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09020092CITY OF CUPERTINO�l�f. BUILDING DIVIS?ON PERMIT BUILDING ADDRESS: 18705 LOREE A E OWNER'S NAME: PHONE'.- HON :BUILDING -.: r C. TWOR TBD — T BE D PERMIT NO. PERMIT ISSUE DATE S p CONTROL NO. BUILDINGPERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description rARCH__NGINEER: affirm that I am licensed under provisions ofChapter 9 (commencing 0) or Division 3 ofthe Business and Professions Code, and my license is pLC E:�T 50GAL WTRHTR & REPAIR GAS LIITE eff �Lie -7 4 � ACIF:.0 COAST PLUMBING PD FOR BUS LIC 2/20/9 Contractor ARCHITECTS DECLARATION nd my p cords License essionai n OWNER ILDE!DECLARATION for I hereby affirm that 1 am exempt from the Contractor's License Law the following mason. (Section 703 1.5, Business and Professions Code: Any city or county improve, demolish, or repair any structure i which requires a permit to construct, alter, prior ler its issuance, also requires tie applicant for such permit to file a signed statement 9 Ft.:Floor Area Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $1500 !A _Jibat he is exempt therefrom and the basis for the alleged exemption. Any violation of fora subjects the applicant to a civil penalty of APN Number Occupancy Type Section 7031.5 by arty applicant permit not more than five hundred dollars ($500). 37519013-00 ❑ 1, as owner of the properly, or my employees with wages as their sole compensation. is not intended or offered for sale (Sec. 7044, Business Required Inspections will do the work, and the structure Professions Code: The Contractor's License Law does riot apply to an owner of and property who builds or improves thereon, and who does such work himself or through his improvements are not intended or offered for sale. If, own employees, provided that such ent is sold within ane year of completion, the own however, the building or improvem- 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 Professions Code:) The Contractor's Li. construct the project (Sec. 7044, Business and cense 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 Contractor's License Law. B & P C for this reason ❑ 1 am exempt under Sec. Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: SIT have and will maintain a Certificate of Consent to self -insure Cor Worker's Compen- 3700 of the Labor Code. for the performance or the den, as provided for by Section work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section of the work for which this permit is issued. 3700 of the labor Code. for the performance My Worker's Compensation Insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not the completed if the permit is for one hundred dollars ($100) or Icss.) I certify that in the performance of the work for which this permit is issued. I shall not to co c subject t Workers' Compensation employ any person in m r u Laws or CalIro-i Applicant NOTICE TO A ANT: !f, after m in Certificate of Exemption, you should become subject to the Worker's Compc provisions of the Labor Code. you must this shall be deemed revoked. Z forthwith comply with such provisions permit CONSTRUCTION LENDING AGENCY ham- I hereby affirm that there is a construction lending agency for the performance oC h% the work for which this permit is issued (Sec. 3097, Civ. C.) I 0 Lender's Name Z Lcndees Address 0 I certify that 1 have read this application and state that the above information is H correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the V above-mentioned property for inspection purposes. ' W (We) agree to save, indemnity and keep harmless the City of Cupertino against "t Ln liabilities, judgments, costs and expenses which may in any way accnm against said City this Date G C Cjv Zin consequence of the granting of permit. UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued b:�: ►4 APPLICANT SOUR ULATIONS. O D / Re-roofs— Shgnat orApplicant/ o for °are DOUS MATERIALS DISCLOSURE T Of Roof 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 be inspected to any roofing material being installed. Codc, Section 25532(a)? ❑Yes All roof; shall prior If a roof is installed without fi rst obtaining an inspection, agree to remove Will the applicant or future building occupant use equipment or devices which Wi nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new naterials for inspection. strict? ❑ yes u I have read the hazardous materials requirements underChapter 6.95 of tie Califor- 25505, 25533 and 25534.1 understand that it the building nia Health & Safety Code, Sections docs not. curen have a tenant, that it is my responsihility to notify the occupant of the ich be m 'or to once of Certificate off Oc Y• Signatui a of Applicant Date requireme m D All roof coverings to be Class rJg." or better Owner or authorized agent are CITY Of CUPEI�TINO CITY OF CUPERTINO WATER HEATER PERMIT APPLICATION FORM 0909 oDqA APN # 7 3 5/ ?0 /.3 , 0 0 Date: �Z o� Buildingg Address: 1070:s 4�"E� Z-0 9 EE Owner's Name: Phone #: CA-(-I+� (/\J G4 v b - 47� Contractor: Phone #: COASrL �'�l f�G ► F l C v r3 c n/ Fax #: Cupertino Business License #: Contractor State License #: F?,5/-,S07 Contact: Phone #: ,iIL l 5- Gc—,,,c<-g ©¢�¢ A�-ec S Fax #: Building Permit Info: Bldg ❑ Elect Plumb a Mech tj--- Residential�Z- Commercial ❑ Job Description: T -EP LA -C C FX t S T-1 n/� S� SAL 1,VIt-75,0e1-(E-A-TEIC A- vO fr:�EPA i f &+S L I IV E Strapped YJ Q Bonded New Location ❑ Replacement Valuation (cost of project): Project Size: Express EL --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 CITY OF CUPERTINO WATER HEATER PERMIT APPLICATION FORM Quantity Fee ID Fee Descriptio n Fee Permit Type Grou 1PCHEATR W Commercial Vv'ater B PCWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICOM Seismic Commercial B 1 PRWHEATR Residential Water B PRWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES ICommission 1'ee 1BSEISMICRE Seismic Residential B 1PPERMITFEE Plumbing Per -nit P 1TRAVDOC Travel & B r Documentation 1BUSLIC Business License B pGAsr-as 1. Use Low/No-VOC Paint 1 IAQ/Health pts yeses 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/H"th pts y=yes 3. Use Low/ND VOC Adhesives 3 IAQ/Health pts y=yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes, 5. Use Engineered Sheet Goods with no added Urea 4 Resource pts y=yes Formaldehyde 6IAQ/Health pts y --yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAD/Health pts y --yes 7..Seal -all Ejg=W Parc WxmM orMDF 4 IAQ/Health pts y=yes B. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 10. Install Whole House Vacuum System 3 IAQ/He filth pts y --yes N. Flooring 1. Select FSC Certified Wood Flooring 3 Resource pts y=yes 2. Use Rapidly RenewableFlooring Materials 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl 51AQ/Health pts yges 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes S. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=ye; Total Points Available: Total Points Project Received: 1 1401 1301 57 �_ 01 01 -01 G:data1progs/grf!enbuildmgguidelinesl odelerslgreenp6intsfina1212-Mproteatedxis � 0 � 1 1401 1301 57 �_ 01 01 -01 G:data1progs/grf!enbuildmgguidelinesl odelerslgreenp6intsfina1212-Mproteatedxis Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 CITY bf (.-,UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # ,, J q q t ff -7b � Lat2� ka l I OWNER'S NAME: Cf{TRf'-7(N PHONE # p� GENERAL CONTRACTOR: 6& r�6F_ `$. 'o S FAX # I am not using any subcontractors: - Si dna e Date �..1 ..,1., „ �t-.e �.,llnterir�Q infnrmatinTl' Please cnecx dVPjjLCLUjLC DIi L^_%J1LLL u�- SUBCONTRACTOR BUSI14ESS 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