Loading...
04050108 (2)/ CITY OF CUPERTINO CONTRACTQRTNFORMATTON BUILDING DIVISION p]•.RIVIIT BUILDING ADDRESS: HOT WATER INC PERMITNOO4OSOIOB pERMITLSUEDATE OWNER'S NAME: GRAIG REAND AVE SANITARY NO. CONTROL NO. ZONE: 650 298-8494 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH :per LICENSEDCONTRACMWSDECLARATION Job Description ti 1 bm 7 al.f that 1 w Of ft Bo under provisions of Chapser 9(commencing ith ScI for by arof thatt I A3 of dw BdunmmARofmiof Codo,mdco menet is r In Wild, emdefect. Can REPLACE WATER HEATER Z License les C Lk.a �Liady Oak AR Hf1ECI'SD CLARA I l, / f undcraunJ my prem chart be used u public records ///--- w Licensed Professional yC OWNER-BUILDER DECLARATION \ I bemhy.Rum that I em ucmpt from the Contractor's License Law for Ilk O i O O following Munn.(Section 703 1.5,Business and Pmfmiom Cock:Any city or county la ff which requires•pm ah m congmm,alter,hnpmve,do nallah,nr repair any nmcture —�„ prior to its issum=,aim requites lM applicant for such Permit to file asignWgatement Ft.Floor Area Valuation FF < that he is licensed pursuant to the provisions of NC COnIruwls License law(Chapter 9 SQ y�$ (commencing with Section 7000)of Division 3 of Na Brsinm and Professions Coda)-1 g- that scan 703is xgaM 5 by any applicant for A permibunds it bjem the eppl curl to a vilny ipsm.hy of 3 [j"er0 0 Occupancy Type not mom Nan free hundred dollen(5500). wi Luownu of and tirea",or myemploym wlNwguuOteirsol.7044.8 utlon, will pr Ncwons end the shame Isnot intended orone do foracrepply 70dd,Business Required Inspections and anywh bar Cade:The m Ate en. rad who Taw does at apply lf an owner property who bui Ido or Ire prows Ther=n,end who d=s still work himself or through his own employ=s,provided Nat such tmprowmmts are not Tear dedOf m leand for mvoAT however.Ina building orhnprowmentissaid withinman Year of completion,Ne owe of builder will have Ne buAen of proving Nn he did not build or improv for Purpose of ..I.J. ❑I,As owner of the property.am ucheovely comraming with licaaaed"Ma acrms M coutoact the project(Sec.7044,Business aha Profusions Code:)The ConrACMr"a Ll' cense law docs nor apply w.n owner of property who builds or improves Neuron.and, who contracts for such pmjccn with a=ntracmr(N licensed pursuant M tin Conlncuses License law. ❑l am exempt under Sm. ,B&PCfor Nis noon Owner Data WORKER'S COMPENSATION DECLARATION I hereby ef1ml under peulty of perjury one of Ne following doe—tcu: 1 have and will maintain a COAWE w of Consent to Asir-Insure for Workcr'a Compcm xoom,u provided for by Section 370 of the labor Cade.far the Perf=mrnce of the W for which this permit is issued. have and will maintain Worker's Compensation Insurance,u required by Section . . or the labor Code,for the performance of Ne won far which this permit is asked. My' y Worker• Compemad..Insurance c.rrlmmd Policy number.¢: Cartier, T/-1T/ f Uh/�Policy No.: CERTIFICATE OF E%EMPr10N FROM WORKERS' COMPENSATION INSURANCE Ohisuction need no N completed ifft parait is fare=hundred dollars(SIM) lat 1 ceAfy Net in the"fr rm.me of the work for which Nis Permit B issued,I.hail not employ any penin in my manner m as M become subject he the Workeri Compensadon Laws of Califomie.Data Applicant NOTICE TO APPLICANT:IL after making this Ccnificak of Eacmption,you should become subject to Nc Workers Compensation pmvbdOM of the lahnr Code,you mug �O foMwiub comply with such pmviaio=or NU Permit shall be deemed ranked. Z y CONSTRUCTION LENDING AGENCY 1 bemby eRrm that Nen 4 a comwctinn lending.gency fm the pmfurman=Of a r7 the work for which this permit is issued(Sec.3097,Ci,C.) W QLmdefa Name g'. Lender.Add. U O 1 cenify Nat I have read this applicadom and auk Nat the.bow inform tun is W F' conecL I agree to comply with ail city and county oNinuuss and sok laws relating M p U building muwee re saw. .rode nifygalAnd eprtxn im of this city to enoing upon Nc k1 .hove-mentioned property for inspection Purposes. gy eWel agree M sew,indemnify end tech May i m the City o(Cup 1fog-against to liabilities,judgments.costs and expenses which may in my war'accrue egainstsaid City Uz In consequence or the granting of this permit. Issued by: Date n+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT SOURCE REG4TIp1gS. �� .�11�//o OS"/91fJ('I Re-roofs Signature of ApP rl caHAZARDO Dk Type Roof 9 A (�� HAZARDOUSMATERIALS DISCLOSURE yp l / Will the Applicant or future building Occupant Stare or handle huarduus mawdai As defined by the Cupertino Municipal Code.Chapter 9.13.and The Health and Safety ode,scctiom 25532(8)7 All roofs shall be inspected prior to any roofing material being installed. ❑Ycs Will the Applicant cor fawn building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it havardnua airirc=uminanu As defined by the Bay Arca Air Quuity Management all new materials for inspection. Diudi,? ❑Ycs �u I have real Ne bmaN=strawrlalemquimmen s under Chap nr6.95 of Ne Califor- nia Health&Safely Cede,SOCti0u MMS.25533 and 25534.1 understand threif Nc building does not currently how A tuna=621 It u my responsibility M early the Occupml of d¢ requireclpilarwissua=e oraCcrtifwakofOm . Signature of Applicant Date iwhkIt ' i �ry�9�� All roof coverings to be Class "B" or better Owner ora Nome qmt Oa Community Development SCITYOF ' 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 Fax(408) 777-3333 OCUPEkTINO Building De artment JOB ADDRESS: PERMIT # �DICe T Wtwo S C`3�j�s0?OQ OWNER'S NAME: 1 g p PHONE # GENERAL CONTRACTOR: 7 Z wi FAX # so &N- 8 y I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin 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 10/28/03 CITY OF CUPERTINO WATER HEATER CUPEf"TIN0 PERMIT APPLICATION FORM APN# 3,2� D ' /� Dat / 7/D Building Address: �D I `f Owner's Name: - Pho �d Contractor: Phone:p License �/ / C31/ HoT WATER. INC. (}��S�sG/C��� / 40 6 d- Contact: 963 INDUSTRIAL Q1 Cupe usi ess License#: SAN CARLOS, CAUFORN14 1)-4. Phone: Building Permit Info: `/ Bldg ❑ Elect ❑ Plumb L!Y Mech ❑ Job Description: Residential V Commercial ❑ Cost of Project: fyo-b • Strapped 11 Op Platform L1 Bonded El New Location fg/ Replacement El Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING / PPERMrrFEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING