08120097 CITY OF CUPERTINO :s:«�P ✓ >i`r" "•bYet»-sk. ?z+i �, «z
BUILDING DIVISION PERMITCONTRACTOR INFORMATION tf
' �a "xt,
BUILDING ADDRESS: PERMIT NO.
21861 HERMOSA AVE ECONOMY ROOTER
OW NER's NAME: PERMIT ISSUE DATE
KPITIN YENQ 3;10 go—X -2252
ONE: S CONTROL N0.
(408) 249-4922
ARCHITECTIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
u o o LICENSED CONTRACTOR'S DECLARATION -
as❑ 1 busby affirm that 1 am loomed under provisions of Chapter 9(mmmme ng Job Description
MU wiNSemion7W)cf Divixlon3ofthe Rusinessmd Noemiomn Code,andmylicentei3
<< in full fame aud eRm W ip _ RPLC 40 GAL WATER HEATER
Dao: C
j i Licenm Clua — Lle,g '
=ro
pp wwwy ARCHITECTSSDFLLDECL
ARATION
W< 1 understand ernd my plansstill the records
u public recordsD
s
yC r^ Licensed Professional
g 5 OWNER-BUILDER DECLARATION
40 S I hereby.(Sce that 11. exempt faro to Comms rs License Law for the
p o (allowing reason.(Scetion]ID 1.5,Business and Pmfnssluns Code:Any city or county
'e m 9 which requires a permit to construct alasa improve,demolish.or mpair my swctum
prior to its issuance.also mquims Neapplieont far such permit to file a signed statement
FEM that he is licenxdpursuant othe pmvisionsofthe Contrselu' UeCoeLaw chapter 9 Sq.Ft. Floor Area Valuation
X� (common cingwith Secnion]OW)of Division3afthe Businmmd Prorcaslons Cade)or
y 5 that he isexempt therefrom and Ne basis For the allotted eumptian.Any violation or 5750
Section 70312 by airyappilco for as permit subject tic applicant o a mil penalty of AFN Number Occas
tot mart tnaa five humbod!dollars(M). �—- panty Type
❑I.no ofttiepropctty.mmyemploymwithwa ofthmlecompecodon, 35716038 . 00
coal do the wm s and the suunure ra not Nxmded or Law
do for sale(sec,to owner
and property
he bas Coder The canommrs and
Law eon not apply lf,t owner is Required Inspections
Own emy who builds m improve Hereon,and who does men wok himself or through his
Own employees,aping or
pr men improvement ars not tendedmaQered formic.Ir,
Wilder.the Wilding ru improvement is cold within one you or completion,the owe of
builder will have Ua burden of proving that W did Out build or improve fm purpose of
sale.).
❑L as on.of One property,am exclusively conVaeung with licensed commucmrs be
construct the,project(Sec 7054,Business and Prof essictu Cade:)The Comactors U.
one Law doss cot apply as an owner of property who Wilds or improves dialects.and
who contract for such projects with a comactar(s)licensed pursuant to the Contractors /
License Law.
❑1 am exempt under Sec ,B dile P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby still under penalty of perjury one of the following declarations:
nave and will for
Se Cmtif mat the LoasCode.furefor Workers Comp em
u provided fPe mi Sanson 3]00 a(the labor Code,for Ne peAormanm of da '
work for which Nis permit is iutaM.
❑1 have and will mainain Wormer Compensation Insurance,as required by Section
3700 of the Mbar Cade,for the performmcc of the work for which this permit is issmd. '
My Workers Compensation Insursonse carrier and Policy number art:
Caniec,Lt/17V 00Z66d7?VZPmliay No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This swim reed rot W completed if Ne permit u fortune hundreEdmllan(3100)
or lest)
I certify,that In the pmfarmenoo a the work For which this permit is issued,I shall not
employ any person in any manmrso as as 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 Ne Worker's Computation provisions of the Labor code,you mut
.J 0 forthwith comply with such previsom or Nu permit shall W doomed mucked.
Z v-' CONSTRUCTION LENDING AGENCY
to IWmb aiTum that there u a conuruction lending a
f—' r g iency'errtk perfmmuxm u(
IY.> the wok for whim this permit is issued(Soo.3091.civ.C.)
QLenders Name
� Z f<nders Add.
U C) 1 sonify that I have read Nis application arm state this the aWm information is -
correct.1 agree to comply with all city and county ordinances and stat laws retuning to
-5 building construction,and hereby summon repmaenmives of this city to color upon the
V4
above-mentioned property for inspection purposes
(We)all.to save,indemnify and kap Wooden the City of Cupertino against
tF—t N
liabilities.judgments.costs and expensm which may in any way accrue against mid City
fJ Z in consequence of the granting of this permit.
^ APPLICANT UNQ��gsRRRRSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:s4tez2i Date
SOURCE REGU[�tTIQNS.
y�I /1450P Re-roofs
Signature of ApplicmVCoDat
HAZARDOUS building
AIS Oat..or URE Type of Roof
Will da applicon m loom bolding acupmtsort or handle hvaAousd Safety
u tis.Sed io the Cupertino Mu 'pal Code.Chapter 9.12,and Ne Health and Safety
Cutts.Semon zss3z(a)t All roofs shall be inspected prior to any roofing material being installed.
❑Yes Na
Wilt the applicant or future Wading occupant use cqulpmmt or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
.barallous air contaminant u defined by the Bay Arta Air Quality Management all new materials for inspection.
Y. IN
I have rest Ne huarNw maarials mquimmenu under Chaptr6.95 of the Cxlifoo
nia Hca]&Safety Codc.Secuons25507,25533wd25534.1 undcrsmmdthxtifthe Wilding
does om cumm " ¢nen,that It is my maponsibitity as notify the occupant of the
me
requirent whit Ito me,plot o iuvanceofa Ccuriew of Occupancy. Signature of Applicant Date
Owner or author'vcd ascot Dam. .
All roof coverings to be Class'W'or better
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Elk: Lot :
APN . . . . . . . . : 35716038 . 00
DATE ISSUED. . . . . . . : 12/15/2008
RECEIPT # . . . . . . . . . : BS000006820
REFERENCE ID # . . . : 08120097
SITE ADDRESS . . . . . : 21861 HERMOSA AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KEVIN YENG
ADDRESS . . . . . . . . . . : 21861 HERMOSA AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2819
RECEIVED FROM . . . . : GEO F LIMA DBA ECON
CONTRACTOR . . . . . . . : GEORGE LIMA LIC # 30367
COMPANY . . . . . . . . . . : ECONOMY ROOTER
ADDRESS . . . . . . . . . . : PO BOX 2252
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95055
TELEPHONE . . . . . . . . : (408) 249-4922
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 750 . 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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ------------
CHECK 106 . 56 #1385
---------------
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---- - ------------------- -------- ----------------------------
518 WATER HEATER
Community Development
10300 Torre Avenue
! WI Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4;UPEkTINO
Building De artment
JOB ADDRESS: PERMIT# r p
OWNER'S NAME: t�yo PHONE # `/D�' L<j j_ �j LZ
GENERAL CONTRACTOR: 6Lc>,.,o p- FAX # _qZ F0
I am not using any subcontractors: 12- / S -off
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 OF CUPERTINO Osla 0�7
Ear WATER HEATER
0 UPERTINO PERMIT APPLICATION FORM
APN # �rJI Cv v 3 U U Date:
C) -ON
Building Address:
c�- I W6 / nrcos11 A
Owner's Name: Phone #:
�iC-V-i 0 C�(JC� CL/ob' 5 V-79 2 92
Contractor: 1 Phone #: 4-109 Zpl�/_C19ZZ
Fax #: �oi) (1 rj,b I ZI'M
Cupertino Business License #: Contractor State License #:
??2 (09r5_
Contact: Phone #:
Fax #:
Building Permit Info:
Bldg Plumb /0 Mech �--- .
Residential (Q� Commercial ❑
Job Description:
C/o
Strapped On Platform ❑ Bonded [r New Location ❑ Replacement
Valuation (cost of project): -0-0
Project Size: Express ❑ Standard Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to
the application or if applicable, include in plan set & the sheet index.
Green Building Points achieved:
Revised 6/16/08
CITY OF CUPERTINO
WATER HEATER
COF
CUPERTINO PERMIT APPLICATION FORM
e
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BSEISMICOM Seismic Commercial B
l 1PRWHEATR Residential Water B PRWHEATR
HeaterNent
C 1BSEISMICRE Seismic Residential B
1PPERMITFEE Plumbing Permit P
•
1TRAVDOC Travel & B
Documentation
1BUSLIC Business License B
•