The URL can be used to link to this page

09020089 CITY OF CUPERTINO �` 1� • BUILDING DIVISION PERIVIIT � R. PERMIT NO. BUILDING ADDRESS: 10119 SANTA CLARA AVE CUPERTINO PERMrr ISSUE DATE OWNER'S NAME: A CONTROL NO. 0HO 408) 253-0618 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH app LICENSED CONTRACTOR'S DECLARATION Job Description U C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Rwith Section 70110)of Division 3 of the Business and Professions Code,and my license is aeffect. T L DUPLEX( 10119 &10121 SANTA CLARA) RE-PIPE & WATER in full force and Z License Class Lic.8 p Date •7 jq—0 4 Contractor D 121 It HEATER@ L 0121) 3 _T_ k ttCCHITECI'S DECLARAA .N 9.4 I understand my plans shall be used as public records wo y Licensed Professional rn� OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the in O following reason.(Section 7031.5,Business and Professions Code:Any city or county yPi which acquires a permit to construct,alter,improve,demolish,or repair any structure _ prior to its issuance,also acquires the applicant for such permit to file a signed statement Valuation z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Y (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or $6000 y 9 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($500)_ 32624024 . 19&21 ❑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 Contractor's 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 Contractor's 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. ❑I am exempt under Sec B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate ofConsent to self-insure for Worker's Compen- ion,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 Worker's Compensation Insurance,as required by Section 3700 of theo Code,for the performance of the work for which this permit is issued. fab My Worke pensationSJ race carrier and Policy��b/er� Z- Cartier. Polary No.: CERTIFIC E. ON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is far one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensadon Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workces Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z t CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) (la Q Lender's Name az Gender's Address U 0 1 certify that 1 have read this application and state that the above information is [L a� correct.I agree to comply with all city and county ordinances and state laws relating to 0 V building construction.and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against Hliabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date ■+ APPLICANT UNDERSTAND,$.AlLFWILL COMPLY WI ALL NON-POINT Issued b": OURCE REGUbATiON. Re-roofs - Signature of A or Dare T of]roof HOMARDOUS MATERIALS DISCLOSURE Type all 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(x)? �� All roof: shall be inspected prior to any roofing material being installed. ❑Yes No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which nit hazardous air contaminants as dcfin y-tbe Bay Area Air Quality Management all new materials for inspection. Strict? ❑Yes o 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 docs not currently have a tenant that it ism irility notify the occupant of the re 'remcnts whit Ar pan 4_ Signature:of Applicant Date All roof coverings to be Class"n"or better Owner o �adfizcd a nl Date CITY OF CUPERTINO D9daZU� .`n WATER HEATER CUPEkTINO PERMIT APP]JICATION FORM APN # Date: off , / qV-� � Building Address: I o 1 i 9 *- lo 12- 1 G.lG�4- Owner's Name: Phone #: gy(s -- 3 38'7 Contractor: Phone #: 2.5-3 _ dG i g CLA- Pe--(-•+)r►-� �tbi'�'�� Fax #: Cupertino Business License #: Contractor State License #: G;� C440S Contact: Phone #: 019 Fax #: Building Permit Info: Bldg ❑ Elect ©` Plumb �— Mech Residential Commercial ❑ Job Description: G cyrw-- -C) Re-lrN) CV4, i� tZl Strapped ❑ On Platform ❑ Bonded New Location ❑ Replacement Valuation (cost of project): Project Size: Express Er Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicat le, include in plan set & the sheet index. Green Building Points achieved: Revised 01/07/09 CITY OF C'UPERTINO WATER HEATER CUPEf�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1PCWHEATR Commercial Water B PCWHEATR HeaterNent 1BCBSC Cal Bldg Star..dards B ALL PERMIT TYPES Commission :-ee 1BSEISMICOM Seismic Commercial B 1PRWHEATR Residential Water B PRWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission :Fee 1 BSEISMICRE Seismic Residential B 1PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel & B Documentation 1 BUSLIC Business License B f j� Pc..sUc s (ZP�1 Q p �C.,_+v Community Development 10300 Torre Avenue bV Cupertino CA 95014 Telephone(408)777-3228 CIVOF Fax(408)777-3333 -UPEkTINO Building Department JOB ADDRESS: PERMIT # i/1 o ��. �( d 2 0 d- civ(� Z — OWNER'S NAME: �� , u.ivt�r-.c_fc:�� PHONE # GENERAL CONTRACTOR: FAX# I am not using any subcontracto<s� 2-- 19 —0 Si;;nature Date Please check apphcable 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 Owner/Contractor Signature Date