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07010119 CITY OF CUPERTINO BUILDING DIVISION PERMIT I �?RMTI®1 ., PERMIT NO. BUILDING ADDRESS: 10234 NILE _AFFDRDAELF PERMIT ISSUE DATE OWNER'S NAME: RICH SHANAHAN 24707 SIN FERNANDO RD 01/19/2007 SANITARY NO. CONTROL NO. 'NE: (661) 25S -7131 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH 0 0 J p C LICENSED CONTRACTOR'S DECLARATION .lob Description Z U =z with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE WATER HEATER H in full force and effect. 3 1 6.1-7 3 b ig �? License Class 1� Lic.# t m Date Contractor ARCHITECTS DECLARATION a< I understand my plans shall be used as public recwr Dau 4 O rn Licensed Professional OWNER-BUILDER DECLARATION M I hereby affirm that I am exempt from the Contractor's License Law for the a O following reason.(Section 7031.5,Business and Professions Code:Any city or county g g which requires a permit to construct,alter,improve,demolish,or repair any structure priorto its issuance,also requires the applicant for such permit to rile a signed statement ;;q,Ft.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $1500 xF (commencing with Section 7000)of Division 3 of the Businessland Professions Code)or .0 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 36950014: . Number 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 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 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. ❑I 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 Workers 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 Insurance carrier and Policy number am: Cartier. / k JP_ WAL15L Policy No.:2 0 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so as to become subject to the Workcrs'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workces Compensation provisions of the Labor Code,you must ,Z forthwith comply with such provisions or this permit shall be deemed revoked. z rA CONSTRUCTION LENDING AGENCY f~t rrA-i I hereby affirm that there is a construction lending agency for the performance of CG> the work for which this permit is issued(Sec.3097,Civ.C.) Lla ALender's Name az Lender's Address U 0 1 certify that I have read this application and state that the above information is (7. F correct-I agree to comply with all city and county ordinances and state laws relating to 0 U 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 liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date t"t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Signature of Applicant/Contractor Dare T of F.00f HAZARDOUS MATERIALS DISCLOSURE Type 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 shall be inspected prior to any roofing material being installed. ❑Yes >dNo If a roof s installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yeso 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- , j c nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tc it.that it is my responsibility to notify the occupant of the Cx✓' requirements which must et-prior issuance of a Certificate of Occupancy' Signatp of Applicant Date ACV ( All roof coverings to be Class"B or better Owner or authori-red gent Date Community Development a. 10300 Torre Avenue M Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "UPEkTINO Buildi:n De artment JOB ADDRESS: PERMIT # IC -34 OWNER'S NAME: fLL`C,L,, S k0,-v. kc,,,v-, PHONE # K o - - 3 i GENERAL CONTRACTOR: FAX# I am not using any subcontractors: u� D� - (01- P-? 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 OI' CUPERTINO A01olIq WATER HEATER OF CUPEIkTINO PERMIT APPLICATION FORM APN# Date: Building Address: 10�3 �d Owner's Name: Phone#: Ll q� 145- a 3)1 Contractor: Phuie: (,-Ce i License#: ti 7 -�13 1 tna 7 310 ' 2GTe fS a Cupertino Business License#: Contact: PhoT ie: b I p « co`r L�� � e.F�eta 5 - n�au Building Permit Info: Bldg ❑ Elect ❑ Plumb d Mech ❑ Job Description: Residential Commercial [] 2 UCe 5DICAiio Clea 2�n-re� - Sur►e � oC�ri bv, = ��rPf '�r C` �SE'i" Cost of Project: Strapped ❑ On Platform ❑ Bonde i ❑ New Location ❑ Replacement Qty. if Fee Group Applicable Fee ID Fee Description BPWHEATER Water Heater/Vent %ILDING PPERMITFEEPlumbin PermitIssuance UMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING