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09040158 7 !7777777 CITY OF CUPERTINO BUILDING DIVISION PERMIT � � � � � . PERMIT NO. BUILDING ADDRESS: 20638 3ARDENSIDE CL AFFORDABLE MZ5XZ_EEA=q K- 09040158 PERMIT ISSUE DATE OWNER'S NAME: SA CONTROL NO. '7 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH RLC WT:Z HTR, SAME LOC �',c o LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 70W)of Division 3 of the Business and Professions Codeand my license is n H in full force and effect & 7 j Iii Z License Class t 3( —Cor �� Date Contractor 3 ARCHITECTS DECLAR7+T10N pX$< I understand my plans shall be used as public records JWU 4 u.i- Licensed Pnufcssional 0 OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county K which requires a permit to construct alter,improve,dcmolich,or repair any structure m—ul prior to its issuance,also inquires the applicant for such permit to file a signed statement Ft.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 S�] 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 Occupancy Type Section 7031.5 by any applicant for a permit subjects to applicant to a civil penalty of APN Number not more than five hundred dollars($500). ❑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 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 Contractors License Law. ❑I am exempt under Sec. B&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 Cor Workers Compen- -tion,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 the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Polity qtr her are: Cartier. l (i. 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.) 1 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of p; > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lenders Name 0 z Genders Address 1 certify that I have read this application and state that the above information is 4UL correct.1 agree to comply with all city and county ordinances and state laws relating to 0 C, building construction,and hereby authorim representatives of this city to enter upon the W above-mentioned property for inspection purposes. Ll m (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 �j U Z in consequence of the granting of this permit. Date �+ APPLICANT UNDERSTAND7a ND WILL COMPLY WITH ALL NON-POINT Issued b` SOURCE REGULATIONS. �l" �1 Re-roofs ' Signature ofApplicant/Contractor Dare T of Roof MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle haiardous material as defined by tine Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code.Section 25532(a)? / All roof: shall be inspected prior to any roofing material being installed. ❑Yes Cho 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 it hazardous air contaminants as defined by the Bay Area Air Quality Management all new f naterials for inspection. strict? i ❑Yes 1 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 does not currency ha7�&;,:-7` tenant,that it is my responsibility to notify the occupant of the requirements which or to issuance of a Ccnificatc of Occupanry. Signatur:of Applicant Date y- 30 L.) All roof coverings to be Class'n"or better Owner of auth ri-d agent Date CITY OF CUPERTINO 0 1 � WATER HEATER CUPEkTINO PERMIT APPLICATION FORM APN # „ � Date: -�� Lp A � o Building Address: r`4 Owner's Name: Phone #: y_ -fo� - `',C-1 Contractor: Phone #: Fax #: Cupertino Business License #: Contractor State License #: �- L73E�' Contact: Phone #: � Fax #: Building Permit Info: Bldg ❑ Elect Plumb [9 Mech Residential El Commercial ❑ Job Description: Strapped ® On Platform ® Bonded-FF New Location ❑ Replacement Valuation (cost of project): 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 aKI-M. CITY OF C-UPERTINO WATER :HEATER CUPEkiNO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1 PCWHEATR Commercial eater 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 Commission F'ee 1BSEISMICRE Seismic Residential B 1 PPERMITFEE Plumbing Pennit P 1 TRAVDOC Travel & B Documentation 1BUSLIC Business License B Str,,, Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "UPEI�TINO Building Department JOB ADDRESS: PERMIT #/ OWNER'S NAME: 04, t c lL Lh c, PHONE # qc,S `1`1 b `E (� GENERAL CONTRACTOR: �4j ,-t,c(^We- �:t :- tett , FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and com Clete the following information: 60 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 dwner/Contractor Signature Date