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04030184 (2) t CITYOFCUPERTINOe, 7 :,g7,77l, BUILDING DIVISION PERMIT ,,kCC0NT9ACT0RAjNFY0RMATIO BUILDING ADDRESS: PERMITNO. HOT WATER INC 04030184 ' OW HER'S NAME: PERMIT norm OATS ONE: SANITARY OL NO. AR CHITECTlENGINEER: BUILDING PERMIT INFO BLDG ELECr PLUMB MECH 0 :Op LICENSED CONTRACOR'SDECLARATION Job Descri tion u 1 Wreby"m that 1 sm licensed under provisions of Chapter 9(commencing P with Scotion 7IXp)of Division 3 o tho Business and Professions Code.and my Ikense u '^ in full forte and effect. -\ 5 a Lemacto _ Lic.N REPLACE WATER HEATER Date CN e A CHr1ECi'SDECLARATION 'Uk Y 1 understand my Plate shell W usud used an u public rennase Dieu 3bid Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from me ConlnclOel License Law for the a o following reason.(Sudan 7(q 1.5,Business and Professions Code:Any city or county x$ which requires a permit to cabinet.alar,improve demolish.or motor my suvcturn Fri^^ prior wins issuance elan populous the applicant for such permit at rile aligned statement p G that he is licensed pursuant tothe prevision ofthe Comment's Lluela - License Sq.Ft..Flo! red Valuatio y $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he Is exempt therefrom and do basis for the alleged exemption.My violuloa of Section 7031.5 by any applicant fora permit subjects the applicant in a civil penally of 3_AFV4-1y1n§Rr0 0 Occupancy Type not more shm five hundred dollen(5500). ❑L as owuer of nd umpmy,m my empleyma with wagee u theh mm camps LW ren, will dothewoss and the snnuu6nals tendedLicarm Lawred term apply In an onmerrf Required Inspections and Rofwhobi Code:The Cennnora Lkeme lava dons nm apply ll ut anus is 9 P property who baslprovidmpmwsch i mn,andwW doenouchwork hr aelfor Btrough his awn employees,provided that such Improvemrnuare not intended!anoBesed(oracle.If, builder me Willingor ImprovementIs midwithinot nor of mmpleum.the purpose of builder will law the burden of proving mat k did not Wild m Improve for purp,¢of ask.). ❑I,as owner of the prnpcmy,am inclusively connecting with licensed cmnraobn in cauuuct the project(Sec.7Wa,Business and PmfesAons Code:)The Conuecu U. cave law dons not apply in an owner of property who Wilds or improves unman.and. who contracts for such pe jena with a eanuuwr(s)licensed pursuant re the Contractors License law. ❑lunexemptundu See .BBPCfortWartamn Owner Dau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury ane of me following declarations: I haw and will maintain a CeniBeste of Consent to SelPlnaure far WorkersCemma- tion,u provided for by Section 3700 of the Labor Code,for the performance of met 1M3; rk for which this permit is Issued. hew and will maintain Worker'sCOmPnlsatlan Waltham,as acquired by Section ofthc labor Codc,for the performance of the work for which this permit Is issued. y Workers Compensation insurance carrier and Policy number art:rrier: Q Policy No.: TIFER ICATEOF PXEMMON FROM WORKER _� S' COMPENSATION INSURANCE (lhissuden nand not W completed if the permit hi Inrane hundred dollars(3100) or least) 1 certify net in the performance of rhe weak for which min Permit is issued,I shall oat employ any person in any manmr at u in become subject to the Whim W Compensation Laws of Califorem.Data Applicant NOTICE TO APPIJCANI:If.ager making this Cerdrate of Exemption,you should became subject In the Wahers Compensation provisions of the labor Code.you muss Qforthwith comply with such provisions Or this permit mall W deemed revoked. z► CONSfRUCDON LENDING AGENCY Eat rs is a comanctinn knding apery nfm me perfmare.of 1 hereby alrnrm thft.> the work for which this permit is issued(Sec.3097,Civ.C.) V4 ELender's Name 7 z0. Lender's Address U0 I aNfy dist I haw reed this application and mm that the above informadon u I34 E correct.I agree to comply with all city and county national and sum lana minding u O C.1 building construction.and hereby authorise representatives or this city m enter upon the W muse-memioned property for inspection purposes. (WO)agree to taw,indemnify and keep harm ea ft City of Cupertino against d..t y liabilities,judgments,costs and expenses which may in my way ancmc against aid City in consequence of the gnting or V APPLICANT UNDERSTANDS A1ND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REM T S. ,�,�,,,,.�.,, T7' J�0 CD22im Re-roofs Signature ofA IicanJContrmmr I Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or fuwm Wilding aceuremt store or handle husrdous material as defined by the Cupenim Municipal Cade.Chapter 9.11,and use Health and Safety admilFcade.S❑Ycotiau n 15631(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Nu WIII the applicmt or fuwm building occupant use cyulpmrnt or devices which If a roof is installed without first obtaining an inspection,I agree to remove Tit Womim,air conluoinanu u Jefinmd by the Bay A.Air Quality Management all new materials for inspection. Dimict? ❑Yes ONO I have mad the hand.,mans rials mquimmcros under Chapter 695 of the Cali foo nice Hu1th k Safety Cede.S.U.25305.25533 and2553J.1 mecum l thetifthe Wilding Jas not currently haw:a levant.Jul It u my responsibility to ratify the occupmt of me myuimmcnunaygm/oemw eracertifteamar�q�symT Signature of Applicant Date Owner Ormmerired�agent ) —�C LS/ Dam All roof coverings to be Class"B"or better 1 CI Community Development 10300 Torre Avenue ;' ° Cupertino CA 95014 Telephone(408)777-3228 OOF Fax(408)777-3333 �UPERTINO Buildin De artment JOB ADDRESS: ^ S/ PERMTT # o-o b © 0 :30/ OWNER'S NAME: >4 6 PHONE # - GENERAL CONTRACTOR �t A FAX # v - I am not using any subcontractors: 03 , d 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- ,TAC 0-1 w wC Roofing Septic Tank Sheet Metal Sheet Rock Tile OVe9ij Contractor Signature Date • • a CITY OF CUPERTINO WATER HEATER b 0 3 /'Jy CUPEkTINO PERMIT APPLICATION FORM APN# 3 59 —( (O —b i (D Date:-2) h9104+ Building Address: 20 -70 (a C h e r �J r Owner's Name: /� Phone#: /� 9 PO-POSc>>l 0�' - Z6;;7 - Sl-7 Contractor: Phone: License#: 7(p 36 I HOT WATER, INC. lD Contact: SAN CARLOS, CALIFORNIA 94070 Phone: Cupertino Business License#: 21 31 I Building Permit Info: Bldg ❑ Elect ❑ Plumb Ltd' Mech ❑ Job Description: la/u— W( *ev- ,r „ _ r _r Residential Commercial ❑] �Q�TC Cost of Project: 456011-9-- Strapped 5601%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