09030018 CITY OF CUPERTINO
BUILDING-DIVISION, PERMIT
BUILDING ADDRESS: PERMIT NO.
10295 MENHART LN AMERICAN RESID TIAL 09030018
NER'S NAME: S ERV I C E S OF CA PERMIT ISSUE DATE
SWtAkA6.2CONTROL NO.
PHONE:
(408) )82-0405
BUILDING PERMIT INFO
ARCHITECTIENGINEER:
BLDG ELECT PLUMB MECH
1400 LICENSED CONTRACTOR'S DECLARATION Job Description
inI hereby affirm that I am licensed under provisions of Chapter 9(commencing
z". with Section 7400 f Division 3 of the Business and PrOessions Code.and my license is RE P LC ?X S TNG PRO PTY LINE/CLEAN-OUT
n<y in full force an
? License Class Lic-
'-^ DateContractor
3 F CHI7ECTS DEC T!
I understand my plans shall be used as public records
DpmU
u.y Licensed Professional
N OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
CO o following reason.(Section 7031.5,Business and Professions Code:Any city or county
y which requires a permit to construct alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to rile a signed statement
2=0
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
F-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $3500on of
y that he is exempt therefrom and Ne basis for the alleged exemption.Any violati
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). 37515032 . 00
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 Contractor's License Law does not apply to an owner of P
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(See.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves themon,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
doer Dale
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a certificate of consent to self-insure for worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I 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 W°rkpes Compensation Insures a carrier and Policy npglygr ',-_�/1g1
Came Policy No.: Y!
CERTIFICATE OF EXE ON FROM WORKERS'
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 Workcrs'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 Codc,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
(~—t rN+ I hereby affirm that there is a construction lending agency for the performance of
a 5 the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
�
Z
Lcndees Address
V C) I certify that 1 have read this application and state that the above information is
LL*- conecL I agree to comply with all city and county ordinances and state laws relating to
0 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
c.1 liabilities,judgments.costs and expenses which may in any way accrue against said City
U Z in conseq e C Nc granting o t Date
APP6L NT NDE S AN ILL COMPLY WITH A NON- OINT Issued l y:
SOU R U S.
v +J Re-roots -
Sign of Applicant/C r are T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
feftncd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
.,dc,Section 25532(a)? / All root's shall be inspected prior to any roofing material being installed.
0 Yes °
If a foo�is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined a Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes
I have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health& Code,Sections 25505,25533 and 25534.1 understand Nat if the building
docs not cu ntl have a tenant.that it is m 'bility to noul'y occup of the
mquiremen wh'h m u be ri U. ° ccnir Ic°r g(I p ,` Signatu a of Applicant Date
V e All roof coverings to be Class'n"or better
Owner ora arized agent Date
0q03 OC)
CITY OF �XPERTINO
TREPIPE/SEWEIVMAIN SERVICE
*:1, E
CUPEi�TINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
/,v
[EnMer'sName: '
Phone�eq .AI
nt actor:
Phone tt.7 �-
Fax#:
Contact: Phone#: 9og Aft�zZ 2727 0`'
Fax#:
Contractor License#: '�,5 j S�
Cupertino Business License#: Q y
Job Description: ,v� /
Residential Commercial ❑
Valuation: 11
Project Size: Express H Standard Large [ Major
LJ
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 B iilding Points:
Quantity Fee ID Fee Description =Group
ee Permit Type
1PCSEWER Commercial buildingP 1CPSS
sewer/sanitary sewer
1BPREPIPE Commercial rc-pipe per fixture P 1CPRP
IP 'rASCOM Commercial C-as Piping System P
1-4 Outlets
1BCBSC Cal Bldg Stan lards Commission B ALL
PERMIT
Fee
1BSEISMICOM Seismic Commercial P
Revised 01/07/09
CITY OF (:UPERTINO
i_r REPIPE/SEWEIt/'MAIN SERVICE
CUPEI�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
i 1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICR Seismic Residential P
1PRSEWER Residential building P IRPSS
j sewer/sanitary sewer
1PRREPIPE Residential re-pi;)e per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
IRPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1 BPFIXTURE Plumbing Fixtur s P
1PGASRES Residential Gas Nping System P
1-4 Outlets
1BPGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permi:Fee Issuance P
1PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing gas Insp. P
1TRAVDOC Travel & Documentation Fee B
1BUSLIC Business Licens,- B
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PER rr#
OWNER'S NAME: Ai 117dm / PHONE #650
GENERAL CONTRACTOR: FAX#
I am not using any subcontract s: .__�
Signature Date
Please check applicable subcontractors and cors lete the followin 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
165_;
Owner/C tractor Signature Date
CITY OF CUPERTINO ��,i{T�T ,�
BUIL DIN•41 DIVISION PF,1�1T�1
PERMIT NO.
BUILDING ADDRESS: 0014
1119 MILKY W Y FA T W �' PERMIT issUE DATE
OWNER'S NAME:
S A CONTROL NO.
riON
T __(800) tI:i 4—8 9 5 5 BUILDING PERMIT INFO
ARCHITECT/ENGiNEER: BLDG ELECT PLUMB MECH
0
a G LICENSED CONTRACTOR'S DECLARATION Job Description
c0 I hereby affirm that I am licensed under provisions of Chapter 9(commencing
l Z t with Section 7000)of Division 3 of the Business and Professions Code,and my license is RMU/RP L GAS WATER H EATR
':'De y in full force and effect
? License Class_.Contractor
tp Dam ARCHITECT'S DECLARATION
-� 1 understand my plans shall be used as public records
�yU
4 tu O H Licensed Professional
OWNER-BUILDER DECLARATION
I hereby ad7rm that 1 am exempt from the Contractor's License Law for the
Q O following reason.(Section 7031.5,Business and Professions Code:Any city or county
K m which requires a permit to construct.alter.improve,demolish,or repair any structure Valuation
y y prior to its issuance,also requires the applicant for such permit to file a signed statement Floor Area
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q 111 8
YF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that 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 five hundred dollars($5M). 36219015 . 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 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. B&P C for this reason
❑1 am exempt under Sec.
OwnerDate
WORKER'S COMPENSATION DECLARATION
1 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 Compcn-
sation,as provided for by Section 3700 of the Labor Code.for the performance of the
work for which this permit is issued.
❑1 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 Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be compacted 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
,J,'Z forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
[�r�•. 1 hereby affirm that there is a construction lending agency for the performance of
a the work for which this permit is issued(Sec.3097,Civ.C.)
(Sa A Lendces Name
]2 Lendees Address
1 certify that 1 have read this application and state that the above information is
(US. correct I 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. y
>'nWi (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
U Z in consequence of the granting of this permit. Date
�, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued E
y:
SOURCE REGULATIONS. _
Re-roof
Signature of Applicant/Contractof Dare T of Roof
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 roof's shall be inspected prior to any roofing material being installed.
❑Yes ❑N° If a roo r is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices whicn all new materials for inspection.
emit hazardous air contaminants as defined by the Bay Area Air QualityManagement
District?
❑Yes ❑Nu
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant.that it is my responsibility to notify the occupant of the Signature of Applicant Date
requirements which must be met prior to issuance of a Certificate of Occupancy-
All roof coverings to be Class'J "or better
Owner or authorized agent Datc
436592
Permit No:NO 3(w
(office use only)
City Of Cupertino Build Ing Permit Application
E-Mail: Building-PermitSCcD-CUDerti no.org (Addrsss is case sensitive).
Jobsite Address:1119 MILKY WAY Date: 3/9/09
Assessor's Parcel Number: 3 b a( qD �5' ''
Owners Name: CANNINGHAN, DENNIS Phone No: (408)446-1793
Project Valuation:J, //3.7D
Building Permit Info: Bldg Elect Plumb X Mech
Job Deccri tion
Remove/Replace Gas Water Heater
Contractor Information
Company Name: FAST WATER HEATER COMPANY Phone No:
Contact Name: Julie Caskey Fax No: 42536-7084
Address: 12601 132ND AVE NE E-mail:carolr@fastwaterheater.com
City, State&zip code: KIRKLAND,WA 98034
State Contractor's Lic. No: 877489 Expiration Date: 5/31/10
Worker's Camp No: A09304465 Expiration Date: 12/1/09
Carrier: Truck Insurance Exchange
City of Cupertino Business License No: 29100
Credit Card Information
Credit Card No: Expiration Date: 11/10
Name on Card: Jeff Jordan
visa ® MasterCard ❑ American; Express ❑
The Building permit application e;�#o°�msubmitted with each permit. _
contractorlsubcontractor form
Community Development
10300 Torre Av=c
Cupertino CA 95014
r Tdephone(408)777-3228
Fax,(408)777-3333
CUPEkTINO
Buildin De artm.ent
JOB ADDRESS: 1119 MILKY WAY Psuwr# 0q v3 00�4
pWNf�R'S NANO: CANNINGHAI7,WATER HEATER COMPA FAX PHONEENNIS 42"36-7085
793
GENERAL coNTRACTM FAS
3/9/09
I am not using any subcontractors:_ Date
Sign iture
Please check applicable subcontractors an.dte the US�'SS NAA BUSINESS LICENSE#
SUBCONTRA.C'rOR B
Cabinets&Millwork
Cement Finishing
Electrical .
Excavation
Fencing
Flooring.CarPeBng
unoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Omamentrl$beet Metal
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature
Date
L