Loading...
08120051 CITY OF CUPERTINO BUILDING IIIVISION PERMIT C,ONTRAC�TRINI+'URMAT ®N BUILDING ADDRESS: PERMIT NO. 7456 TIPTOE LN HOME DEPOT OWNER'S NAME: PERMIT ISSUE DATE NE: A CONTROL NO. (425) 636-7054 ARCHTIECT/ENGINEFA: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 a00 LICENSED CONIRACrOR'S DECLARATION IOb Descriptionv�u 1 hereby affirm Nns at 1 am licensed ands' na nds'providoof Chapter 9(come mncing with Section 7(1111)of Dh ivan 3 of the Business and Profeafov Code.and my license In infull to=macfra REPLACE GAS WATER HEATER , 3Ll z ueeva C1w Lie.0 F,q Data uam Cancr W ARCHTIECrS DECLARATION 1 [ 77 1 undersand my Plans shall be used as Public raordo owu g 0. 0 Licensed professional 1. OW NER-BUILDER DECLARATION iI hereby affirm that I am empn from the Continental License Law for the C O O u following reason.(Section 7031.5,BuAnus and Profusions Cods:My city or county , _ V. which mqun,a Permit to cowrut after,improv,demrd W,or repair any structure IIn priorb its car..also mquiru the applicant for such permit to like a signed statement that W is licensed purnam m the IlIriMent of thn Contrxmas Licause Law(Chapter 9 Sq.Ft.Floor Area Valuation y�$ (commencing with Sadon 7(13(1)Of Division 3 of the Business and Professions Code)du — that W is emmpn Nercfrom and the beau to,rhe allagrA esempd.My violation of $449 Section 7031.5 by any appnaut for a pemrit mbi<m the applicant to a civil penalty of APN Number Occupancy Type not mom Nan Gov hundred dollars($3=. 35932057 . 00 ❑I,u owner of dm propmy.a my wploym with wage u their sok campevadon, will do ftwork.and the structure Is Out inumadedw.ffenn!rotation soc.7W.Bustiness, Required Inspections and Plafemk n nuc Cods,TOC Com uns Lianks Law does oat Imply m an owmar of 9 P P.Pany who Wilds Orimprows Neroan.and whodas;swis WorkllimYl(m Nmngh his Own employees,proNded that such impmwrnenu the not intended oro@rat for ale If. however.the building or improvmwmn u sold within oro year of compktim,the ower- . Wilder and law tis hurter'of p omg Nil W did ma build or improve for purpose of ale.). ❑1.as owner of the property am eaciusively contracting with licensed contnctan m contract tW project(Sec 7014.Business and Professions Code:)The Contraction's Li- cense law does not apply to an owner of property who Wilds or impsavu theme,Md. who contracts for such projects with aeantilna'(U licensed pursuant to the Conuactoas license law. 01 ard eaempt under Sa, .B k PC for Nis wan Owner Date WORKERS COMPENSATION DECLARATION 1 Wmby aRrm under penalty of pesjury one,of the fallowing declarations: _ 1 hove and will outlook a Certificate ofConsenn to self-ivum fa Workeaa Compms alien.at provided for by Section 3700 of the labor Cade.for the performance of the wort for which this permit is wood. 0 1 lave and will murrain Wark es Compensation lusurura,u ns Bred by Section 3700 of the labor Code,for the performaa of tW wort for watch Nit permit Is heated My Worker's CarroMmuion Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Ibis recdon reed notaecomple ed if tic Permit Is(mane hundred dollars($1(0) or las) 1 certify char in dm perksmauce of the work for which this permit is issad,l shall rot cmplay anypca an in any muter an as b become subject N the Wod¢rs'Conewmation Laws of Califomia Dam Applicant NOTICE TO APPLICANT:IL after making this Certificate of Eampoon,you swuld become subject m the Worker's Compeaauon provfsiona of the Labor Wr Code,you muse O forthwith comply with such pmviainns or this permitthe]]W darned revoked. Z CONSTRUCTION LENDING AGENCY [—r l thereby affirm that two,is a conswcunn landing agency far the Performance of fLa i Na work for which this permit Is issued see,3097,Civ.C.) 6U. 0 Lender's Name z leader's Acidness U O I certify that I baw mad ova application utd aur that the show informadm Is U. H mama I Mun an comply with all city and county ordinances and aur laws rebating as OU Wilding construction,and Wmby mtharim mpwnuuves of Nis city an crac"pon the show-mentioned property for inspection purposes. (We)agree to saw.indemnify and kup hornless the City of Cupertino against f4A 1labilitiu,judgmma.costs and expenses which may in my way accrue against aid City U Z in consequence of ths granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs AZAR Signuurt of AppliwHA2Al acme Data IIDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or(arum Wading etsmor huddle allous material ufie defied by the Cupertino Municipal Code. Chapter te'9.13,roHe ti the Health and Safety Cale.Semon 25532(47 All roofs shall be inspected prior to any roofing material being installed. ❑Yea El No Will the applicant or comm Wilding acupar t use cqulproml or dedas which If a roof is installed without first obtaining an inspection,I agree to remove It hrnNtu err anaminanrs as deanM by the Bay Arta All Qaiiny M...gcmem all new materials for inspection. n7 ❑Yat No I have mad the huanhws materials mquimmcnaunder Chammr6.95 ofthe Califor. nia Health h Sdmy Cade.Swoons 25505,25533 and 25534.I u wereand thatifdc Wilding does net currently haw a women,that in is my responsibility m notify the aaupaut of the requirements which most W met prior In Issuance of a CmIlcate of OccoPanry. Signature of Applicant Date Owner sur mthavcd age., Date 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 . . . . . . . . : 35932057 .00 DATE ISSUED. . . . . . . : 12/04/2008 RECEIPT #. . . . . . . . . : BS000006760 REFERENCE ID # . . . : 08120051 SITE ADDRESS . . . . . : 7456 TIPTOE LN SUBDIVISION . . . . . . .. CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : YIQUN CAI ADDRESS . . . . . . . . . . : 7456 TIPTOE 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 1PPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40. 79 0 . 00 1PRWHEATR UNITS 1. 00 24 .48 0. 00 24 .48 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 'a 10300 Torre Avenue Telephone Cupertino8) 777-3228 OF Fax(408)777-3333 OCUPEkTINO -� Building D partment JOB ADDRESS: 7456 TIPTOE LANE PERAUT# 0 pId 705-1 OWNER'S NAME: CAI,YIQUN PHONE # (408)2052-8167 GENERAL CONTRACTOR:HOME DEPOT FAX# 425-814-9516 I am not using any subcontractors:_ `D °j1114108 Signature Date Please check applicable subcontractors and com Tete the followin,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 Permit No: 000000 SDX5/ • (office use only • City Of Cupertino Building Permit Application E-Mail: Building-Permits(cDcupertino.org (Address is case sensitive). Jobsite Address:7456 TIPTOE LANE Date: 11/4/08 Assessor's Parcel Number. sy 'joZ bS� Owners Name: CAI,YIQUN Phone No: (408)252-8167 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 Lic. No: 602331 Expiration Date: 9/301/c Worker's Comp No: 1928756 Expiration Date: 3/1/09 Carrier: AMERICAN HOME ASSURA City of Cupertino Business License No: ""ked 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.