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07060260CITY OF 'CUPEK11 NU BUILDING DIVISION PERMIT BUILDING ADDRESS: 10390 MANN DR OWNER'S NAME: MAPLES M D ET AL SNE: ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 orate Business andProf, ip C de, at�my license is in full force and effect. 2�! /e5 715 License Cl. Lic• if Date Contractor LA le 4j� RCHrMCPSDECLAR ION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5. Business and Professions Code: Any city or county 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 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 Business and Professions Code) or 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 (5500). ❑ 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 Contractors 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 pne year of completion, the owner - builder will have the burden of proving that he did not (wild or improve for purpose of sale.). ❑ I, 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- ccnse 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. ❑ I am empt under c. B & P C for this n Owned C/ Date WORKER'S O SAnON D RATION 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 Workcrs Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars (EI00) or less.) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any m rrt "C& o c etlpject to the Workers' Compensation Laws of Cali rota. Date Applicant d0 K .P �1 NOTICE TO APPLICA : If, after making this Certi teat of xempuon, you should become subject to the Worker's Compensation provisions of the Labor Code. you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z "" CONSTRUCTION LENDING AGENCY Fr I hereby affirm that there is a construction lending agency for the performance of p; the work for which this permit is issued (See. 3097, Civ. C.) W Q Lender's Name 2 Lender's Address U 0 1 certify that I have read this application and state that the above information is VZ ► c correct. I agree to comply with all city and county ordinances and state laws relating to Q J building construction, and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We) agree to save, indemnify and keep harmless the City of Cupertino against Hfn liabilities, judgments, costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL OMPLY WITH ALL NON -POINT sour REG ION L� / Si nature of ApplicxAC_QWdat0r Date HAZARDOUS MA ALS DISCLOSURE 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)? ❑Yes Will the applicant or future building occupant use equipment or devices which (.nit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes 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 my responsibility to notify the occupant of the rcquircmcntp which �i be met prior tej i slyance of a Certificate of O;cupancy. or authori-rcd PERMIT NO. ALL VALLEY PLUMBING 07060260 PERMIT ISSUE DATE 3345 SELDON CT 06/28/2007 SANITARY NO. CONTROL NO. (510)3"6-4816 BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description WATER HEATER REPLACEMENT; 50 GAL GAS. Ft. Floor Area 3264501)9 qVNumber Issued by: 11 11 Re-roof:; Type of Roof $450 Required Inspections uatlon 6-9 6� 1K1J? Date All roof; shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signatuie of Applicant Date All roof coverings to be Class "B" or better CUPEkTINO CITY OF CUPERTINO WATER HEATER PERMIT APPLICATION FORM 0i0� 0Z( oa APN # Date: BUILDING PLUMBING BUILDING BUILDING Building Address. U /1�G1I'1 �� • r i Owner's Name: Phone #: Contractor: License #: Contact: ( one- r n Cupertino Busines License #: Building Permit o: Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: Residential Commercial ❑ Cost of Project: q5-- a U strapped On Platform ❑ Bond& New Location ❑ Replacement Qty. if RPP iiecrrintinn Fee Group Applicable ree I" BATERHeater PWHE Y PWHE TFEE BENERGY BUSLIC ` Water 1 Vent Plumbin Permit Issuance Energy Business License BUILDING PLUMBING BUILDING BUILDING r i G CITY OF U PEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: 1031e 14an `t J PERMIT #��0� - j U CP OWNER'S NAME: les PHONE # o4OF - 970 - SS�eZ. GENERAL CONTRACTOR FAX # I am not using any subcontractor . •12.07 Si anature Date Please check applicable subcontra rs and comi:)lete the following information: Owner/Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Lz- 100 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