03060031 (2) CITY OF CUPERTINO 'uzd,
BUILDING DIVISION PERMIT 1, CON�TRACTORANF RMATIQ,�N�e
1 BUILDINGADORESS: HOT WATER INC PERMIT N"03060031
10989 RONALD WY
OWNER'S NAME: 2531 GRACELAND AVE , PEflA51TS`tJV ''93/2003
CHIEN AND NING-SUN
ONE: (650) 298-8494 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O66 LICENSED CONTRACTOR'S DECLARATION O O O
ti 1 boreby affirm that I am Ilcenatl undgf provisions or Chapter 9(commencing lob Description
^¢
wt Semon 7")of Dlvidon 3oftw BuslppSj and Professimu Cotle.antl my license is
< in fu and df)5r
ig
V
z5 Dam c°a �1ZEPLACE WATER HEATER FINALED
cwTE �tltlIun n �y plan`¢shall bords s^ 1 0 2003
5 Licensed Pmfca¢onal rT NO Y`I
a OWNER-BUILDER DECLARATION
<0 I hereby reaso.(Rent that 1 1.acmpl from the Contras Co License Law for the
i p o following recon.Permit
t 71D m Business and Improve,
d eluM Cade:Any city or county
u�$� which mquim s permit to enruuuct.ally.Improve,OemolLvh.a repair any awc,um
H prior m its imam.alar,requires the applicant forsueh permit ur rile a signed moment .
Sq.F[.Floor Area Valuation
< thmMiaricensedpunr,antorftproviaansoftheConuaclnrau<ntelaw(Chapter9
(commencing with Section 7000)of Division 3 of the Business and Professions Cole)or $500
Nat he Is exempt lhem(rom and the Buis for the alleged eararnim.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil porosity of Ap Nu�nher Occupancy Type
not mom than live hundmd dollars ISSUE). 3 S 6 $0 l)8 . 0 0
❑1,as owner of ft pmper ty,or my employes with wages as their sale compenaadon,
will dothewomt andthesa Canto me.Lntleda offeredsnet apply
in an owsi of 502 — FINAL ffa 1ftechnRGY
as
end Rafessiobu Code:The Conuaemn, red he Law doh not a I man owner of
property who
bisittis kimpmm thereon,andwho does such oak himaltor edBuough his
own employru,pmvidW that such improvements art not amended or offered for sale If, 506 — GAS TEST
however.the wilding or lmpmvemcnttawld within oro year of compindmn.the owtur. 507 — FINAL PLUMBING
builder will have the when of pmving that M did not wild or Improve(or purpose of l
ale.).
❑1.as owner of the property,am exclusively contracting with licensed contractors to
common and project(Sec.7W.Bumnea and Professions Code:)The Conmsam's Li.
ttnse law dm not apply m an owner of prom my who wilds or improves themon.and,
who contracts for such pmjects with a matrimonial limned pursuant in the Contrutoei
Leena Law.
❑l on aacmpt under See .B&P C for this count"
Dau
WORKERS COMPENSATION DECLARATION
I hammy mErm under penalty of perjury on of the following declarations:
❑I have and will maintain a Carolina,of Consent to self-ilium for Weakees Compcm
anon,as provided for by End.3700 of the labor code.far the pemhmance of dK
oak for which this permit is issued.
❑I have and will maintain Workels Compensation Imuran¢,a required by Section
3700 of the Labor Coale,fns the performance of the work for which this permit is laved.
M WarkeYa Co pent ionlwr cecarier aM Policy numbor am:
Ga e Nr,.:.�4 U p3A�
�/ CERT 'ICA OFEKEMPTI�ON ANCE ER5
COMPENSATIONI ANCE
(This sectl"n need nor he canpkud If the permit Isfnrane hundreddollan($100)
or less)
I certify that in the performance of the work for which this permll u issued.I shall not
employ any parson in any manner an u to wnme abject to the Workers'Compensallon
Lamar California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Ceniricau of Exemption,you should
become object to the Worker's Compensation provisions of the lahor Code you muse
,J 0 forthwith comply with such provisions or this Permit hall w dceme l revoked.
'Zpre CONSTRUCTION LENDING AGENCY
'E+ I herebyduthe
sem the n is a commuction lending agency for the performance or
Ce
;> tis,wort fur which Nis pernit u named(Sec.3097,Civ.G
Landar'
LU A comcros Name
7 Z Lender'sAddmh
U Q I certify that I Mere mad this application and arms,that Nc above information Is
O U corms I arts m comply with all miry and county dNirunch and sou hos mining m
OU abovingennumctimpcnd far Imyauuodmmoses. roof Nis city to tout upon the
CL eM1ovc(We)
nedi agree in save fa Impaction an keep ha.
gy (We)ague m cove,indemnify and keep humins the City of Cupertino sold
against
res in
liabilities,judgments,etcosuand g Of this Permit. may In any my acme ugainsusitl Clly
(„)z, APPLI ANT ofthegnTANDfthis permit
^ APPLICANT UNppERSfANDS AND WILL COMPLY WITH ALL 0 POINT Issued by: Date
SOU GULATIONS.
Re-roofs
court of Applimmn' r Data r
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicantserfuture wilding occupant am or handle humdo ,maunial
a defined by the Cupertino Municipal Code,Chapter 9.12,and the Heslth and Safety
ode,sttn"":ss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yee Nu
Will thea applicant or future building Occupant ca If a roof is installed without first obtaining an inspection,I agree to remove
pp e p equipment or mvlma which
emit hanNoua air canumin a defined by the Bay Ama Air Gamily Management all new materials for inspection.
Disaic,7
❑Ycs Nu
1 have mad the hmudmn maemala requ nanco u under Chapter 6.95of the Califor-
niaSall
th&Safety Code.Sections25305.35533u 2553a.1uak:nundtheif Pa wilding
due currently have Lunen.del h u my ddy m n fy ds,occupant thcnt3.vrh'hmu�metim u aehn Ce of0ccuP� Signature of Applicant .Date
OU're,h suthomcd agent Dam All roof coverings to be Class"B"or better
n
CITY OF CUPERTINO
WATER HEATER
CUPEkTINO PERMIT APPLICATION FORM
APN # Date.
3Sio /$ 00 '8
Building Address:
0 n � � �� Phone#:
Owner's Name: �• 9 _
(n
Phone: License#:
Co tr ctor: '71a3 Ce/ �
o ufcgenc G a �'y8•
Contact: Phone: Cupertino Business License#:
kris Gus ahs G5a•�-9� ��` 3
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech ❑
Job Description: Lk,
Residential Commercial ❑
Cost of Project: 919z)
• Strapped On Platform Bonde
New Location ❑ Re laceme
Qty. if Fee Group
A able Fee ID Fee Descri tion
BpWAR Water Heater/Vent BUILDING
PPERMl1 FEE Plumbin Permit Issuance PLUMBING
Ener BUILDING
BENERGY BUILDING
BUSLIC Business License
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