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04030146 CITY OF CUPERTINO - CO BUILDING DIVISION PERMIT $4 Wu �^ , , " t� - BUILDINGPERMIT NO. 1°Y"` STAFFORD DR ALL VALLEY PLUMBING 04030146 OWNER'S NAME: PERMIT ISSUE DATE iialkWILLIAM MILLER 170 BRANNON DR 03/16/2004 ONE: SANITARY NO. CONTROL NO. 996-0480 TRACY, CA 95376 ARCHITECTIENGiNEER: BUILDING PERMIT INFO REPLACE WATER HEATER BLDG ELECT PLUMB MECH 0 0 0 0 �Op LICENSED CONTRACTOR'S DECLARATION Job Description 1 michy affirm that I am Ilcen cd under provisions of Chapter 9(commencing p i with Section 7")of Division 3 of the BusinessaMProf ssionsC end mylicev is nIS in force n 1, t7�' C'NALE® Z ,Z Licen La.r r 3 Dam Contracmr g ARCHLTE tic RAT RATN a< 1 untlCptdnJ my plana shall W Saud u lie rtcnrM MAR 2 2 2004 Deo tea Licensed Pnsfessiunal OWNER-BUILDER DECLARATION A I hereby affirm that 1 am exempt from she Compactors License Law for the ��'�®I�� E o o following mason.(Section 703 1.5,Business and Profevium Code:Any city or county M I E Which Acquires a permit to construct.alter.Improve,demolish,or repair any slNCtum prior h,its issuance.also requires the applicant for such permit to file a signed statement that he is licensed Pursuant m the provisions of Ne Contractor's U..Law(Chapter 9 Sq.Ft. Floor Area Valuation FmFa (commencing with Section 7")of Division 3 of the Business and Profsions Code)., $ Nu he Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fora Permit Subjects the apphcam m a civil p really of APN Number Occupancy Type not more Nan Eve hundred dolls,($5001, ❑I,as owner clubs property,or my employees with wages u their sole compensation, will do the work and the sma um is notintentled ora@red fmsam(Sec.7044,Business Required Inspections and Professions Cade:The Construes License law does not apply to an owner of q p property who builds or improves thereon.and who does such work himself or through his own employees,provided that such improvements tie not intended or offered for tile.if. however.the building or improvement Is sold within one year of completion.the owner- builder will have the burden of proving that he did not Wild or improve for purpose or Sale.). ❑1,as owner of the property,am exclusively contracting with licensed.nuamaa to construct the project(Sec.704,Business and Professions Cade:)The Contactor';Li. cents Law docs not apply to an owner of property who Wilda or improve.;themon.and, who contracts for such pmjccu with a ca,racsar(s)licensed pu,uant to Ne Conincmrs License Law. ❑I am exempt under Sm. ,B&P C for this mason Owner Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury ane of On,following decimations: 1 have and will onsumin a Certificate of Cement In self-Inaart for Workers Co.,.- Soon,as provided for by Section 3700 of use labor Code,for the performance of fie work for which this permit is issued. C 1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of Ne Labor Coda,for Ne pe ormance of d work for which his permit is issued. My Workers mr Cad nim race..,orth Policy number Cartier. '� Polity Na.: �yCEATIFl A PE%EMP170N FR0 WORKS S' ✓ COMPENSATION INSURANCE (This It.ncetl trot Ise completed if u,Permit Ishumic hundred dollars($1001 nrlcss) I anify that in the Performance of the work for which Nis permit is issued.l shall not employ any person in any manncran As to become subject to the Worker'Compensation laws of Califamu.Data Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should become Subject m the Worker's Compensation previsions of tint Lebo Code,you must ,J O forthwith comply with such provisions or Nis Pt shal ermil W deemed revoked. y a-" CONSTRUCHDN LENDING AGENCY Fa I hereby alfiml that thea i9 a construction lending agency for the Performance of a> the work for whim this permit is Sound(see 31»7.Civ.C.) A W� Lenders Name cl z Lcnders Address - . I certify Net I have rod this application and sum Net Nc eWve information is correct.I agree 10 comply with all city and county ordinances and sate laws relating in 0 building convection,and hereby autharix representatives of this city to enter upon the W shove-mentioned propeny for inspection purposes. Qa (We)agree to Save,indemnify and keep harmless the City of Calamine against M liabilities,judgments,casts and expenses which may in any way accom against said City �, V Z in consequence of the Scanting of this permit. APPLICA UNDE TANDS AND WILL COMPLY WITH ALL NON Of Issued by: Date SOURC GU A Re-roofs Sig Ap c Cuntncmr am AZARDOUS MATERIALS DISCLOSURE Type of Roof Will the Inset or future building Asturian store or handle Imoodun material n defimetl by the CupeninA Municipal Code,Chapter 9.12.and the Health and Safety atic, E]YOS]5532(a)? rte/ All roofs shall be inspected prior to any roofing material being installed. ❑Yea p . Will the applicant or fuure building occupant oat equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hmardnus Sirwnaminants n dcfmcd by Ne Bay Amo Air GAO,y Management all new materials for inspection. 7District? '}� ❑Yes t I have mad the hxaatdous memos[$requirements under Chapter 6.95 of the Califor. a HcalN&Safely Code,Semon 25505,25533 and 25534.1 understand thattrue building ocs nos currently ham a tenan4 Nat is a my responsibility m notify the uaupanl Ncqui ntswhic IWmclpdormisssmmeo(aCc 'ficateof0scup Signature of Applicant Date ruram o'.edegcm Dam All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 1C, Of Fax(408)777-3333 UPEkTINO Building Department JOB ADDRESSI, PERMI 4030 3v / OWNER'S NAME: PHONlb#51 GENERAL CONTRACTOR: 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 JG ooring: Carpeting noleum/ Wood ass / Glazing ating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing l Roofing Septic Tank Sheet Metal Sheet Rock Tile 0n or Signature l ©e CITY OF CUPERTINO WATER HEATER CUPERTINO PERMIT APPLICATION FORM [Building PN # r— O i Address: 17 Oo7wner's�Name: Pho #: ?r-eq 1iZ Phone: v Li�guse#: o - L Contact, P ne: Cupertino Business License #: bY-/ / Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: Residential Commercial ❑ r st of Project:apped n Platform ❑ Bondedw Location ❑ Re lacement Qty, if A lic e Fee ID Fee Description Fee Grou BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY Enerav BUILDING BUSLIC Business License BUILDING F-o