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09030207 CITY OF CUPERTINO BUILDING DIVI&ION PERMIT BUILDING ADDRESS: PERMIT NO. 1538 PRIMROSE WAY SBL ENTERPRISE OWNER'S NAME: PERMIT ISSUE DATE 'ONE: A CONTROL NO. (408) S73-9101 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 90 p LICENSED CONTRACT'OR'S DECLARATION Job Description ImSc'hereby affirm that I am licensed under provisions of Chapter 9(commencing Z ui with Section 70(10)of Division 3 of the Business and Professions Code,and my license is 1=y in full force and effecL REPLC MATER HEATER . D t2Z License Class Lle•tt n F,a Date Contractor ARCHITECTS DECLARATION C< 1 understand my plans shall be used as public records JyU 4 O y Licensed Professional a 3 OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Cafe:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure n Z} prior m its issuance,also requires the applicant for such permit to file a signed statement =G 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 Cale)or $1400 y .. 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(5500). 3661501.5 . 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 does not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his awn 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.). PA,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. 0 1 am exempt under Sea / B&P C for this reason � Owner, j�l'kA 610L-0L 1 Date —{ 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 Compen- -.ion,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 Worker's Compensation Insurance carrier and Policy number arc: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certifv that in the performance of the work for which this permit is issued,I shall not employ any person in any mannerso as m becophc subject to the Workers'Compensation Laws of California pate ^_ `11 Applicant &ULI� fW n) 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of (x A✓ the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name Z Lender's Address V 0 1 certify that 1 have toad this application and state that the above information is V." corrccL 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. LL (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments,toss and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit ►" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b'r: Date SOURCE RE U ATIOjJS L)CUdj_( 3_7_6 -Ly Re-roofs Signature of Applicant/Conuactor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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)? rte All roof: shall be inspected prior to any roofing material being installed. 0 Yes Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. strict? 0 Yes P'Nu 1 have read the hazardcns materials requirements under Chapter 6.95 of the Califor- nia Hcalth&Safety Codc,Sections 25505,25533 and 2.5534.1 understand that if the building does not currently have a tenant that it is my responsibility to notify the occupant of the require which m�ust/be el prior ntoj'r-suance of a Certificate of Occupatn�cy. Signature of Applicant Date :7 w� 3 �Dare All roof coverings to be Class'A{'or better Owner of authorized agent CITY OF CUPERTINO c,,, 3 OOS 1 WATER HEATER CUPE(�TINO PERMIT APPLICATION FORM APN # Date: 3 �(0 - 0� Building Address: 1,5-3 PV>r�VflSL_ W Owner's Name: // ll Phone #: c - ( � Sl•.evi ( W�� c�Ltcvv� Ll08"- dYJ- a7&? Contractor: S (L �� pnse� Phone #: 0Y _ '5S-(o'7_ Co 0 0 Fax #: Cupertino Business License #: I -1 Contractor State License #: � F-19 S ( Contact: Sc o..t C3 S L Phone #: &� _7 / 0 oY SkZ✓i �J��dbc�� d5S'�Ao7 Fax #: ow Kvv- Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech D Residential FZ Commercial ❑ Job Description: Ye etuc,e d wcjt� t� Gck-,kZ L UL ��r J Strapped ET----On Platform Bonded R�— New Location ❑ Replacement Valuation (cost of project): 1)q v k� 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. Green Building Points achieved: - Revised 01/07/09 CITY OF C'UPERTINO S-41 -U-1--, WATER HEATER CUPEi�TINO PERMIT APPL]':CATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1 PCWHEATR Commercial Nater B PCWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee IBSEISMICOM Seismic Commercial B 1 PRWHEATR Residential 'Water B PRWHEATR ` HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Resic.ential B 1 PPERMITFEE Plumbing Permit P 1 1TRAVDOC Travel & B Documentatic n 1BUSLIC Business License B - Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ',UPEkTINO Building Department JOB ADDRESS: PERMIT #r)n Oar;n&vnse (,l�c, 03 o OWNER'S NAME: PHONE # s a GENERAL CONTRACTOR: ,te-- S�d FAX # S vL Ev,\kv PV«s I am not using any subcontractors: c-ignature Date Please check applicable 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 S (. ►� r ✓ISvs Roofing Septic Tank Sheet Metal Sheet Rock Tile --� . Owner/Contractor Signature Date