icoscl cQz , CA- D t(oz'-�d OWNER'S NAME: adz.,( �! PHONE # p Z ( GENERAL CONTRACTOR: -6, „_,_N- ; FAX # I am not using any subcontractors: 4VL -cam Z( S (9CP 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�. �� 2 Z �Z Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Con tr or Signature Date CITY OF CUPERTINO lam 1 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36651033 . 00 DATE ISSUED. . . . . . . : 04/05/2006 RECEIPT # . . . . . . . . . : 33856 REFERENCE ID # . . . : 06040026 SITE ADDRESS . . . . . : 11509 ROCK SPRING CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ALICE JANG ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5124 RECEIVED FROM . . . . : JASON SCHERR CONTRACTOR . . . . . . . : PAUL HENDRIXSON LIC # 27607 COMPANY . . . . . . . . . . : METRO MECHANICAL INC ADDRESS 1000 N RAND RD, #112 CITY/STATE/ZIP . . . : WAUCONDA, IL 60084 TELEPHONE . . . . . . . . : (866) 293-3031 •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- -------- -- ---------- TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING 1 CITY OF CUPERTINO WATER HEATER iCulp VINNO PERMIT APPLICATION FORM APN t tl ^ - 51 - I - b33 Date: Buildi g Address: "Sbq ZC>a fcvt Owner's Name: Phone#: V i-4b Contr,ctor: License#: �,Lrrtb � �� tve_ Conta't: Cupertino Business License #: Buildi g Permit Info: Bldg ❑ Elect ❑ Plumb` Mech ❑ Job D scription: CC)O, n;co \�c t112 Resid ntialbA Commercial ❑ Cost o Project: Strapp d ElOn Platform ❑ Bonded New I cation ❑ Re lacement ❑ Qty. if A li able Fee ID Fee Descri tion BPWHEATER Fee Gro Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING f BENERGY Ener y BUSLICBUILD ING Business License BUILDING Y', ---T�,v149- tv.bNno (-Cat �,fg5Aat Lo e U00K4 �blQlQ aG�-3o�1 t5-35(9 -Ocs�3 �aV