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07030107 CITY OF CUPERTINO BUILDING DIVISION PERMITIRA BUILDING ADDRESS: PERMIT NO. 20375 VIA VOLANTE ALL VALLEY PLUMBING 07030107 OWNER'S NAME: PERMIT ISSUE DATE FUNG POON T 3345 SELDON CT n-i/i4/2007 ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO REPLACE WSTER HEATER BLDG ELECT PLUMB MECH C7 D O C� i p O LICENSED CONTRACTOR'S DECLARATION Job Description U s= I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 70(10)of Division 3 of the Business and Professions Code,and my license is t 6 a in full force and a ect 9 0 j ? Licensc Class Lhc.R Date Contractor N{„ ARCHITECTS DECLARATION i a< I understand my plans shall be used as public records )qV Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the o O 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 Z} prior w 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 ;;q.Ft.Floor Area Valuation u1- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L 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 APN Number Occupancy Type not more than five hundred dollars(5500). ❑I,as owner of the property,or my employees with wages as their sale compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q p 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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Conuactoes Li- cense Law does 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 Contractor's- License Law. ...-- ❑1 am exempt under Sec. -_.B&-P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following,declaratops: I have and will maintain a Certificate of Consent to self-insure for Workefs 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 Workces Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workees Compensation Insurance carrier and Policy number are: Carrier: 111 Z .0.41 VH Policy No.:_C0LllbSH o CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Phis section need not be completed if the permit is for tme hundred dollars($100) 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY E"C6 1 hereby affirm that there is a construction lending agency for the performance of ai> the work for which this permit is issued(Sec.3097,Civ.C.) Rwi Q Lender's Name a z Lender's Address U 0 1 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 Jbuilding construction,and hereby authorize representatives of this city to enter upon the W ahovc-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against rn liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Dale APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: S02E REGULATIONS. 4 __ 4 k Re-roofs SignafireS Applicanontractor Da Type of Roof HAZARDOUS MATERIALS 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)? All roofs:;hall be inspected prior to any roofing material being installed. ❑Yes >111° Will the applicant or future building occupant use equipment or devices which If a roof i:;installed without first obtaining an inspection,I agree to remove ,tat hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yeso 1 have read the hazard s materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the rcqu; ents which must be mel 'or to ibrsuance of a Certificate of Occupancy. ^ Signature of Applicant Date / All roof coverings to be Class "B"or better Owilrr or authoriK4 agent Dare CITY OF CUPERTINO WATER HEATER CUPEkTINO PERMIT APPLICATION FORM APN# Date: 5)2- 1M Building Address: Owner's Name: e? l VbVA Phone#: � ":6- _ I Contractor: Z2: P ni� License#: � fill`� � �W//- ----'9 ,',5;�0 Contact: Phoncr Cupertino Busines License#: Building Permit o: Bldg ❑ Elect Plumb Mech Job Description:�yvgja- Residential Commercial ❑ Cost of Project- 7 Strapped On Platform Bonded New Location JT!5 Replacement Qty. if Applicable Fee ID Fee Description Fee Group BPWIEATER Water Heater/Vent BUILDING PPERWITEE -Plumbing Permit Issuance PLUMBING BENERGY Ener BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue _ Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT # 2 31 Vlex- q -?G 30y v OWNER'S NAME: bA V) PHONE # GENERAL CONTRACTOR: U FAX # I am not using any subcontractor Signature Date Please check applicable subcontra rs and com :.ete 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 T Date