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08120044
MY OF' UPERTINO ,#1 .a .mt'�xT BUILD,IN�DIVI�ION_ PERMIT �dCQNTRACTOtR IN,FORMATPIO,N , 5, V-11, nim BUILDING ADDRESS: PERMIT NO. 739 STENDHAL LN HOME DEPOT 08190044 OWNER'S NAME: PERMIT ISSUE DATE NE: A CONTROL NO. (425) 636-7054 ARCHf1ECnENGINEEA: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 u o o LICENSED CONTRACTOR'S DECLARATION Job Description U F 1 hueby affirm that 1 am Ile:nacd under provisions of Chapter 9(commumcros P =`n 1.ullto.��ons. ka of 3otNe Business and Professions i ans Code, myllecn 5 REPLACE GAS WATER HEATER , 2�x Iuacvc Clan Lle.I Fq Date T'S DELL 7W ARCHITECT'S WTS DECLARATION ill IuMcrstand my Pls"s sh+llbeutedupublic record gC Licensed Professonsl a,�5 OWNER-BUILDER DECLARATION ComrmON rZ O O 1 memo afnrm Sat 1 1. exempt tram the CanuactCo License law for tite ZOO following mason.Permit t 703 L4 Business and improve. derons Code:Any city of county Y$- which its •permit med.thm alter.improve,h Per i t or ed structure IM; Prior o its tensed pursuant regatta pro applicant for such pener's Li le a sigaW stsmmw F e NalbeiccnsedSectioto the,of Didons of 3the Conuacorbnd Prasehaw(Chapter9 Sq.FC Floor Area Valuation M; 5 theim(commencing pt Section 70nd the Division 3 the al eg dress ed on,Anyovi Code)or Q^3— that a u eumpt M^frmn and the Esso for the alognd eamPtion Any violation of 4 4 9 Section 7031.5 by any applicant for permit sablacu the applicant to a civil Panslty of APN Number Occupancy e not more than five hundred donan(SM. 37542034 . 00 P yTyP ❑1,u.of tie pmputy,or my employees with wags.their sole eompewtion, will do the wart.and Ne soetme is not intended warranted for sale(Sec.7044,Business Required Inspections and Profesd..Cade The Cone uoes License n e ns Law de -1 apply b an acoreas of q P property who builds o Improws Huron,and who does such work hinuel f or through his own cmplayees,provided that such improvements are,not intended ooacsd forsate.If. however,Ne building or improvement 4sold within one year of o mplction,die awner- buildor will lave ds,hurbcn of proving that be did Out Ntikl Or improve for puryoe of ale.). 1,as,ownce m the property w eaelsiwly conmauimg with licensed anaacbn to cunatroct the project(See.7044.Bund.and Professions Cade:)The Contractors U. cease Law door not apply to an owner of pmpeny who Wilts or impross Nerton,+nd who contracts for such projects with a conm.cor(s)licensed pursuant at Ne Commences License Law. ❑1 am exempt under Sec .B&P C for Nis reason Owter Date WORKER'S COMPENSATION DECLARATION I hereby ono under Pendry of perjury one of Ne fallowing dkelarNas: 401 have and will amdn•Cutificem ofeen omt to self-insum for Workers Campm. m on,as provided for by Secdon 3700 of the Labor Cade.for she Performance of Na wok for which this permit is isucd. ❑1 ave and will maintain Workees confrontation Insurance,as mgoired by Section 3700 of On LaborCnde.to,me perilmmancc of Ne work for which m s Permit is issued. My Workers Compensation Inwnnce canner and Policy number tic: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE TDmts section reed trot M completed lime permit iforao hundred dollars($100) o leas) 1 centify mal in Ne Performance at the work for which Nu Permit is wood.l mall not employ my penon in my mamterm as m beaten subject to me Wodmn'Compenudon Laws of California Date Applicant NOTICE TO APPLICANT:IL after making this Cemliieale of Sam prion,you should become subject to the Workers Compensation pmvisiom of the Labor Code,you most .J z foMwiIh comply with such pervisioru or this permit.hal c deemed swled. ?Di CONSfRUCnON LENDING AGENCY [-a.�. I tamby a1Bmm mat demi a construction lending agency for the Ferformartce of Ci the work far which this Permit is Wood(sce.3091,Civ.C.) Q L endeh Name D z Landers Address U O 1 arty that I have mad this application and suite mar Na stow information is ^ cam""1 Agra m comply with dl city and county ordinances and sate laws slating to O SCJ: Wilding construction.and hemhg sumorias mpresenudvo croon;city o enter upon me r Gil move-mccum od property for inspection purposes I„t G (Wal)agme to nue,indemnify and kap harmless the City of CuPOIJOO agaist ,.y H liabilitis.judgrouts"mum and eapa.which may in any way acaa.,.lost said City U Z in consequence of the gnnung of mu permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signatureof ApPlica uContractor Dole HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will me applicant or future Wilding occupant store or handle hasrdaus materia as defined by the Cuptudw Municipal Code.Chapter 9.11 and use Hath and Safety Code.Semon 23532(+)T ❑Yen Ohio All roofs shall be inspected prior to any roofing material being installed. will the applicant or future building Occupant use equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove 1 harardns air Wourro nano s defined by the Bay Area Air Quality Manage... all new materials for inspection. b0 ❑Yes ONO 1 have mad me auardousmalerials squimmmus under Chapter6.95 ofthe Califor. nice Health&SafnyCade,Sections 25505,25533 and 75534.1 undersand dNarifNe Wilding does not currently haw a wnanl mal It a my mannumbitity Or notify the occupant of the squimmcncs which mus Esu met prior to iguana oft Certificate of Occupancy. Signature of Applicant Date Owner or autharisd.gem Dam' All roof coverings to be Class'%W''or better • CITY OF CUPERTINO 4 ITEMS OF 28 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37542034 .00 DATE ISSUED. . . . . . . : 12/04/2008 RECEIPT #. . . . . . . . . : BS000006760 REFERENCE ID # . . . : 08120044 SITE ADDRESS . . . . . : 739 STENDHAL LN SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CHEN-WEI SHIH ADDRESS . . . . . . . . . . : 739 STENDHAL LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JEFF JORDAN CONTRACTOR . . . . . . . : FRANK BLAKE LIC # 30610 COMPANY . . . . . . . . . . : HOME DEPOT ADDRESS . . . . . . . . . . : 12601 132ND AVE NE CITY/STATE/ZIP . . . : KIRKLAND, WA 98034 TELEPHONE . . . . . . . . : (425) 636-7054 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ------- ----- ---------- ---------- ---------- --------- ----- 1BSEISMICR VALUATION 449 . 00 0 .50 0 . 00 0 . 50 0 . 00 1PCWHEATR UNITS 1 . 00 24 .48 0 . 00 24 .48 0 . 00 1PPERMITFE FLAT RATE 1. 00 40 .79 0 . 00 40 . 79 0 . 00 1TRAVDOC FLAT RATE 1. 00 40 .79 0 . 00 40 . 79 0 . 00 TOTAL PERMIT 106 .56 0 . 00 106 . 56 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ----- -- --------- -------- ------- 518 WATER HEATER • ^�, Community Development 10300 Torre Avenue ,w� Telephone 08)777-3229 OF Fax(408)777-3333 OCUPEkTINO Building Department JOB ADDRESS: 739 STENDHAL LANE PERMIT# O g R,00Y4 OWNER'S NAME: SHIH,CHEN-WEI PHONE# (408)832-4559 7 GENERAL CONTRACTOR:HOME DEPOT FAX# 425-814-9516 I am not using any subcontractors:_ "4V_aa 11/4108 Signature Date Please check applicable subcontractors and com Tete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &NTillwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Instilation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering PIumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile • Owner/Contractor Signature Date 000000 Permit No: '��i (office use only) $� `f' • City Of Cupertino.Building Permit Application E-Mail: Building-Permits Rcu pert!no.org (Address is case sensitive). Jobsite Address:739 STENDHAL LANE Date: 11/4/08 Assessor's Parcel Number: 3 75—�a�03 Owners Name: SHIH,CHEN-WEI Phone No: (408)832-4559 Project Valuation: 449.00 Building Permit Info: Bldg Elect Plumb X Mech Job Description Remove/Replace Gas Water Heater Contractor Information Company Name: HOME DEPOT Phone No: • Contact Name: Carol Randall Fax No: 800-454-8955 Address: 12601 132ND AVE NE E-mail: carolr@fastwaterheater.com City, State & zip code: KIRKLAND, WA 98034 State Contractor's Lie. No: 602331 Expiration Date: 9/30IpK-i Worker's Comp No: 1928756 Expiration Date: 3/1/09 Carrier. AMERICAN HOME ASSURA City of Cupertino Business License No: Credit Card Information Credit Card No: Expiration Date: 11/10 Name on Card: Jeff Jordan Visa © MasterCard ❑ American Express ❑ • The Building permit application and a completed & signed contractor/subcontractor form need to be submitted with each permit.