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06030098 (2) CITY OF CUPERTINO na `�x v x "• x ''� a`" BUILDING DIVISION PERMIT ;CONTRACTOR INFORIMATION $: BUILDING ADDRESS: PERMIT NO. 10968 VIA SORRENTO OWNER'S NAME: PERMIT ISSUE DATE HENRY KING 1000 N RAND RD, #11203/20/2006 NE: SANITARY NO. CONTROL NO. (866) 293-3031 ARC HITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 100 LICENSED CONTRACTOR'S DECLARATION w I hereby affirm that I am licensed under pmvidonf of Chapter 9(commencing Job Description �z with Section]O(p)ofDiviaian 3ofNC Business And Profcuinns Code.and my license is REPLACE HOT WATER HEATER 50 GAL GAS/TALL 12 YR ^3� L emoogeandA a y�Z Li c teClaw C Lica n F DTIC a.` ConmLbta/�^iC.i ARCHITECTS DECLARATION U 1 undcru m my plans shall W used u public rtrnrds �� a Licensed Profcuional .� 3 OWNER-BUILDER DEC,C..tr ON a C 1 hereby alum Nal 1 L exempt from the Contractors License Law for the J $500 O O followwhich reawn. erroit 1 ]03 Cott,Business and Fmfcsdn li Cade:Any city stcounty APR /P 2006 i 3 which requs u a permit recouuum,alter.impmw,h permit er i h,ore a sig any awnure y 2} prior N its issuance.pursuant to ncethe the pmyisio and forthe Contractor's ractor's BIC nalga(ChapteCn1 JOW< (commencing incingudpSectio 7MOOofviiomnfoftheBusines'snirmclsw(Chapur9 Sq. FL Floor Area Valuation x€O (cammcneing with Section]000)nf Division7nithc Business and PmfcsainnsCMc)ur y $ that he is exempt thmefrom and the buis for she alleged exemption.Any violation Of Na Section 7031.5 by my applicant fora permit subjects dre applicant in e civil penalty of A Um not mom then fins hundred (SSM). OccupancyType yP 1,as owner Of the property,Or my employees with wages as their sole compensation, will do Ne work,and are svucmre is not intended Or offered for sale(Sec.7044,Business Audi Pmfessiom Code:The ConuacmrA License Law dors Trot apply in An Owner of Required Inspections property who builds or improve thereon,and who docs such work himself or through his own employee,provided that such improvements am not intended or Offered Tarsale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving Nat he did not build Or improve for purpose Of saic ❑1.As Owner of the property,em exclusively convecting with licensed contrecmrs to construct the pmjcct(Sec.7014.Bulinus and Professions Code:)The Contractor's Li. ceme law docs not Apply to in owner of property who Wilds or improv thereon,and who contracts for such projects with a contrssmr(s)licensed pursuant in the contractors License law. ❑I am exempt under Sec. B&P C for this moan #nm Dam WORKERS COMPENSATON DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Cerdfiate of Conaml to self-ileum for WthiersCompen- sation,As provided foe by Section 3700 of the labor Code.for the peAortnamz of the work for which this permit is ismad. N have and will maintain Worker'sCompensation Insurance,As required by Section Of the Labor Cade.for the performance of ds,work for which this permit is issued. My Worker'sR C W Comppensation huumna Cartier and Policy 1num-JC am: Cartier: � _rw Policy NO.: L 3`,(Z 1AL40 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This sectio reed natbeeOmpleted ifth Ie.i,is for one hundred dollars(SIM) or In..) 1 cenify that in the perfonnAncc of Ne work for which Nix permit is issued,I shall nut employ any person in any exanster an As At become mbjec0o th Workers Compestsadan Laws Of CalifOmia.Date AppEant NOTICE TO APPLICANT:IL after making this Ccnificam of Eacmplion,you should become subject in Ne Work.'.Campcwdon provisions of in.Labor Code,you net .J O foMaith comply with such provisions w this permit stall W deemed revoked. '—' CONS RUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of ce the work for which this poplin u issued(See.7097,Civ.C.) {gl Underf NArnc = z Lender's Address - U Q 1 certify that I have mad this application AM sum that the shout information is ly H correct 1 agree to comply with all city and county ordinances and 1.111..relating m CU Wilding construction,and hereby autharim rcpraxcrosde ofthis city to enter upon the HW ahovoms,judgdpmpent for inspection purpowhich ms. G (We)agree to save,indemnify and keep humlcu the City of Cupertino against Z inet liabilities,judgments,costsmd91.6.9 ofpis parr which may in any way ecrncagainst said City U Z APPLICANT`of UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. 6a �D a is —20actr —G9(� Re-roofs Srgnazurc ofAppliHAZAA DR OOUS MATERIALS DISCLOSURE Dau Type of Roof Will the applicant ar future building eccupmt store or handle haratdous man niel U defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety Code. 0y. Ifo 25532(x)? All roofs shall be inspected prior to any roofing material being installed. 41 Yes Will the applicant or future building occupant Am equipment or dcvica which If a roof is installed without first obtaining an inspection,I agree to remove coil hazardous air Contaminants as dcrined by Ire Bay Area Air Quality Management all new materials for inspection. Disvict? ❑Yes 16No 1 have read the hvmdous materials requirements under Chapter 6.95 of the Califor- nuHealth A Safety Codc,Sections 25N)5.25533 and 25534.I undcrstaM then ifthe Wilding does not Currently haw a tenam,that it u my respomihiliny m madly the emopenl of the requirements which mass IN,met prior toiamamx Of.CmaECate of Occupmry. Signature Of Applicant Date S-10 —QPG All roof coverings to be Class "B"or better Owner or authoriecd Agent Dam CITY OF CUPERTINO 2 of 5 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31601167.00 DATE ISSUED. . . . . . . : 03/20/2006 RECEIPT #. . . . . . . . . : 33636 REFERENCE ID # . . . : 06030098 SITE ADDRESS . . . . . : 10968 VIA SORRENTO SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HENRY KING ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : METRO MECHANICAL CONTRACTOR . . . . . . . : PAUL HENDRIXSON LIC # 27607 COMPANY . . . . . . . . . . : METRO MECHANICAL INC ADDRESS . . . . . . . . . . : 1000 N RAND RD, #112 CITY/STATE/ZIP . . . : WAUCONDA, IL 60084 ' TELEPHONE . . . . . . . . : (866) 293-3031 •EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL _______ _____________ __________ __________ __________ __________ __________ BENERGY PERMIT FEE 1. 00 34 .86 0.00 34.86 0.00 BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0. 00 38.37 0.00 __________ __________ __________ ---------- TOTAL PERMIT 84 .02 0.00 84.02 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • £ Community Development 10300 Torre Avenue ✓' Cupertino CA 95014 X Telephone(408)777-3228 CITY OF Fax(408) 777-3333 OCUPEkTINO Building Department JOB ADDRESS: PERMIT #()GQ G o OWNER'S NAME: ¢, ,� PHONE # Z4.c 133 GENERAL CONTRACTOR: °D FAX # Vp l{ I am not using any subcontractors: 3f249 - O 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 L/ Plumbing eAar - Lr f= v ,e 27 C.Q-7 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date - CITY OF CUPERTINO WATER HEATER CUP` or PERMIT APPLICATION FORM APN # 310- 01— ica� Date: o Building U c� �c•e� Owne Phone #: Gl bComm _ _ 36o L.. 'c( LicenseXL #: 61A(31 Contabt VS S1 3S6 VC) Cupertino Business License #: Buildi ig Permit In : Bldg ❑ Elect ❑ Plumb Mech ❑ Job Discription: Residential SO 6Q Commercial ❑ Cost o Project: • Strappd n On Platform Bonded ❑ New cation ❑ Re lacement Qty. if 7P, USLIC Fee ID escri tion Fee Group PWHEATER ater Heater/Vent BUILDING PERMIE Plum mg Permit Issuance BINENERGY Ener B LDING Business License BUILDING •