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05110112 (2) CITY OF CUPERTINO , �t�° 7P��yy'T�g+..�9'k,,Lg�' ->a ""' `�"° 1I '�' BUILDING DIVISION PERMIT IV0,t�\Pi:"q NFURMA.T.IgN,,,, BmLDD10 ADDRESS: BETTER WATER HEATERS PEnMITN0.05110112 10552 JOHNSON AVE OWNER'S NAME: PERMIT MUT DATE ALEX LEI. 351 FALCAT NE: SANITARY NO. CONTROL NO. (408) 250-6672 ARCHITECr/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH as �- t� l� j � LICENSED CONTRACTORS DECLARATION Job De r' rryyt�y 1 kroby arms Na I am ftheaari under Provisions of Chapter 9(mmmcnclag p V with Seellon]OOU)e(DiNtlon]ofNe arithmetical Pro2�sltM, mylicense4 W�/'$7Ar ;� inTOcaa Anda xamarg FF�� REPLACE WATER HEA'�'E�e/, 1� al �� 1 ty�z D ns C I OARCHITECr3 DECLARATIrI�N~ �/`y3 i p pi IPrefic and my Plans shall k used u public mcorN I�j��1 s and LicensedPmfcOianal NsNQ kN OWNER exam BUILDER DECLARATION 0 0 1 hereby,a1Rm on 1 am exempt from the Caeoamars My C taw for to p O following mesa.Permit in 7031.5.Business and ...moor Cade:My city or county z� which requires a permit m ani=t L ales.Improve,damal4h.a c.sir any msture $639 z`a' that M i u kawma.res mquim ter applicant for soh permit m 0cuum Law lCo mem < thak4lkeued pursam to the provisionsof3Ne Cowmmrand PnolllawlChapta9 Sq.Ft.Floor Area Valuation 5p (can menciagwhh Section7000)00)1f Division de al Bed cor exacpton.My viCade)or r3$ Nal k 4 exempt lkse(rom vb de baro for the alleged eaanptm My violation of Section 7031.5 by any applicant fa a permit subject the applicant in a civil penalty of r U U Occupancy Type Out more than Live hundred dollars(5300). ❑1.u owner of the pmpeM.a my wpla)cas with wga u deo mk munpeuadm, Na n°ffe,tthe`�;Code'The c`onl�intended La ern ME a(pppiy l'�'�or Required Inspections property who bulida or i mprovu thertan.and wk dors ouch work bianwr or amugh ilia aweemployees,provided aarsuch improvement,am nntlnmded oroRered for aye IL however,Ne building or improvement 4 anld within orc year efmorpkdon,ds ower- mimor win have tic harden of proving that he did net build Or Wprma for purpose of um.). ❑1.an owner of Na Property.am emotively contracting with accrued aomicu rs in caulrum the prolat(Sec.]144,Baiuss and RofadOu Cade:)The ConosW'a LI- ecce taw tau sot appy man ewes of pro aaly,wbo ha1143 or improves tenon,and, who cadoetfa fain projects with a eontacuu(i)licenced pa ter the CoMebYl LILCIIG Law. ❑I are esempt under S. ,B h P C for Nit ream. ons -Data Da WORKER'S COMPENSATION DECLARATION I hereby-Pum order penalty d perjury Me of the following demarulome I have and will m-inuin a Cartfram orcouem m ulf-insm for WorkeYsCamino. ,1M.u provided for by Seton 3700 of the tabor Code.IN the performance of Na work far which Nis permit 4 iaued. ❑1 have and will malneau n Worte's Compmuien Omomseu. requird by Savo 3]00 of dm Labor Code•for On pe forma n e often work for which this permit is load. My WerWlaC urian Wu artier and Polity number are: Cartier: CER'13FIUTT E F E IOPoliN FROM WORKERS COMPENSATION INSURANCE (This salon need onlkcomPlemd if the permit 4 fare=Initiated dOm($100) or leas.) 1 certify Not in the international of the wait fa which this permit 4 must.l ileal nor employ any P.M.in an atyrlc rd sbT lulftwakrn'Canpenuto Laws of CSWomi`-Bak-y Applicant -51 NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you should become subject in the wort compensation provisions of am labor Code you moa .,0 forthwith amply with ash provisions or Nit permit shall k dared mated. zti CONSTRUCTION LENDING AGENCY EI kmhyallim that Nem 4 a cououNnn lending agency for the performance of E4 > de work for which and,pemit Is used(Sec.3097.Civ.C.) p Lenders ame 7,Z Lessice ANddrtas U0 i sNfy the I have red this spplleaien and mm thio de abovelefartuton 4 Ip,r". srreeL 1 agree to comply with all city and county on iuues and slam laws relating to O SV^ Wilding m^muction.and hereby authorise rtpmm^uNu of this city to enter Open lk {Ll above-mentoncd Property for Inspection purposes (We)agree to save.Idemyly and kap hawks ds CITY of Caperton-90111 rrA IiWilitica dgmenu.cau and exRua which may in any my-mue against aid City U7 in consequence of the germing M this peon. G APPLICANT UNDERSTANDS AND WILL CO WL ALL N N-POINT Issued by: Date /2(-0 4- 4f P? �°r Re-roofs Sipwure of�� Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupantuore orkdk hazardous material m definedby theCupera Munici ode.Chamm 9.13.and the Health and Salmy de.Section 25532(x)] All roofs shall be inspected prior to any roofing material being installed. ❑Ya o Will the appliest or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hmAoa air commeiunt u d by as Bay Ams Air Quality Management all new materials for inspection. Decries? El yes No I have read invariant m e hrasriW myukmnu eundarCkpmr A93afthe Califon. nia Hulih,Sycty Code,Sedou255O5.25533a 25534.1undemtndaalfde building does of currently hes a meant.dant It 4 my mpouildlity m Mary de naupant of the •wa",•-a•h akmypda amaar aroaapmry. Signature Of Applicant Date All roof coverings to be Class"B"or better Owner or au harocul agent Dam 0D Community Development 10300 Torre Avenue ,� I O Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPERTINO Buildin , De artment JOB ADDFSS: S o PERMIT# OWNER'S NAME: A L4 c.- PHONE # o$ 2-so 16.672 GENERAL CONTRACTOR: ��r (�J�� I��n FAX # Co3 L(-"? I am not using any subcontractors: �`s�- �✓ l l 2t 65 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date ZZZ�• 322 &' CITY OF CUPERTINO �' WATER HEATER CUPERTINO PERMIT APPLICATION FORM APN# 37s — �g c 3 s, Date: (' f O Building Address: 10552— Owner's 0552— Owner's Name: L �` Pho��U • SU 8• 9 3-2- Contract 2Contract icense #: Contact: F:;"g S �9n _____ `OL Cupertino Business License #: Building Permit Info: � '�' Bldg ❑ Elect �y Plumb Mech 21 Job Dg�cription: Ir�z l%,, Lok 4pr �a Residential 4 Commercial ❑ Cost of Project:4160 3 P—" • 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