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09020038 CITY OF CUPERTINO ` BUILDING DIVISION PERMITJ. N.F �� ' PERMIT NO. BUILDING ADDRESS: 1436 S STELLING RD q nT TrrH PERMIT ISSUE DATE OWNER'S NAME: , S A CONTROL NO. lmoii: 408) 370-3535 BUILDING PERMIT INFO ARCHITEC IENGINEER: BLDG ELECT PLUMB MECH 0 0 u p p LICENSED CONTRACT'OR'S DECLARATION fob Description V 01 hereby affirm that I am licensed under provisions of Chapter 9(commencing R with Section 7000)of Division 3 of the Business and Professions Code,and my license is I N S T L W TR HTR @SAME LOC O y in full force and effect , s��` v�Z License Class Lic• n y Date Contractor ARCHITECT'S DECLARATION I understand my plans shall be used as public records �yU 4 O y Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the r a O following reason.(Section 7031.5,Business and Professions Code:Any city or county 9 which requires a permit to construct,alter,improve.demolish,or repair any structure 14 prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq Y F$ (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 of APN Number Occupancy Type not more than five hundred dollars($50o). 36617093 . 00 0 I,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 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.). 0 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 conuactor(s)licensed pursuant to the Contractor's License Law. 0 I am exempt under Sec. B 8t P C for this reason 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 of Consent to self-insure Car Worker's Comport- Jon,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 37700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's compensation Insurance carrier and Policy number am- carrier Carrier. ; T—V 7Jn _Polity No.:e�Gp_ = CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be 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,L 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 (~-t I hereby affirm that there is a construction lending agency for the performance of .7 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Z L.cndees Address V 0 [certify that I have read This application and stale that the about information is ` V.s" correct.I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorise rcpresentativc"f this city to enter upon the \ Uabove-mentioned property for inspection purposes. _ CL (We)agree to save;indemnify and keep less the City of Cupertino against H,t liabilities,jkdgmcnts,eosts and expenses which y in say way accrue against said City �J C),Z in co race oC the ranting of s permit Date r-» APP C NT UND STAND ND WILL OtyI�LY WITH ALL NON-POINT Issued bJ SO R GU A NS. i 2 f Re-roofs t Si re of pplicant/Con bate T of 1 Wof HAZARDOUS MATERIALS DISCLOSURE Type \� Will the apptLcanj w-fnNrc building occupant store or handle harardous material as defined b penin Municipal Code,Chapter 9.12,and the Health and Safety Code, n 25532(a)? All roofs shall be inspected prior to any roofing mat eing installed. Yes Will the applicant pr future building occupant use equipment or devices which ti� If a roof is installed without first obtaining an inspecgzee.to remove _....... iit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection. strict? r' 0 Yes tYNo 1 havcRcad the hvap�ous m nals dthcquiremcnta undc�Chaptcr fi.95 of the Calilor- nia Health afety Codd,Sections 5533 and 25534.I understand that if the building docs n c nd ha 'a tenant it' my responsibility to notify the occupant of the reyui bich m t be and or t�issuance of a Ccrtificilc of txcapancy. Signature of Applicant Date All roof coverings to be Class'W'or better 10 r or aut rued agent Dale (0tA1V CITY OF CUPERTINO WATER HEATER CUPER ANO PERMIT APPLICATION FORM APN #5 (P G I -? D 9 Date: Building Address: IA � � e 2 Owner's Name: Phone #: Contracto • Phone #: �� -3I�)�3 J Fax #: o� Cupertino Business fAcense M Contractor State License #: 8s8c'-+ I Contact: Phone #,030 e)5�/(/ Fax #: Building Permit Info: Bldg ❑ Elect ❑ PlumbW Mech ❑ Residential Commercial ❑ /V Job Description: L'o Qs', c7 Strapped On Platform [ ] Bonded New Location ❑ Replacement Valuation (cost of project): / 511, Project Size: Express , 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. IGreen Building Points achieved: ( / Revised 01/07/09 CITY OF CUPERTINO WATER HEATER CUPEkTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1 PCWHEATR Commercial `Vater B PCWI-IEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICOM Seismic Commercial B J 1 PRWHEATR Residential water B PRWHEATR HeaterNent 1 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES ! Commission 1;ee 1BSEISMICRE Seismic Resic.ential B 1 1PPERMITFEE Plumbing Permit P J J1 TRAVDOC Travel & B Documentation 1 BUSLIC Business License B Community Development sba� 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 'rUPEkTINO Buildin De artment JOB ADDRESS: PERMIT # OWNER'S NAME: I PHONE # f 3 3 GENERAL CONTRACTOR: AX # 1eh� Z C G I am not using any subcontractors: Signature Date Please check applicable subcontractors 4k corn lete 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