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09040156 CITY OF CUPERTINO BUILDING DIVISION PERMIT 1TR� C� � � • 5. BUILDING ADDRESS: PERMIT NO. 7660 WEST HILL LN AFFORD. OWNER'S NAME: PERMIT ISSUE DATE ^HO SA CONTROL NO. BUILDING PERMIT INFO ARCHITEC IENGINEER: BLDG ELECT PLUMB MECH RPLC WPR HTR SAME LOC u o o LICENSED CONTRACTOR'S DECLARATION Job Description v CI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z m with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in full force and effect z j License Class ( 0 Lle•# Dae - T '�^ Contractor 3 f. ARCHITECTS DECLARAT O t understand my plans shall be used as public records D9L Oy Licensed Professional h W OWNER-BUILDER DECLARATION n I hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county y Pi which requires a permit to construct,alter,improve,dcmolLch,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement z< that he is licensed pursuant to erre provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation yFS- (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 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). 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 w an owner of q 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.). 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 Caw 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 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 for Worker's Compen- .don,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 Workees. ompensation Insurance carrier and Policy number are: Carrier. "\,/L\ Policy No.: L"Cf,U /i S � 1� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars 1$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 Cotte,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z ► CONSTRUCTION LENDING AGENCY (-~•d►�—m 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.) W Q L.entices Name z Lender's Address U 0 I certify that I have read this application and state that the above information is GL " cored.I agree to comply with all city and county ordinances and state laws relating to Vbuilding construction,and hereby authorim representatives of this city to enter upon the W above-mentioned property for inspection purposes. Ia. (We)agree to save,indemnify and keep harmless the City of Cupertino against rA 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 �� 0 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULAT I?pN�S. � Y•+ . 1 Re-roofs Signature of AppliErflonuactor Dare T Of Roof 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 roofs shall be inspected prior to any roofing material being installed. 0 Yes ❑No If a roof s 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 materials for inspection. itrict? ❑Yes ❑No I have read the hazardous materials mquimmcns under Chapter 6.95 of the Califor- / 73 nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building /) �� ( 7l / does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which dtst be met prior to issuance of a certificate of Occupancy. SignaFdre of Applicant Date 6� �— `1" 3" t G! All roof coverings to be Class" "or better Owner ora orized agent Date "Oil oil d CITY OF CUPERTINO WATER HEATER CUPEk ANO PERMIT APPLICATION FORM APN # Date: Building Address: Owner's Name: Phone #: Contractor: Phone Fax #: Cupertino Business License #: Contractor State License #: Contact: Phone #: Cul Fax #: Building Permit Info: Bldg ❑ Elect [ Plumb Mech [� Residential [ Commercial ❑ Job Description: Strapped On Platform Bonded 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: t�" Revised 01/07/09 CITY OF C UPERTINO WATER HEATER CUPEt�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Descripti,)n Fee Permit Type Group 1PCWHEATR Commercial Water B PCWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICOM Seismic Commercial B 1 PRWHEATR Residential W ater B PRWHEATR HeaterNent ( 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission lee 1BSEISMICRE Seismic ResiCential B 1PPERMITFEE Plumbing Permit P r 1 TRAVDOC Travel & B Documentation 1BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 5�_ CITY OF Fax(408)777-3333 %HkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: t - PHONE # t{0 S L 1 - 0 d c: GENERAL CONTRACTOR: FAX # I am not using any subcontractors: q Signature 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile Cmme4i/Contractor Signature Date