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07010117 CITY OF CUPERTINO BUILDING DIVISION PERMIT � 'l'�AGT�1] IR4TI©lY: :.. BUILDING ADDRESS: PERMIT NO. 1 OWNER'S NAME: RLE HEATERS UE DATE SNE: TERRY DUNCAN 24707 SAN FERNANDO RD 01/19/2007 (661) 29-7131 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a O Z0 LICENSED CONTRACTOR'S DECLARATION 4 u v 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description -2 m with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE WATER HEATER y in full force and effect. /y 7 ? License Class 1 J tC Lic,g 213 4 Date (— 7—Contractor W ARCHITECTS DECLARATION to U 1 understand my plans shall be used as public records e, o y Licensed Professional n OWNER-BUILDER DECLARATION X I hereby affirm that 1 am exempt from the Contractor's License Law for the L G O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure _Z y prior to its issuance,also requires the applicant for such permit to file a signed statement _`e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation y F $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $1700 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number not more than five hundred dollars(5500). 3J 7 O 4 O 6 Occupancy Type ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractoes Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. C31 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. i have and will maintain Worker's Compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurancp carrier and Policy number are: r' l Carrier: �Q A%V\ Policy No.: Db7 7L1 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE or less.)(This section need not be completed if the permit is for one hundred dollars($100) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must .J O forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of 1:4 > the work for which this permit is issued(Sec.3097,Civ.C.) a Q Lender's Name a Z Lender's Address U Q 1 certify that 1 have read this application and state that the above information is U. correct.I agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against ,.y coi liabilities,judgments,costs and expenses which may in any way accrue against said City V 2 in consequence of the granting of this permit. �. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date . SOURCE REGULATIONS ^ &ft- I -1 c)- e 7 Re-roofs Signature ofApplicantICAn, ook Dale HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? [3 Yes All roofs sh ill be inspected prior to any roofing material being installed. �{o f( If a roof is i istalled without first obtaining n inspection,I Will the applicant or future building occupant use equipment or devices which g aagree to remove p emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes V11) 1 have read the hazardous materials requirements under Chapter6.95 of the Califor- nia Health&Safcty Codc,Sections 25505,25533 and 25534.1 understand that if the building -Q docs not currently have a tenant,that it is my responsibility to notify the occupant of the rcquircmcns which must be me nor to iss cc of a Certificate of Occupancy. Signature of Applicant Date Owner or authorized a g < < Date v All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue f Cupertino CA 95014 Telephone(408)777-3228 01V Of Fax(408)777-3333 "UPEkTiNO Building Department JOB ADDRESS: PERMIT# 10510 ry,�ro-, ►4 OWNER'S NAME:Ttrrq Ovhco v, PHONE # Lf 0*-- - 4k`�7 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: v 1� 1 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 _ CITY OF CUPERTINO 0q010111 WATER HEATER CUPERTINO PERMIT APPLICATION FORM Date: APN# I - 161 -0-) Building Address: Phone#: rk Owner's Name: ��_ y�t�- Phone: License#: Contractor: o,gi 3�v G b e w o.-re e-c,Te rs a ei - 13 1 Phon�: �b I Cupertino Business License#: Contact: Co'r LJITle-(e A 5 - o7412 Building Permit Info: _f -Bld3r ❑ Elect ❑ Plumb LTJ Mech ❑ Job Description: Residential 9 Commercial ❑ e Ckee SCA S Bio �s erg-ger - �,e lcc�,rin� = C E ject: 7Q _❑ On Platform ❑ion ❑ Re lacement Qty. ifFee Group Applicable Fee ID EFee Description Water Heater/Vent BU>Z,DING BPWHEATER PLUMBING PPE RN [TFEE Plumbin Permit Issuance BUILDING BENERGY Ener BUSLIC Business License BUILDING