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05020040 (2)�u _z ^moi S 1G UDyU 3LL� xo3 �p0 sac22 m-vr G Z ceFF kw 0 z Z r h d � az U_O OF U �a �z CI'T'Y OF CUPERTINO-�,��_- .�,x;rxr BUILDING DIVISION PERMIT . CONTRA CTORINFORMATION BUILDING ADDRESS: - 1 79 BYPPLY CT HOT WATER INC PE111IT1,190 5020040 OWNER'S NAME: PERMIT ISSUE DATE CHARLES ONE: RY SANITANO. CONTROL NO. (650)298-8494 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing P with Section )DPU) of Division 3 of the Business and Prolusions Code.sed my license is License fall � 'Rd If , REPLACE WATER HEATER Lueg Da¢ T COS. 90 u)A ^` ARCHITECTS DECLARATION I understand my plans shall be used az public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm Nat 1 am exempt farm Be Contractor's License Law for the following mason. (Section 7031.5, Busineas and Professions Codd: Any city or county Which Farm s a Nbeli to Consumer, alter, Improve, demolish. or repair Ny MaAhAa Patio to Its MUMCC, also pairrour BM applicant for such permit to EIC a signed aleLL'mC01 I", he is licensed pu¢vanr to dlc provisions of the Conmcmti license Low(Chapler 9 Sq. Ft. Floor Area Valuation (commencing with Section 7600) of Division J of the Business and Profossions Cade) or that he is exempt Brtrefrom and the basis far the allcgc l exemption. Any violation of er0 0 Occupancy T P y yPe Section 7031.5 by any applicant for a permit subjCCU the applicant to a civil Penalty of an not mart thfive hundred dollars(5500). ❑ 1. as owner of the propcny, a my cmpawas with wages az their ask Compensation, Required Inspections will do the work and Ne swmufe is not intended or offered for sale (See. 7014, Businev Commerce's License Law does and Professions Code: The net apply7warr o me, Of property who builds at imprnvu thereon, and who dark such work himlGforda; ugh his Own employ=, provided that such improvements are not intended or offered for sale) It, however, dte buildingorimpromment is mid within as year ofcompletion. Beawned r /7 builder will hoe the burden of proving Nat be did not build or inners sal.j. I ❑ 1, as owner of the properly, am exclnsivdy Prof contracting with IiQ/Crased ronbacbm to consumer the, pmjm (Sec. 7014, Business and Professions Cadc: • e Conuactm j Li 1 _ CO. law does nor apply m an owner of property who builds or improw'Bempn, and I r who conmcta for such projects with a eoneractor(s) licensed purwaor to the Conuaetoes License law. ❑ 1 am exemDr under Sec. . B k P C far this ream. Ll/Ili Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury oro of the following dmloun cors: T have and will maintain a Certificate of Coment to self -insure for Worker's Compere u provides for by Section 3700 of the Tabor Coat. for the performance of de, r`kfor which this permit is issued. r have and will maintain Workeri Compensation Insurance, a required by Section 1c, 00 of me labor Code. for roe performance of Ne work far which this permit is issued. y WorkerssCompensmionlasunnceafficr and Policy number are:arrier: tii/w'/v �Zg n./r Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section mad not be completed if the Permit is Intone hundred dollars ($IN)) or less.) 1 certify than in the perfurmaxc of Be work for which this permit is issued. T shall not employ any pennon in any manner sec as in become subject to the Workers Compensation Laws of California. Dow Applicant NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should become subject to the Worker'a Compensation provisions of the Labor Cade, you mon forthwith comply with such provisions or this permit hall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a cmulrvction lending agdnry far the perfurmancc of Bid work sur which Nu Permit is issued (Sec. 3091, Civ. C.) lancers Name Lender's Address and state that do above information is I Certify Nall have mad this y and county rofmck 1 and sum laws totaling to m comply with all city and county oro iveS mpruenmivu of Nu city m corer upon the on Upohe construction, arta herby a Of cuodrz Moveng ahovc property for emnify an puepn ea (Wtirn re the City of Cupdnst against (We) agree to save, indemnify and keep hay in an liabilities, erica o arecoolsdna cxpenseawhich may in any way accrvc Against said City in PLICA T of thegaming of this DWI APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALy.NONPOINT �. Issued by: Date SOURCE.RE`GNTIONS. �- 111 6 f— C�/GG / _ uN/"� (fes Re -roofs Type of Roof Signature of ApplicanteContractorU Date HAZARDOUS MATERIALS DISCLOSURE Will roc applicant or fMuni building acupant Tamar handle us material az aefaA by the Cupertino Municipal Code, Chapter 9.12 and the Health and Safety Health ace an zss3zta)7 All roofs shall be inspected to any roofing material being installed. �Yts ON. 0 prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building acupant use equipment or rhymes which it hanrdous air contaminants az defined by the Bay Arca Air Quality Management all new materials for inspection. DiWIcO ❑YCs ❑Nr I have mad the harardousmaterials requimmenB under Chapter 6.95 of the Califon r nu Health h Safmy CodC, Sections 25515.25513 Ma25534.1 undcrsmrtl Jut if the building does amt surreally how a tenant, two u no responsibility m ramify the acupant or the �yuimmcn hich must M,mc pdorro Su oret.r.ccatint.to of Occv cy � . . _J� "i/i/ Signature of Applicant Date eprr All roof coverings to be Class "B" or better Date r rr,rmasiuc ascot Its J CITY OF �UPERTINO Community Development 10300 Tone Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 10/7g el -I C PERMIT # a 5-02-00 `0 OWNER'S NAME: ,-Ie S 6 u of PHONE # - a57- 738/ GENERAL CONTRACTOR 111D1vtla-fel-rye. FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information Owner/ Contractor Signature Date 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 a Ci r //I C-. a 3// Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date • CITY OF CUPEkTINO CITY OF CUPERTINO WATER HEATER PERMIT APPLICATION FORM APN # - 3 � � � 1 I Z — � Date: a y/vS Building Address: 0/7� Plumbing Permit Issuance Ct- BENERGY Owner's Name: CAar/ Su m BUSLIC Phone #: Ild?- aS7- 7?PJ Contractor: /4-0f kvet�cr-/mac, Phone: 6o0-(a3/-&'Y9y License #: 'ix3&/a Contact: Phone: Cupertino Business License #: ChrIS Givala� LPSo-(v31-8�f�iy otl �a// Building Permit Info: Bldg ❑ Elect ❑ Plumb Cg-� Mech ❑ Job Description: P J liliGc/'G4,'- S/'17G %ZQSh'a/n/5 Residential [g/ Commercial ❑ -Tt P �x�C/dor Cost of Project: i/ S -DU Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement ❑/ Qty. if Applicable Fee ID Fee Description Fee Group / BPWHEATER Water Heater / Vent BUILDING PPERMTTFEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUB -DING W,,W--Wg-