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07020086 CITY OF CUPERTINO CiT�2AGt1R IURMA�'I(IN' . BUILDINC•DIVISION PERMIT .. PERMIT NO. BUILDING ADDRESS: 10293 DENISON AV ALL VALLEY PLUMBING 07020086 PERMIT ISSUE DATE OWNER'S NAME: HSUE LO 3345 SELDON SANITARY NO. CONTROL NO. SNE: (510) 376-4816 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH 0 0 0 0 p C LICENSED CONTRACTOR'S DECLARATION Job Description W P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z U with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE WATER HEATER y in full force and effecL J h ? Li CI s Lle•g Date/�—Contractor Al ARCHrIECI'S DECLARATION i a< I understand my plans shall be used as public records )yV U.H Licensed Professional ' < OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the p oyfollowing reason.(Section 703 1.5,Business and Professions Code:Any city or county Ii which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement t, Valuation Ft.Floor Area -?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 •hq tz-0 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $375 L r 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 3162905-, qQ Number not more than five hundred dollars(5500). 0 I,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 docs 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.). 0 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. 0 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: 0 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. 0 1 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 Insurance carrier and Policy number are: Carrier.—M fC 7 Lc�.JI't'I-1 Policy No.:C.0Q-101"01 CEWTMMCA OFEXEMPMONFROMWORKERS* COMPENSATION INSURANCE (ntis 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,I 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. Z" CONSTRUCTION LENDING AGENCY (~-h ham. 1 hereby affirm that there is a construction lending agency for the performance of �. the work for which this permit is issued(See.3097,Civ.C.) W A Lender's Name z Lender's Address U 0 I certify that I have read this application and state that the above information is [I correct.I agree to comply with all city and county ordinances and state laws relating to .J Ubuilding construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. (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 2 in consequence of the granting of this permit. Date 6 `U ►- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOU E REGULATIQNS. e n .r^�> - _,-MlU" 2-l!S/J1 Re-roofs �- Signaturc ofApplican ontractor ate 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)? All roofs shall be inspected prior to any roofing material being installed. 0 Yeso U If a roof is 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? 0 Yes Nu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant that it is my responsibility to notify the occupant of the requireenLs which must be el prior to issuance of a Certificate of Occupancy. S ignaturc of Applicant Date ZZ/_1 All roof coverings to be Class"B"or better Owner or authorized agcnr Date Community Development 10300 Torre Avenue t. Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEKTiNO _ Buildin De artment JOB ADDRESS � l PERMIT # O�C�,L�✓V� OWNER'S NAME: PHONE # Z GENERAL CONTRACTOR 1qjj V FAX # I am not using any subcontractor Signature Date Please check applicable subcontra rs and coni Mete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets&Millwork Cement Finishing IIectncai Excavation Fencing Flooring:Carpeting Linoleum./ Wood Glass/ Glazing Heating Insulation i Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering ------ Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date Owner/Contractor Signature ___ CITY OF CUPERTINO 3 ITEMS OF 7 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 31629057 . 00 DATE ISSUED. . . . . . . : 02,'16/2007 RECEIPT #. . . . . . . . . : BS000000476 REFERENCE ID # . . . : 07020086 SITE ADDRESS . . . . . : 10,193 DENISON AV SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . HSIJE LO ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2428 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : MARY SANDBRINK LIC # 23015 COMPANY . . . . . . . . . . : ALIS VALLEY PLUMBING ADDRESS . . . . . . . . . . : 3345 SELDON CT CITY/STATE/ZIP . . . : FREMONT, CA 94539 TELEPHONE . . . . . . . . : (5:-0) 376-4816 FEE ID UNIT QUANTITY ;MOUNT 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 CITY OF CUPERTINO offrffy WATER HEATER CUPEkTINO PERMIT APPI-4ICATION FORM APN# 91-49 Date: l /� Building Address: 1 n�3 f ice- /&M- Owner's Name: Pone#: Z Contractor: �Q P nc License#: Contact: J one•r Cupertino Busmes License#: pl VL,:D� Building Permit o: Bld ❑ Elect L--"- Plumb Mech Job Description: a ze G -) Residential �L Commercial ❑ Cost of Project 57 Strapped On Platform Bonded New Location ❑ Replacement Qty. if Fee Grou A77fo FID Fee Description Water Heater/Vent BUILDING PlumbingPermit Issuance PLUMBING Ener BUILDING BBusiness License BUILDING