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07090164CITY OF CUPERTINO BUILDING DIVISION PERMIT BUIL(1ZC�4[tES IVERSIDE DR OWNER'S NAME: TUNG-PING HSU .TONE: ARCHITECT/ENGINEER: p O LICENSED CONTRACTOR'S DECLARATION % WC I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z m with Section 7000) of Division 3 of the Business and Professions Code. and my license is t a a in full force and effecL I j? License Clasp Lic. B . n p Datc _ Contractor RCHITECTS DECI i a < 1 understand my plans shall be used as public records >yU IL y Licensed Professional n OWNER -BUILDER DECLARATION �^ 1 hereby affirm that 1 am exempt from the Contractors License Law for the -00 following reason. (Section 703 1.5, Business and Professions Code: Any city or county <.' 0! which requires a permit to construct, alter, improve, demolish, or repair any structure J — n prior to its issuance, also requires the applicant for such permit to file a signed statement Z a that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Businessand Professions Code) or 3 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 not more than five hundred dollars ($500). 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 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.). 0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contrxwr's Li- cense Law docs 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 Contractors License Law. 0 I am exempt under Sec . B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION .7 Q z� t-. W? 0.. A �z UO LT. H �U rH C/1 Uz t�r 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 Workers 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 Insurance currier and Policy number are: Cartier. W6 (J1-i%Ur! Policy No.: WRIS2 101* CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars (SI00) 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lenders Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the shove -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 in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND -WILL COMPLY WITH ALL NON -POINT Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupantstore or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? 0 Yes o 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 District? 0Yes u I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534. I understand that if the building docs not currently have a tenant. th t;riy responsibility to notify the occupant or the rey which must be me rior k issuan crtilicate of Occupayty. Owner or authorized agent _ /Dart d BETTER WATER HEATERS 351 FALCATO DR INSTALL 40 GAL W/HEATER- Sq. Ft. Floor Area _O(. Issued by PERMIT NO. 07090164 PERMIT ISSUE DATE 09/24/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description Occupancy Required Inspections Type of Roof All roofs ;hall be inspected prior to any roofing material being installed. If a roof i; installed without first obtaining an inspection,.I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better CITY OF C UPERTINO : a URTIV-) PERMIT APPL [CATION FORM APN # Date� 1240 Buildinu Address: lLi� Sr 9r PYUV PPERMITFEE Piumbin<u Permit Issuance PLUMBING Owner's Name: IV &' Pf�EJ �� Phone !/ � ��'�� r 2 -- Contractor: Lice?e Contact: / Cu rtino Business License =: Buildin�� Permit Into:_�o BId<, ❑ Elect �� Plumb Mech Job Description: l AI5-jxl�4- (�,o Residential 0,Commercial ❑ Cost of Project: SS,�15- ✓Strapped StrappedOn Platform Bonded - � New Location Replacement Qtv. If' A nnl;rnt,la Fpp m Fee Descriotion Fee Group BPWHEATER Vater Heater Vent BUILDING PPERMITFEE Piumbin<u Permit Issuance PLUMBING ( BEN ERGY F nen-, N, BUILDING BUSLIC E'usiness License BUILDING CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 35603039.00 DATE ISSUED.......: 09/24/2007 RECEIPT #.........: BSC00002745 REFERENCE ID # ...: 07C90164 SITE ADDRESS 22433 RIVERSIDE DR SUBDIVISION ...... CITY CUE ERTINO IMPACT AREA ...... OWNER TUI�G-PING HSU ADDRESS ..........: 22433 RIVERSIDE DR CITY/STATE/ZIP ...: CUPERTINO CA, 95014-3960 RECEIVED FROM ....: FRFNS CARTWRIGHT CONTRACTOR .......: FF -TNS CARTWRIGHT LIC # 26514 COMPANY ..........: BETTER WATER HEATERS ADDRESS ..........: 353 FALCATO DR CITY/STATE/ZIP ...: MIIIPITAS, CA 95035 TELEPHONE ........: (4(,8)250-6672 FEE ID UNIT QUANTITY 1,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 40.79 0.00 40.79 ---------- 0.00 ---------- TOTAL PERMIT ----------- 86.44 ---------- 0.00 86.44 0.00 CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Buildin De artment JOB ADDRESS: PERMIT #b' �vq33 /�ry-5�� Dv� OWNER'S NAME: -t'R 1v6 —10,,nV6 PHONE # _ GENERAL CONTRACTOR: 687P,- FAX # o ' 5 S ? - Y I am not using any subcontractors: Sig nature Date romnlPte the followine information: 11GG47G %-AL%-%-. 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 U "'''LJ 2 Iq Roofing Septic Tank Sheet Metal Sheet Rock Tile 7; 2L d Owner/ Contractor Signature Date '7Z CUPE TINO -iW Assessor's Parcel Number: Name of owner. T '? VID o e Contact person. ra.r Ice .-a �5 Phone. S, 2- I—an ra, /,I, et, --S Fax. q, Sq 2—& Net square footage of lot. Proposed Square footage: First floor: Second floor: Garage: TOTAL: — Are -there at -least -two -10 foot -by -20 -foot clear -spices inside J e gUage? -Y Is privacy protection planting required for the project? On what floor(s) is work being done? Brief description of work. K176 t-le"I e- v\,� p e e- i"Ac(vie Code editions: 2001 CBCN)2001 CFC N) 2001 CMC N) Inni P "JN52001 NEC N) r 6-7 Effective 11/1/0 -t-ks kill ve v-01 A Plan Re -view Process Work BOA page -8-Revised 8/22/05 I R FnT-.,-TVED �,mi 9 9 —4 4: 6£ — 5£ — £L n £66 � � N � ZLZ 4 - so t1 ti is I[ Zi? co a I � � 0 O N �-- O .. N ro 00 E a) a) V JSP c j q, 000 I' OW —4 4: 6£ — 5£ — £L n £66 � � N � ZLZ 4 - so t1 ti is I[ Zi? co I c r 0 O N �-- O .. N ro 00 E a) a) V 000 I' OW coLL -,(% U O N co d' L Q3