03010035 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT to
TOR
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BUILDING ADDRESS: WATER HEATERS ONLY PERMIT NO.
10270 BONNY DR 03010035
OWNER'S NAME: 970 E. MAIN ST, SUITE 200 APPLICATION SUB DATE
LAI HUNG CHI AND CHOK K 01/07/2003
PH ONE: (415) 566-2209 SANITARY NO. CONTROL NO.
ARCDITEC XENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
On. LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under previsions of Chapter 9(commencing Job Description
with Section 7(10(dof Division 3 of the Business and Pdfcrsinns Codc,and my license is
�� in fall fnrceadd c as 36 �'� REPLACE WATER HEATER. FIIVe4LE®
0Ztk�..�Z Licene Class�fLic.M
: Data /)1/ 3 CWmcmr
P=�2 �� A R C I IITF.CT'S DEC LARATIO JAN 1 6 2003
WU ndcrsmad my p1mo shall he med es p.hit,rcemm
OwU
3 m Licensed Professional
S Oat I am exempt
from
DECLARATION BUILDING 1 hereby.affindsee the 1 am exempt from the Contractors License Law for the �/ �e gM
tats—p 0 which following remora.Permit
t 7031.5.Business altar.
apd Professions h..dc:Any city stemma
$ which requires a permit m uiras due
tier,improve,akermit t or repair any swmum
that heprior incenses also Pursuant
pre viiions o thefor suchCon permit a ice se signed statement
G (em oorneicenwit pursuant toiinuf Division
of the Contractor a License Lions Coper9 Sq. Ft. Floor Area y�V�lIQI11100
$ (commencing with Section 71a d of Division 3 of the Business and on.Anyovi Cade)of
Net io ts exempt therefrom and the basis for be alleged exemption.Any violation of
Schon ID3Ls by any innsfar a.TS500mit subjects the applicant s civil penalty of Occupancy Type
not mom then five hundred tlsllen(f500).
❑I.m owner of the property,or my employees with wages as their sole compensation,
will do the work.and Ne atrucmhe is not intended or offered(or We(Sm.7014.Business and Professions Code:The Crankcases Limine law does not apply to an owner of 506 — GAS TE Ulre Dspec Ions
property who Wildsor improves demon,and who dressuch work himself orthrough his
own employem,provided that such Improvements We not intended oroRered for scale.If, 507 — FINAL PLUMBING
however.the building or improvement is sold within one your of completion,the owner.
builder will have the burden of proving thsa W did not Wild or improve for purpose of
sale.).
❑1,as owner of the prop uty,am exclusively contracting with licensed conuacmrs to
construct the project(Sea 7094,Business and Professions Code:)The Conuetnri Li.
cane Law does not apply to an owner of property who builds or improves thereon.and
who contracts for inch projects with a conusetor(s)licemed purmantto the Contractor's
License law.
❑1 am exempt under Sec. .B&P C for this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a CeniBcme efcansent to el(insure for Worker's Compere
-Milan,u provided for by Section 3700 of the Labor Crile,for the pertormamx of the
wont for which Nis permit is issued.
have and will maintain Wnrkes'a Compensation Insurance,as required by Section
]W of the labor Code,for the performance of the work for which this permit is issued.
My Worker's Cam n n l nonce carrier end Policy number am:
Cartier: Policy No.:. �Cy 5`J' "'0
CERTIFICAMO EXEMPFION FROM WORKERS'
COMPENSATION INSURANCE
ohissection need not becompleted if the Permit is for am hundred dollars(1 00)
orleasJ
1 eenify that in the peromm um,of the work for which this permit is issued,l shall not
employ any person in any manner an as to become subject to the Workefe Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:II:after making this Cer ificam of Exemption,you should
become suhjcn to the Worker's ComPensation provisions of the Labor Cat,you must
OZ forthwith comply with such provisions in this Permit shall he deemed resulted.
z O CONSTRUCTION LENDING AGENCY
[r I hereby affirm that there is a cunroueion lending agency I or the Performance of
�i ;> the work for which this permit in issued(See3mD.Civ.C.)
Wj
Q Lenders Name
z larder's Address
U O 1 cenify that 1 have read this application and stale that the eMrvc information is
IL (, correct,l agree to comply with all city and county ordinances and sere laws relating to
CV building combustion.and hemby authonm representatives of this city to enter upon the
U above mentioned property for inspection purposes.
(We)agree m save,indemnify and keep handlers the City of Cupertino against
„y N liabilities,judgments,cora and expenses which may in any way accrue against said City
U z in consequence of the granting of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO -P INT Issued by: Date
SOURCE REGULATIONS /O�
f / Re-roofs
Signature of ApplicanVConnazmr Date
HAZARDOV9 MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle ha'mNom material
m defined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safely
code.SeasoYesn 25532(.)7 023 All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit hu.iado s air contadimds as defined by the Bay Arca Air Quality Management all new materials for inspection.
Disuict?
❑Yes 4wr--
1 have read thc h t ardour materials requirements under Chapmrfi.95 of the Califon
nia Health&Safety Code.Sextions25305.25533 and 25534.1 understand that if the building
des not cunendy have a tenant,Nut ii is my reapumibiliiy u,notify tM accupud of 0c
rcquiremcnlsw stWompmissanmor.Certificate ofGee u cy Signature of Applicant Date
Owner or mthmLjidigent Dam All roof coverings to be Class "B" or better