05120037 CITY OF CUPERTINO -,
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BuLEINGADDRESS: LOEWEN & FRECH INC H PERMIT NOO 5 12 0 0 3 7
50 STONERRTT)rF ST
0!R'S NAME: PERMIT ISSUE DATE
PETER & LINDA MORRONE PMB #242 12/08/2005
E: SANITARY NO. CONTROL NO,
8313354632
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
o p LICENSED CONTRACTOR'S p DECLARATION
1 hereby affirm then I am lose Bu under provisions of Chapter 9(commencingsis Job DeSCIIp[I00
�� with T00117 of Division Sefton BusinasandProfcssiam Cadc,and myliccve is
tarter in run rota a^d ertecr. REPLACE WATER HEATERP/Al
jy�? Licenx12 Conti I��
'F
Data CanIIHCIOrFILCHH (�
ARCHITECT,DECLARATIONo /�
w1 understand my plans¢hell he used as public moths {p`F/}jbV1'lllJ
Ja
p O
G to Licensed Profossional O6
S OWNER-BUILDER DECLARATION -
E n o I hereby affirm Nat I em exempt from the Caths Coo License Law for the
O o which
mason Permian?11313,Business and improve.
de oas Code:Any tiny or roomy
E m which mquims a permit m construct,eller.improve,demolish,or repair any swclurth%la O 0
Lmi prior m its issuance.also requires the applicant for each Permit to File a signed statement
ire Nan he is licensed pursuant to the provisiomMthcContracor''sUameLaw(Chapter 9 Sq. Ft. Floor Area Valdat
R,
(commencing with Section 7f)(10)of Division J of the Business and Professions Cade)or
On.lie is exempt therefrom and de basic for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of
not mom Nan Eve hundred dollars(5500). Ef Occupancy Type
El I,as owner of On,properly,or my employees with wages is then sale compensation,
will do Ne work,and the c rac um is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's Lt.Law does nor apply m an owner or Required Inspections
property who builds or improves Ihemon,and whodoessuch wart himself orthrough his
own employau.provided Nan such improaments One not intended claimed forsala.It.
however,Ne building or improvemmnt is sold within as year of eompledon,the Owan
Wilder will ban the Waited of Proving Nal he did not build or improve for purpose of
sale.).
❑1,u owar of the propi em exclusively contracting with lianxd contractors to
construct the project(Sec.7W4,Business and Professions Code:)The Container's Li.
arve Law does not apply as an Owner of Propenywho builds of improves thexon,and.
who contracts for such pmjcm with a contractors)licensed pursuant to to Contracroes
Lim
am cacm andel Se ,B At P C for this
Data
WOR
1 'S COMPENSATION DECLARATION
I hereby such under penalty of perjury one of the following decla sitiom:
have and will maintain isCer iOate of Consent o xlf-insum far Workers Carrier.
union,as provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Inaunnce,as required by Section
3T000(thC Inbar Code,fm Nc pame of the work for which Nis pemhit is issued.
My Workers COmperwton Inw.rana ccarrier and Policy number are '
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section and net Wcompicvd if the permit 4 foram hundred dollars($100)
or ass,)
I cenify than in the perfafm of the Warl,for which this permit';issad.I shall not
cmployanyperwninan man an a,5 aaboadjgCant, oNe Workefi Compensation
Lawsof Califomi. a t 1 r]S
Applicant �s
NOTICE 70 AP CANT:14 after making this Ccnifcate of Exemption,you should
become subject o the Worker's Compensation provisions of the LOW Code,you mot
.J Z forthwith comply with such proviuoas or this permil shall be lamed revoked.
Z OCONSTRUCTION LENDING AGENCY
PI hersby afMn and there iso eorvuuction lendingagcay far the perform.Of
1>rto work for which Nu permit is issued(Sm.3097.Civ.C.)
4W A Lmdm'f Name
z Lcadera Address
V Q 1 certify that I ban read this application and auto that the above informNon is
w F macro I Agra in comply with all city and county onlassa Cs and aide laws mining on
0U building eonwacrion,and hereby authorim represenmives of this city to enter upon the
G ahovc-mentionedpmperty for depenses purpvwhich may
(We)agree to can.indemnify and keep harmless the City of Cupertino against
Ter incoiteejudgmenv,coalst fth expenses which may in any way eccroc ageinsrcaid City
V Z m consequence of the gra it of this permit.
vC
^ APPLICANT DERSTA OS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RE A 0!
d Re-roofs
Sgnazuroof Appir HAZA DOUS MATERIALS DISCLOSURE Dam Type of Roof
Will to applicant or future Wilding aceup tum nom of handle hasasdo er material
coneby rhe Curtino Municipal Code,Chapter 9.12,and the Health and Safety
.Secd tion 13532
(pea)? All roofs shall be inspected prior to an roofing material being El Y. o P P Y g g installed.
Will the applicant or future building Occupant ae,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hat dow air contaminants u d hand by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑tics u
I have mad the Wa dous materials requirements under ,Chapmr6.95 of Oc Califer-
ad.14.lthkSafctyCode. am25505.255JJand255J4.l unaerazam Nazi(the Wilding
docs run c have ¢nanx Nat in n my mxpomihiliry o notily the aceupul of the
does n e hidh us et prior tu issuance of a in,'On
1�ff Oma cy.
A Signature of Applicant Date
Owner orauthorindagen �� Dam All roof coverings to be Class "B"or better
x Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEKTINO
Building Department
JOB ADDRESS: PERMIT#
zz bso ��/ z o 0 3
OWNER'S NAME: MO 9ZOlb- PHONE # 8 - 2 U
GENERAL CONTRACTOR:LO 6b 1 I AX #
I am not using any subcontractors: 6XC
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
TjJ,e
-Mr-
Owner/Contractor Signa Date
CITY OF CUPERTINO
WATER HEATERCffY
7
CUPEI�TINO PERMIT APPLICATION FORM
APN# -3L) 2- 13 0 3 CF
Date: 12-- 08—0S
Build in Address:
SCS SIO`(1'e (�2tD(�
Owner's Name: +—/10 Q-Cor p— Phone#:
O ev e✓L Ll N �134 2y O
Contractor: Phone: License#: qj��g �
2 ctije c. ; J 335 y63�-
Contact: Phone: Cupertino Business License#:
�� �tfi I 335-463`Z 2 12- 1 1--
Building
t_Building Permit Info: ID
/
BldgEl Elect El Plumb LW Mech ❑
Job Descri tion:
12
Residential 91--- Commercial ❑
Cost of Project: fi
Strapped On Platform Bonded ❑
• 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
t1— Z Z