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07010118 CITY OF CUPERTINO BUILDING DIVISION PERMIT e� �G ��INQRMTI�N. BUILDING ADDRESS: PERMIT NO. 10415 PRUNE TREF IN AFF RD OWNER'S NAME: PERMIT ISSUEDATE RICHAR CHAO 24707 SIN FERNANDO RD 01/19/2007 .ONE: (661) 25 -7131 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 J O p LICENSED CONTRACTOR'S DECLARATION Job Description V(= I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 70(10)of Division 3 of the Business and Professions Code,and my license is REPLACE WATER HEATER H in full force and effect j ? License CI Lic.# p Date Contractor ARCHITECTS DECLARATI CI understand my plans shall be used as public records DWU U.y Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the C O Oo following reason.(Section 7031.5,Business and Professions Code:Any city or county t,., which requires a permit to construct.alter,improve,demolLsh,or repair any structure y Z y prior w its issuance,also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $1300 Valuation EEC (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of a BST Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 31 6 3 312 .4�J'` Number Occupancy Type not more than five hundred dollars(5500). ❑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 Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q p 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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's 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. C3 am exempt under Sec .B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 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 Workers Compensation Insurance,as required by Section 3M of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation�-l�nsurancScarricr and Policy n b�an, Cartier. 7-hQ C ` Policy No.: W� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Crhis section need not be completed if the permit is foronc hundred dollars($100) or less.) 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'Compensadon 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 O forthwith comply with such provisions or this permit shall be deemed revoked. z Cr) CONSTRUCTION LENDING AGENCY [—�Cr) 1 hereby affirm that there is a construction lending agency for the performance of G4 the work for which this permit is issued(Sec.3097,Civ.C.) W0, Q Lender's Name Z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is U. t- correct.1 agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against Hliabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by SOURCE REGULATIONS. r _ -0 ACV -0 Signature or Applicam/Contrac Date HAZA OUType Of Roof S MATERIALS DISCLOSURE 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)? All roofs ihall be inspected prior to any roofing material being installed. ❑Yes 1 t10 Will the applicant or future building occupant use equipment or devices which If a roof i installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes �rvu Q /�) I have read the hazardous materials requirements under Chaptcr 6.95 of the Califor- nia Health&Safety Codc,Sections 25505,25533 and 25534.1 understand that if the building LL-- I U docs not currently have a tenant,that it is my responsibility to notify the occupant or the requirements which must met prior tu'ssuance of a Certificate of Occupancy. Signature of A leant Date 19 " C 11 All roof coverings to be Class"B"or better Owner or author'.c gem Date Community Development D- 10300 Torre Avenue ;FE Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: f -t-U a rCV,c&o PHONE # qO© -3l 6- IW? ? GENERAL CONTRACTOR: FAX # I am not using any subcontractors: �"G- 1 (c) Si€nature Date Please check applicable subcontractors and comF lete 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 TINO C�Otollo CITY OF i�UPER WATEI: HEATER CUPEt�TINO PERMIT APPLICATION FORM =ate: ,APN# 0 Building Address: Phone#: Owner's Name: q ok is (�Gl� (Z C v, i ck C v\ License#: Contractor: Phone: �� aS l 13 1 (0 a- =3�8 a b e i�a1eA�T�rS phone (�b I Cupertino Business License#: Contact: is t,51� Cod L1T� � e.F�Ela 5 • n7317 Building Permit Info: Bld ❑ Elect ❑ Plumb d Mech ❑ ------------ Job Description: S O v Residential Commercial ❑ ��E� 4-6141.- 2 v�Ce yC �Io ciCAS�,Me I occ�r� o� = Cost of Project: Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement Lel*- Qty. if Fee Descri tion Fee Grou Applicable Fee IDBUILDING BpwHEATER Water Heater/Vent PLUMBING Plumbin Permit Issuance BUILDING BENERGY Ener BUILDING BUSLIC Business License