04070100CITY OF CUPERTINO
BUILDING DIVISION PERMIT
PCONTRACT0% ORMATIONP
BG51 ADDRESS:
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AAAA -DRAIN PATROL
PERMITNO04070100 '
OWNER'S NAME:
PERMIT ISSUE DATE
JAMES WU
ONE:
SANITARY NO. CONTROL NO,
(408)98 -
ARCHITECT/ENGINEER:
BUIIDING PERMIT INFO
BO O PLUOMB MEOCH
j LICENSED CONnsed A R'S DECLARATION
I Mrtby a)of that I sat ad hap
under pmviuona of 9 (commencing
Job Description
f ft R
with Sai ] )Of Division lofom Buil and Profeuiom Coda, and mylicenmh
Cock,
°"� �J
//V'�
License L'I L .g
Dam us cloy
j
REPLACE WATER HEATER 8/
A .,I cm, D TIOf
1 un my plans,hall he used blit mcI
/Ot/
,n -
Licensed Professional
OatNE. DECLARATION
am.OER
I1 Mmhy .(Seco that 11. exempt farm the Cmumtoo License Law for the
'
L4 Business and sans CWC: Any city m county
cores
-
whfollich
which roquires a permit re construct,
a Permit he co alma improve, e o
vet demolish.m repair atmcmm
ante
the h pc i t ed
thatprioI LL1 its licensed iee purs a. also nt t111Me tyro visions o duefor Comobrmil lO censele a gaCd a hapten l
Ihatheincpursuant to of ole CnaRmmr 6lJanmisw(Chapmr9
Sq. Ft. Floor Area Valuation
(Commencing of Division Cade) Or
g xempth Sautn ]0nd of the Businesseexemption.
Nn he I,
V exempt thcmfmm and Ne bub far the alleged Gumption. Any violation of
basis for M
io any led doll for a Permit subjects the applicant to a civil penalty of
Settlor 7051.5 five
not mare Nm Ow hundred dollar (g5007.
Z/�N$�Qttl`k�er0 0 p
(]CCU ane
01. As owlmr of cox property, or my employees with wile, as their sole compensation,
r
will do the work, and the aWC1um is net Intended IX offered rot tale (Sec. 7044. Business
And Profusions Code: The Contractor's License Law it. net apply to an owner of
Required Inspections
properly who builds or improves thereon.and whodoesouch work himself or Waugh his
Own employes, provided that such improvements re net immoded oroRertd forsale IL
however the building Or impmwmcnt is sold within one yesx.fic n,l.d.a. Ne owner.
builder will have me burden of proving Nal he did not Mild or improve for purpose of
sale.).
0 1. a owner of Ilse Porten, am exclusively contracting with licensed contractors l0
construct the pretest (Sec. 7044, Business and Profession Cede:) The Contrmmrb Li.
'
came hew does no, apply M in Owner of property who Milds or improves Moment, and.
'
who contracts for such pmjeeu with a connotations) licensed pursuant to Ilse Convector's
License Law.
0 l un exempt under See , B& P C for this resacn
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury one of the following da mumar:
I haw and will maintain a Certificate Of Consem m selfdmurefor Workers C"mpcm
for by Section 5]00 Of the Labor Code, far the performance of the
this permit is issued.
ill maintain Workels CompemAMm Imurmre. ss required by Sectionor
"Vmvidedded
Code, far the performan. ofthe w for which this permit is issued.
mpemation Inaumnce carrier end Polity nu�m./bfeyr a/m:
a�
•11.0 PolicyNoA / f/'07 f` _ �
CERTIFIC • OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nal he complemd if the Permit is fm one hundred dollars (S I00)or
less)
1 anify Nat in the performance of Me work for which this Permit is issued. l shall not
employ any person in any manner so as in become subject to [be Workcu' Compensatlon
Law, of California. Dam
Applicant
NOTICE TO APPLICANT: If. ager making that Certificate of Exemption, you Mould
become mbjcct to the Worker's Compensation provisions or Ne ISMr Cede, you must
forthwith comply with such provisions or Nis Permit shall M deemed invoked.
CONSTRUCTION LENDING AGENCY
1 hcmby affirm that ft. is a cloomamon lending agency for the perfmmma of
the wart for which this permit is issued (Sec. 309L Civ, C.)
Lenders Name
Umber's Add.
I cebiry, that I haw read Nis application erdi sum Nal the Move information is
correct. 1 agree b comply with all city and county oNinaam and auk laws retailing to
building construction, and hereby aphorize, repmseautives Of this city t0 enter upon the
above. mentioned
rty for ms
purpo
(WO agree 10 saw, indemnify and kap ha mless Me City of Cupcniao against
judgmpmpcst
judgments, noAs nsts which
and erpensu which may in any way accrue against said City
f.
I" CimsegU
A Consequence of the
Of the Of this Permit.
I
UNDERSTANDS
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:
SOURCE REG ATI NS. \
4Da
7 F�-
Re -roofs
.7
Type of ROOF
sure of AppliemUConlrDO , f Data
HAZARDOUS MATERIALSlopoll SCL@&$E
Willdms future buildingMan mhaatlhe
Cupertino e, Chapter
25 Cupertino Muni 'pet Code, Chapter 9.12. and the Health and Safety
Health and Safety
As d.,Setl Section
ode,SeWon255y3(e)?
-
❑Yes Nu
All roofs shall be inspected prior to any roofing material being installed.
Will ,Lac applicant or Iu1um building oaupanl use equipment or devices which
If a roof is installed without first obtaining an agree to remove inspection, I
P
mil havardnua it cerominanu&road by W Bay Arta Air Quality Management
materials for
all new inspection.
District?/p
Dyes
I have mW the hvardmsmamnals myvirtmcnu under Chapter 6.95 or the Califor.
nis Real" SafclyCodc, sections 15505.25577 And25554. 1unticrsund chat ifox Wilding
does Am c.me.Ily have a mnanl Net it is my rtsFeasibility to badly Ne acapml of me
myuimmcnu whichylAtte met pdyrmyW.rmaan aniEmak, nracapanay
1
Signature of Applicant Date'
71 � y t� �-
All roof coverings to be Class "B" or better
Owho/arm hmitedagetl / r
1
CITY OF
UPERTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department 1)4 h7 f) )IN)
JOB ADDRESS: •�
851 S. T�IT�v ,AuP. �v�rpno �Svi4
PERMIT #
OWNER'S NAME: 'Tiw12S u
PHONE # 279 - 017 U
GENERAL CONTRACTOR: a;t^ — L
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the fnllnw;no;nfnrmaHrn•
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets
/Contractor Signature
9 �
A Date
SUBCONTRACTOR
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
'' lR�
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
/Contractor Signature
9 �
A Date
FJ
t
CITY OF
CUPERTINO
CITY OF CUPERTINO
WATER HEATER"
PERMIT APPLICATION FORM
APN # /� n C 3
J
Date:
CJ'
G
Building Address:
PLUMBING
$ 51 5 . 'r TivU A\Je- u 0
�3 h 0 14 -
Owner's Name:
Phone #:
16 u
BUILDING
Contractor: .f M C-A;c/1N AL Li AN C E Pho :
v41vS
Fr�. VA,1AS1E DBA NRIMQ P+:7 gaL, (40m)Z79-0170 '
License #:
42- 2) 3 f
Contact: Phone:
Cupertino Business License #:
107 5
Building Permit Info:
Bldg ❑ Elect ❑ Plumb C�/
Mech ❑
Job Description:
Residential a ial ❑
Cost of Project:
Strapped ❑ On Platfqrnni Bonded ❑
New Location Replacement
y. f
ACnoksa le Fee ID
Fee Descrintion
Fee Groun
p BPWHEATER
Water Heater / Vent
BUILDING
PPERMTTFEE
Plumbin Permit Issuance
PLUMBING
BENERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING
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