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07050170 CITY OF CUPERTINO BUILDING DIVISION PERMIT T - oxM�TION'. PERMIT NO. BUILD�NQ�J 8ESMIRA VISTA AV WATER HEATERS ONLY 07050170 �J PERMIT ISSUE DATE OWNER'S NAME: WETLESEN MERETE 970 E. MAIN ST, SUITE 200 05/17/2007 SANITARY NO. CONTROL NO. NE: (800) 83-',-5946 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p p LICENSED CONTRACTOR'S DECLARATION Job Description I up I hereby affirm that I am licensed under provisions of Chapter 9(commencing z with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE WATER HEATER t y in ful��A '7� ? LicenLic•# �� o DatcF.wCI'S DEC i aa a 1 understand my plans shall he used as public records )yU U.in Licensed Professional _ :a a OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the p 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 u-N prior to its issuance,also requires the applicant for such permit to file a signed statement c Valuation -?4 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 .,q.Ft.Floor Area $0 0 t=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i 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 ofNumber Occupancy Type not more than five hundred dollars(5500). 3 5 7 0 2 0 2 7i� 0 1,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 Required Inspections and Professions Code:The Contractors License Law docs 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 one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). C]I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors L- cene 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. ❑I 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 declarations: -1 I 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. have and will maintain Worker's 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 arc: (/ CarrierrA-f us, +3'UJ 1N C Policy No.: C� CEWIFICATE OFEXEMFnON FROM COMPENSATION INSURANCE (This section need not be completed if the permit is for one 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 z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY [+►vl- I hereby affirm that there is a construction lending agency for the performance of ((✓ the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name a, z Lender's Address U 0 I certify that 1 have read this application and state that the above information is Cl. H correct.I agree to comply with all city and county ordinances and state laws relating to U 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 fF',y to liabilities,judgments,costs and expenses which may in anyway accrue against said City U z in consequence of the granting of this permit. Date 7 -- APP NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOU54 REGULAI IN, 157 —e7-c1/ Re-roofs Signature ofCo for Appli.W Date Type of Roof ` HAZARDOUS MA LS DISCLOSURE YP 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 o Will the applicant r future building occupant use equipment or devices which If a roof i;installed without first obtaining an inspection,I agree to remove emit hazardous air contamyas by the Bay Area Air Quality Management all new materials for inspection. District? YesIhavereadthehazayuiremcnts under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 75534.1 understand that if the building / doe of urrcntly have a tenant,that it is my responsibility to notify the occupant of the rc ' nos whicAgn me w Issuance of a Certificate of Occupancy. Signature Of Applicant -- Date All roof coverings to be Class"B"or better Owner or autheriz Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: kiersaw COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot : APN 35702027 . 00 DATE ISSUED. . . . . . . : 05/17/2007 RECEIPT # . . . . . . . . . BS000001368 REFERENCE ID # . . . 07050170 SITE ADDRESS . . . . . : 10250 MIRA VISTA AV SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER WETLESEN MERETE ADDRESS CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2705 RECEIVED FROM . . . . : EDVARD GREGORY CONTRACTOR MCGEE, PAT LIC # 18986 COMPANY WAFER HEATERS ONLY ADDRESS 97C E. MAIN ST, SUITE 200 CITY/STATE/ZIP . . . : GR7.SS VALLEY, CA 95945 TELEPHONE (8( 0) 835-5946 FEE ID UNIT QUANTITY 1,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 .00 BPWHEATER PER HEATER 1 . 00 10 .79 0 . 00 10 . 79 0 .00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 .37 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 84 . 02 MASTERCARD --------------- TOTAL RECEIPT 84 . 02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF CUPERTINO WATER HEATER CUPEI,TINO PERMIT APPLICATION FORM APN# 3 1�;+- oa - 09-1- Date: may;�- Building Address: s � /c� o ,� r- V"JA � C, Owner's Name: Phone#: /71 e r 2 /4/0 y Contractor: Phone: License#: i. c 4.zq 14 ec: lx4 s ,,, � ;- Z -7'- 3 00 1 1-2 ? � Contact: Phone: Cupertino Business License#: i s �.- 1 13G1,&P Building Permit Info: Bldg ❑ Elect Plumb Mech T:F Job Description: Residential Commercial ❑ Cost of Project: Q OL) Strapped IT On Platform Bonded New Location ❑ -Replacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 *TPEkTINO Building Department JOB ADDRESS: � PERMIT# �;-O/ V.- 7j OWNER'S NAME: W -5e PHONE # qV6 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: L m,6• , Si;; nature 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 7"0,17 Owner/ContractdSig4izffe Date