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05120112 (2) CITYOFCUPERTINO BUILDING DIVISION PERMIT � Q.0 6 ' CTQR INFORMATl©' " ,%"+wR.AR:T-:t1y ¢f w i &P:M 2 .w's,Y'!rdK° ti BUILDING ADDRESS: TOM r S PLUMBING PERMIT 110.05120112 OWNER'S NAME: PERMIT LSl10 DATE EDNA CATE 46 2005 NE: SANITARY NO. CONTROL NO. (408) 867-6010 ARCHI7ECflENGINEER: BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH X00 LIC ENSEDCONnRACNR'SDECLARATION JobDescri ti 1 WrebY affirm Wel 1 am licensed under previsions;of Chapter 9(wmmencing p p�f m+ with Suction 7M)of DIA.M.3 of me Business and Profvsinv Code.and my license is Al a'a1 inmumaAnd ar /_ I ` REPLACE WATER HEATER jJ� LI.. CI t/' Llc.M � e9e Dem consARCHI'fECPSD Cid 1 '46 Y I untemund my plan N.IIWusW vpubl recaNs �� 6vI `f® y C Lksnacd Pmfcssionm �j y3 OWNER-exempt an CLARA770N ` .a 9 1 ousts .(firm on 1 am exempts An the Contractors License Law for 1W a o O which ac moon.(Section 7 construct, Business and n,do Tum Code:Any city sionnum EC// county is which mymrca a Permit to cnnswct Ghat W pmw,dcmnikh,nr repair any stmctum S925 prior to its issuarori.also mquims tlmapleiesnt forsuch Permit In Blri a signed mammcm < that heklicensed pursuant totheprovisionsoftineContractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation si a (cammcumi;with Section7000)of DiNston 3 of the Be.[.and Poefeesiam Cook)., — War he is m empt therefrom and the basis for me alkgcd exemption.Any violation of Sectian 70313 by A"applicant for a permit subjects use applicant to a civil pamlly of y�r/�p not mom than Rw hundmd dollars($500}- er O C'J • pe 0 1,v owner of the property,an my employees with wiles A!tiseh sole compensation, will do the wort thenrocwm is not intended o OBered for ask(Sm.fess7014,Bted—•• Required Inspections and Professions Code:The Contractor's Liaise Law dos net apply to an Owner of e q p property who builds Or improves thereon,and who discs tach work Mnuelf Or Uvough his Own employees,provided thmsuch improromenu am net Intended Muttered for sale,If. hawevsr,the building or improroment Is sold within aro year of completion.the owner. builder will have We burden or proving Wes ke did not Wild or improv for purpose of 0 1.v owner of me Pmpeny.am eaelunwly contracting with licensed rontranon to construct We project(Sec.7044,Business and Profesda s Code:)The Conuactorl Li. crime Law does not apply to an owner of propenywW Wilds or improves dmmon,and, who contracts for such projects with acontractors)licensed pursuant to We Conuactola Liceme Law, 0 l am earept Motu Sec .B k P C for this recon DO Dam - WORKERS COMPENSA71ON DECLARATION I hemby affirm under penally of perjury ane of the following declaradom: I baro and will bout n•Certificate of Comemtoalf-imam fo Worker's Compete nation,as provided for by Section 3700 of the Lat o Code,for the,performance of me work for which this permit is issued. 0 1 than and will maintain Wokcls Conpensuion Insurance,u required by Section 3700 of the Labor Code,four the perfermana of the wok rowhich this Permit is issued. My Worker's Campamadon lmoance artier and Palley number am: Cartier: TILt�v T. Polity No.:C I4I5271JJ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE fhusation tied tot W Canptio d if the Permit is Areas hundred dmlan(SIM) or lees.) 1 unify that In the perGwmanet of the work run which this permit is muse,I Nall no employ any Person in any mirror an v to became subject to tine Workcti Compemation Laws of Califomia.Dam Applicant NOTICE TO APPLICANT:If,after making this Ccnifcam of Exemption,you should become subject W him Worker's Compensation provisions of the Labor Code.you most .JO forthwith comply with such pronWW inns or this permit all decmW rovnked. Z Er WCONSTRUCTION LENDING AGENCY � Imey alarm that mem is a construction lending Agency for the parfonnance Of IM work for which this permit is Issued(Sec.3097,Ci,C.) GQ Lender's Name Q z lender's Address fJ Q I«nlfy that 1 haw rad this application and tum has the aWw information Is ' n.Pconed.I aline to comply with all city and county oNiasnces and sum law mining to 0 building comuuction,and hereby authodm represcomiws of this city in enter upon the W shoe-mentioned Property for impaction purposes. �,m 4 (We)agree in row,indemnify and keep harmless the City of Cupertino against r.c y Ilebilitieajudgments,coo and expenses which may In any way accrue agalnstaaid City U7 in consequence of the trading of this permit rte- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 'Date SOURCEREGU ATIONS. � Re-roofs 2, y9 .-r jigifistum o ppllanu ontmcmr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof - Will me applicantor Room Wilding occupant mom or handle hazardous mammal As dented by the Cupertino Municipal Code.Chapter 9.11.and 1W Health and Safety Code,Sroums 25532()? All roofs shall be inspected prior to any roofing material being installed. 0Yes t� Will me applicant or Room Wilding necupanl sax equipment or mkviaa which If a roof is installed without first obtaining an inspection,I agree to remove It havardnm ter conummanm As dcRncd by the Bay AMR Air Quality Management all new materials for inspection. Ideas arder 0Ya KN. I ban mal the hazardno maurials mquimmenm under Chmuct 6,95 of de,Califon Health h Safety Cede,Secfiam 25505.35533 mul25534.1 undersand thatirme Wilding mol currently hew a tenant Net It' my mAPomihility to anli(y date osupvt of datem ntewIdb umWmetP m ...I.C."amMf pane Signature of Applicant Date ( Zr ;7 All roof coverings to be Class"B"or better O Emma nudagenl Data g Community Development 10300 Torre Avenue Cupertino CA 95014 AS Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building De artment JOB ADDRESS: PERMIT# It OWNER'S NAME: PHONE # 7' GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 21 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile caner/Contractor Signature Date CITY OF CUPERTINO WATER HEATER o_rll CUPEkTINO PERMIT APPLICATION FORM APN# 0 00 Building Address: Owner's Name: Phone#: Contractor: Phone: License#: PI. sb7 6610 `12 15 K/ Contac Phone:, ,,,,, oy Cupertino Business License#: b ��y Buildi g Permit Info: Bldg ❑ Elect 0! Plumb R Mech 3' Job Description: Residential Commercial ❑ Cost of Project: c�v7 Strapped On Platform Bonded • New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMFFFEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING