00050011 (2)CITY OF CUPERTINO- _
BUILDING DlvtstoN PERMIT CONTRACTOR INFORMATION: t .
P U ILDINGA Ii. S: RYNN`� DR 'HOT +^ is PERMIT -9
(IWNER'S GRACELAND •, e APPLICn .0 E
ONE + — SANITARY NO. C(INTROCNo
G K.Z ARCHITECT/ENGINEER: - ` EUILDINOI FERMITINPO, -
w O _ ••
Fd -DG ELECT PLUME - MECH
Zed
F} 6
LICENSED CONTRACFOR S DECLARATION '
o s - o I hereby « tl t l ed 1 provisions fen pt 9T „ REPLACE WATE,f�b �i�'t
tr aIFiS f 7fK1U) fD Envision of the BL svui Profess' Cd.mA'nyl an. ,
a y S o fill f . ,d effeel +
O ddb a I.ic Class _ i p ,
ly 3 w y Thare Council
r ° 4
ARCHITECT'S DECLARATION
—0, I understand mr'pliaa.snml be used a, nuhrm record..
are `o g 1, cc,.ed Pr..fissional
°.Y o � OWNER -BUILDER DECLARATION
i.7 I hereby affiiin thin I alm exempt f [tie C I I Larcfre Law for the a...
C ¢
following real(S 1 7031 5, and P f Ld Any city a ancon, - ..
FQ which an'ttifirs. a _ II :I attenuations, mor ,h p y'Imlure
' edt
3 p
prior to itsI. q - . (lie applicant fral factor his ' B d is lemenl
'her he is licensedpursuant t the provismas ofl Contractors License La (Cbpmre"Sq..Ft. Floor Area Va
(comms ,Bwith Section 'ma0)nfo,fu , 3 a fore On xi, as, .,,it Profession. Castle)
or d t _•mpt merchant and the pairs for the II ged exemptionAny violafot - �' • • • .
.1 Section 703lsmyany artificial fill a rannit bl ,, the'appican,a a livil party
ofart l d_.fillhundreddollars ($500) •, ;A 6r- • VJ VJ Occupancy.rlype
O1, vs owner oRhe pmpenY.onny employe: with wrgen us their sale con,penxvdon, - .
willia m si me.I I nI fi d ic R dr r .9(wa 502 FINRIRe.16u"os @ rgNERGY
wi odor,,: CJ�Th C t a L' Law1 t Illy man i h, O _
nature
fp party Who t if p - h I workI ne,df t 506 — CTAS TE..T-
nrtl through h: own coil ywx-pmvidm lhn:uch rola-wme,Ix are not intended or � _ - _
oRared for sate. If. hearts,, the haiwrag or imProvemeal, is, soh[ within one year of 507 — F I NAL PLUMBING
constriction, the owner-bufldar will have me burden of proving thin he did not Budd or - -
r.
Improefor purposeol'sale
).
` v
! O I, as owner of the property, am exnlusiSoly conducting with IiccnsaYcaniructorr m - - -
construct he pi Jcet (Sec. 7044, Eusinms and Profession, Code:) The Contractor's
License Law does nm apply to an owner oI' pet won builds or improves thereon, - - -
antl who mothat for such pr..ill wits a commrcun(a)-licensed layman it, the
Chinni License Law.,
❑tmor ekerapt under5 ii B & P C for In, reason-
Owner Dm' +
'
WORKER'S COMPFNSA910N ULCLARAl10N
I level,afC J penalty f per,or, of the following dcrlaraI
I la nd II frogiodl C Ifs ofConsent or If 1. for Worker's
73700
ope i p d 1 f ly S t 370(1 f II Lab r C do hr th rt fth kf n'hthisl t I O
1 n a d 'ill a t W Re : C pa I 1: r d 6 Sect f II e Labor Code r the perfor mace of the work for which lh s permit s --ued My Workers Compensation Inwmnce wrier mod Policy number nor
nter- PnlfcyNo: ,
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(phis--,alihol not he completeal if the permit is far who hundred dollar, -
'
($100) let lmo.)
I certify that in the ppriumar nce of the .,it for which this permit is Issued, 1
- shall not employ any person in any manner so as to become subject to the Worker,'
mp-
- Ctiensatian Laws of California. Dom
Applicant' - - •
NOTICE TO APPLICANT''., If, after making this Cwtlf,elne of Exemption, you should
lice bJ u 0 W k : C pen. I p ,f the [.shot Code You rust
forthwith comply with had Prov: n or ths prod mull hoderned none d.
-
CONSTRUCT 'Ichosta INC AGENCY +
I hereby affirm this there Iss csued (See. Icndl ng agency for the performance _
W C Lea the work for worms Imo pnrtnil i. ixennd (See. 3097. civ, c.) - ..
. y
Leader's Name
1 conify that II d],is ,,uml and .l t that the abate Fluorination
correct i agme to comply with all city and col artheareasund state laws ralrejug
' C) mbuilding c I r' ,nod dumpy antharce representativesof ars, city u, enter upon r
,.the above nemmuld property for inspection purposes
a (Wergree weve. indeardlyandk p harmless the City of Cupertino gird
liabilifies, judgmerays, colf, an(] e penacs h stay ,sty y o against said
City as narynena inn treatingof mi: crimil. I
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.FOINT 1
SOURCE REGULATIONS 1 i Issued by: _ Date
Signatme of Appli eri canl...I DataRe-roofs
• HAZARDOUS MATERIALS DISCLOSURE, �.
'suds enc 5pphcvnra future building a,,ems more nr home atenserha,,;accol TypeofRoof '.
u defined by the 32m)?no Munimpul Cala Chapter 9.12, tmA the Ileal0 and Safely - +
Code, Section 25532(x)?
t7 Yax - ON. _ - All roofs shall be inspected prior to any roofing material being installed.
'
Will the appncantoralgltaanimiagocenpaalpseequi"tri,atdrather, which If a roof is installed without first obtaining an inspection, Iagree"to remove ,
mil hawtdnue stir eontenl Inane as dunned by the Puy Area Air Quality Multimillion,,
xhief!
all new materials for inspection. Applicant understands and will comply with
°Yds 0 N all li
CITY
OF CUPERTINO
I 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: yvonnek
Sec: Twp: Rn9: Sub:
Blk: Lot:35912027.00
DATE ISSUED.......:
06/02/200D
RECEIPT #.........:
12393
REFERENCE ID k ...:
00060011
SITE ADDRESS .....:
10147 BONNY DR
SUBDIVISION .......
_
CITY .............:
CUPERTINO
IMPACT AREA .......
OWNER ............:
WIGGINS E V AND SYLVIA TRUSTEE
ADDRESS ..........:
CITY/STATE/ZIP ...:
CUPERTINO CA, CA 95014-2903
RECEIVED FROM .. ..:
MAIL IN
CONTRACTOR .......:
GUSLANI, CHRIS LIC p 21311
COMPANY ..........:
HOT WATER INC.
ADDRESS ..........:
2531 GRACELAND AVE
CITY/STATE/ZIP ...:
SAN CARLOS, CA 94070
TELEPHONE ........:
(650)298-8494
FEE ID UNIT QUANTITY
AMOUNT PD-TO-DT THIS REC NEW HAL
____________________
__________ _____________ __________
BPWHEATER PER HEATER 1.00
____________________
9.99 0.00 9.99 0.00
MITFEE FLAT RATE 1.00
35.52
---- _ - 35.52 0.00
.L PERMIT
-
45.51 0.04 45.51 0.00
METHOD OF PAYMENT AMOUNT
NUMBER
__________________
_________________ ____________
OTHER 45.51
VISA
• • e••
TOTAL RECEIPT 45.51
VOICE ID DESCRIPTION
VOICE ID DESCRIPTION
........ ............................
502 FINAL PLUMBING ENERGY
........ ............................
506 GAS TEST
507 FINAL PLUMBING
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A