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05030144 (2) CITY OF CUPERTINO �'zi= `Eux 3'' -w. A9 +` -"' BUILDING DIVISION PERMIT CONTRACTOR INF,ORMATIO BUILDING ADDRESS: HOT WATER INC PE ""%5030144 11ric; OAK 2PR:LNQ QT_ OWNER'S NAME: PERMIT MUEDATE ii�ilONE: SANITARY CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH xoo LICENSED CONTRACTOR'S DECLARATION O O O O I hereby affirm that I am limned under provisions of Chapter 9(rommcncIn a Job Description _<�' wine's acn]IXI0)ofDivWon3ofthc Busi wdprofessiom Code.andmyliceme4 P�� /(\\ t . oro mfull foeeand c@c 5E2? Liccma Class Lk.g a— '� WATER CHEATER REPLACEMENT n�o Dat Contractor S~S� A shined Used DECLARATION �s��` _ W u 1 undersand my Plans ahold bo used ss public records >' (/, 3 3 'Wt; Licensed Profeuioml OWNER-BUILDER DECLARATION �n)a +�0 0 I herehy.(Sero that 1 1. exempt from the Canuacmoa License Law fee. II{9 ioO followhich re sawn. emits 7031.5,Business anden.dcoum Code:Anycity arcounty I 111' I\f\\•�/^/ a�$ which requiem a ,also re consumer,alcor,impmw,demolish,at¢pais any summers U +� that heor sitscensed ,almost MAW tWvision of for amhpermiuoimersm a,ned aw(Chnomcm qSp Wmmencis iec withSection7")ofDiviomofmcComrxwhndProl Uw(Chapmr9 Sq. Ft. Floor Area Valuation y+l-$ (cat Amis (commencing Sceion]IDO)of Divisionr nfineegedexeendon.Anions Co@)or _ Nat he u 31.5 b ncirefmm and the burs it the alleged crvemant 10 Any=of notSecon than by airy red doll for•permit subjects the applicant to a civil penalty of 3 [�I�r�0 Occupancy Type not mom Nan fw hundred dollars(5300). p y yp ❑1,As owner of the property,in my employees with wages an their sole comp osadod, will da the work,and the structure is not mounted in offered formlc(Sec.7041,Busimu and Pmfessiom Code:The Conuacmrs Limme taw does not apply in an owner of Required Inspections property who builds orimproves thereon,and who doessuch work himselfor through his Man employees,provided that such improvements tie not intended eeolfered for aide.If. however,the building or improvement is mid within one year of completion,the owner- Wildcr .wig have the burden of proving that he did not build Or improve fee purpme of sal.). ❑1,As Owner of the property.am exclusively contracting with limned canuacmrs to mostwct the project(Sec.7014.Business and professions Code:)Thc Contractor's Li- mme Taw docs not apply in an owner of property who Wilds or improves themon,and who contracts for such projects with a contractor(s)licensed pursuant to the ConuumYs License Law. ❑I am exempt under Sec. ,B&P C for this meson Owner Data WORKERS COMPENSATION DECLARATION ' I hereby affirm under penalty of perjury one of dive following declarmom: 1 have and will maintain a Certificate of Cnmen in self-insure for Workers Compere satien,in provided fm by Section 3100 of Use labor Code,for the paformarme of the week for which this permit is issued. ave and will maintain Wmkefs Compemuion IrtsWanm,in required by Section 3]00 of the Tabor Code,for the performance cordite work for which this permit is issued. My Worker'Comp{e.ju.a c arti ficar or and Politymbo nur art: C� Carrier. 61u FL(k/r Polity No.: 1'S 3l1 CERTIFICATE OF EKEMPDON FROM WORKERS' COMPENSATION INSURANCE (This merino need not beeompleted drive permit is forum hundred dollars(SIM) or less.) 1 canify that in on,performance of Are work for which this permit As issurd.I shall nm employ any person in any 7ne,w As An Weome subject m the Workers'Compensation Laws of Califmn Applicant `..J NAPPI ICANIT,IL after making this Ccniftca a of Exemption,you should become subjmt to the Worker's Compensation provision of the labor Code,you must .J O forthwith comply with such provision or this Permit shall W deemd ed mmo . zN CONSTRUCTION LENDING AGENCY (-i l bunchy oflirm tWt then iso eomwclom lendingagcnry for the perm-mvtm of C' the work for which mu permit Is issued(Sec.3097,Co.C.) QLender's Name D z Under,Add. U C) 1 artily that I have mad this application and rut that the above information is convect.1 agree m onmply with all city and county oNimnms and sot laws relating t OO building comwction,and hominy mthorim rsprxxomxiws of this city m enter upon theI\'fy-/////f _ J abovc-.s.judnedproperty ort forimpecnes purposes (/`'_�/W,/ / � ,©�� F C (Wer)agree he ssw,indemnify and kmp barmkss the City of Cupertino against _ ti into sequence or nts. stein expemmwhich may in any way acmeAgainst.wid City C)z A consequence of UNDERSTANDS mating of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. SlgnWre of AppImA%Can.1.r Dam Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building mcupant store or houlk hvardoua manorial As dcfincd by tbo Cupertino Municipal Code,Chapter 9.12.and me Health and Safety cede.see ore 25532(.)' 4lr— All roofs shall be inspected prior to any roofing material being installed. Will mea applicant or future building Occupant um a If a roof is installed without first obtaining an inspection,I agree to remove PP Ba Air Qu or devices which g emit District?hazardous air conuminanu u deli d by the Bay Area Air Quality Management all new materials for inspection. District] ❑Yu u IhavercatyC hvudnmmamrialvequiremcnts under Chapmd thmifrim Califon nu Hcahhgmeml,h.ve A mmant. hat it is 3313and23334.1 undcrstnde ussop WildingaN- Joel our curt whit how a mnan4 mat it i issuance nce omiC ori m notify rite oceupan of the .L rtym me tawhichmuabc�mc�tgiormAss�ofaCcnfirato OveaY Signature of Applicant Date 0umor or ammmunred agent I Dam All roof coverings to be Class "B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building De artment JOB ADDRESS: C-� PERMIT # 0-3-0 3 0/c� OWNER'S NAME: i U, o PHONE # - - GENERAL CONTRACTOR: �{ c -1 FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 60 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 Ajj� /1/� Tile A" Owner/Contractor Signature Date CITY OF CUPERTINO 0 -z3 WATER HEATER CUPERTINO PERMIT APPLICATION FORM APN# 3(o(o _ a _ D rZ Date: / Building Address: (P ( OakSP c I n l� Owner's Name:. IPhone #: I 'I" p Contractor: Phone: License#: �- ln)�e� Tr c� - --)� Contact: ; Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb Er Mech ❑ Job Description: e 0�_C a C � �lSl� c, /Z2s/ra/�f3 Residential 6CI Commercial ❑ Cost of Project: 5-DQ '• Strapped ❑ On Platform ❑ Bonded ❑ . New Location ❑ Replacement Qty. if A licable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING