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09020082 CITY OF CUPERTINO BUILDING DIVISION PERMIT 1 Z O� �� PERMTT NO. BUILDING ADDRESS: , 20371 GILLI K WAY WATER HEATER PERMIT ISSUE DATE OWNER'S NAME: _SWA 2089 CONTROL NO. ^�tONE: TRT TL' (800) 835 -5946 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH y p C LICENSED CONTRACTOR'S DECLARATION Job D2SCnptlOn v I hereby affirm that 1 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 RE PLC EXP WTRHTR W TNKL S WTR HEATER (TAKAG I) n=y in full force and effect Dig 2 License Class Lic•# r F p Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records �aU ; U.H Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the pO following reason.(Section 7031.5,Business and Professions Code:Any city or county .4$ which requires a permit to construct alter,improve,demolish,or repair any structure 4"y prior to its issuance,also requires the applicant for such permit to file a signed statement Sq.Ft.Floor Area Valuation ?< that he is liccrtscd pursuant to the provisions of the Contractor's License Law(Chapter 9 xFs G (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $4000 ythat he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than eve hundred dollars(_=• 36936017 . 00 ❑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 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 one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who Milds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractors License Law. ❑I am exempt under Sec B&P C for this reason owner I 1 ' 'G' ZC�'_r""' Date Z1L4 r5 9 WORKER'S COMPENSATIO DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- ,on,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 Workers 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: Carrier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is far 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 W r3' mpensation Laws of Caliy1rrtia.Date O Applicant a.=_ NOTICE TO APPLICANT:If,after makin this Certficate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must `,t, forthwith comply with such provisions or this permit shall be deemed revoked. Z OZ CONSTRUCTION LENDING AGENCY E.o►N.. I hereby affirm that there is a construction lending agency for the performance of GG the work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name Z !.enders Address V 0 1 certify that I have read this application and state that the above information is w correct I agree to comply with all city and county ordinances and state laws relating to 0 U building construction.and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes �'LL (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City V'Z in consequence of the granting of this permit Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIQNS• _ Re-roofs f---' — Signature of Applicant/Comractor bats T of R sof HAZARDOUS MATERIALS DISCLOSURE Type 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. fi ❑Yes CZKo If a roof i:.installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management all new in iterials for inspection. ,snot? ❑Yes 3216 I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SafetyCode.Sections 25505.25533 and 25534.1undcmmndthat ifthe building does not curtendy ha:..41 nt.that it is my responsibility to notify the occupant of the Date reyut cots which et prior to issuance of a Certificate of occupancy. Signature Of Applicant z//9/0'7 All roof coverings to be Class"W"or better Owner or authorized agent Date e)qo'-) CITY OF CUPERTINO WATE:R HEATER CUPEkTINO PERMIT APPLICATION FORM APN # Date: .5 6 9.3 ( W -7 . v � a /,.7/ © 1 Building Address: o?O 3 3 1 � I �►c /� �� ���-�Lr �� n��� C� q Sal y Owner's Name: Phone #: Wa rL Contractor: Phone #: q y Fax #: Cupertino Business License #: Contractor State License #: l8ag �. 3 � 1-E5-4- 3 Contact: Phone #: sy y� ��?1�u3�1�t�) Fax #: ;0-�-1q- 3o 3 Building Permit Info: Bldg Elect 2Plumb [ Mech ❑ Residential 2/, Commercial ❑ Job Description: -fin 4-0 Strapped F-1 On Platform ❑ Bonded EFNew Location ❑ Replacement ❑�' Valuation (cost of project): 0 q , 0o o Project Size: Express LL?'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 01/07/09 CITY OF CUPERTINO WATER. HEATER PEkT CUINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Gr 1PCWHEATR Commercial Water B PCWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission lee 1BSEISMICOM Seismic Commercial B 1 PRWHEATR Residential Water B PRWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residontial B 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel & B Documentation 1BUSLIC Business License B M.Indoor Air Quality and Finishes 1.Use LoW/No-VOC Paint 1 IAQ/Healthis es 2 fAQ/Health 2.Use Low VOC,Water-Based Wood Finishes y--yes D pts y--yes p 3.Use LowMo VOC Adhesives 3 IAQ/Healthis es 4.Use Salvaged Materials for Interior Finishes R y—y D 3 Resource pts y=yes p 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6IAQ/Healthy is y es 1 IAQ1Health p 6.Use Exterior Grade Plywood for Interior Uses pts y= D =yes p 7.,59W ill ft*19bewd or 110DF 4 IAQ/Hsalthis es B.Use FSC Certified Materials for Interior Finish yy D 4 Resource pts y=yes p 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes p 10.Install Whole House Vacuum System 3 M/Healthis es p y--yes D N.Flooring 1 1 1 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes p 2.Use'Rapidly Renewableflooring Materials 4 Resource pts y=yes p 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes p 4.Install Natural Linoleum in Place of Vinyl 7l 5 IAQ/Health pts y=yes 1 5.Use Exposed Concrete as Finished FloorD Resource pts y=yes p 6.Install Recycled Content Carpet with Low VOCs 1 Resource pts y=yes p • 1 i t Total Points Available: 140 130 F 57 Total Points Project Received: 01 77F0 G:daWprogs/greer buildingguidelinesremodelerslgreenpointsfinat212.04proteot.:dxls