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09040024 CITY OF CUPERTINO BUILDING DIVISIONPERMIT t PERMIT NO. BUILDING ADDRESS:7656 NORMANDY WAY COUNSIL PNG PERMIT ISSUE DATE OWNER'S NAME: S A CONTROL NO. —ONE: (408) 2"'2-2272 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH a a 0 0 u p C LICENSED CONTRACTOR'S DECLARATION Job Description v C I hereby affirm that I am licensed umkr provisions of Chapter 9(commencing ZUro with Section 7000)of Division 3 of thc Business and Professions Code,and my license is INSTL TI dKLE S S WTR HTR W/NEW 1" GAS LINE y in full form and ret. v�2 License Cl Contractor ±F o Date ARCHITECTS DECLARATION I understand my plans shall be used as public records �06U 2.O y Licensed Professional n rAOWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License law for the a O following reason.(Section 7(X31.5,Business and Professions Code:Any city or county m Pi 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 file a signed statement ;q Ft.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 yF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $4200 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(5500). 36617055 . 00 ❑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 Contractors 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 We.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 for Workers Compen- .mp,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 Workers 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 (Chis 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 rmit is issued,I shall not employ any person in any man so as to become subject Workers' ompcnsation Laws of California.Dare Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,y 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. Z OCONSTRUCTION LENDING AGENCY Cf] I hereby affirm that there is a construction lending agency for the performance of p(,5 the work for which this permit is issued(Sec.3097,Civ.C.) W A Lenders Name aZ Lenders Address I certify that f have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to O 1-4 V building construction.and hereby authorize representatives of this city to enter upon the W above-mentioned s property for inspection purpose fin (We)agree to save,indemnify and keep harmless the City of Cupertino against Hliabilities,judgments,costs and expenses which in any way accrue against said City U Z in consequence of the tin of this permit APPLICANT UND SANDS AND W] L CO PLY WI AL NON-POINT Issued by: Date S S UR G IaA O AA Re-roofs - ignature of Applicam/contractor Dare T of F.00f 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 roofs shall be inspected prior to any roofing material being installed. E]Yes 1No 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 ,iit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Strict? ❑Yes Nu t have mad the her us materials requiremc un Chapter 6.95 of the Califor- niaHcalth&SafctyCodc, ns 25505.25533 and 534.1 un the building docs not currcntiy�have a that His my respo 'bility to natCy(the occupant of the u' me rs ichmhrst met rio of ofa crtif ate eyp Signature of Applicant Date (o All roof coverings to be Class'n"or better Owner or authorized agent Date CITY OF CUPERTINO WATER HEATER CUPEkTINO PERMIT APPLICATION FORM APN # Date: Building Address: -46 '5b NoeMaQd,\ Owner's Name: Phone #: I r,c- I e �TbP-I Contractor: Phone #: Z72-227?— La 72-227Z Fax #: Cupertino Business License #: Contractor State License #: 92756 Contact: Phone #: 408 Q9- Q� v 1 �e- Fax #: Building Permit Info: Bldg ❑ Elect Plumb Mech [l----- Residential 4 Commercial ❑ Job Description: 7n,3A G ) 1 I n TG Yl e5S Woo e2 W Ai nem I �C�S 1 i �e Strapped ❑ On Platform ❑ Bonded ew Location ❑ Replacement Valuation (cost of project): 4 , 266 Project Size: Express-[- tandard ❑ Large ❑ Major ❑ Green Building: Please complete relevant po rtion 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 CUPERTINO all WATER HEATER CUPE(�T1NO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1 PCWHEATR Commercial `Vater B PCWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission 1'ee 1BSEISMICOM Seismic Commercial B 1PRWHEATR Residential Neater B PRWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Ii ee 1BSEISMICRE Seismic Residential B r 1PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel & B Documentation 1BUSLIC Business License B Community Development st, 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 rUPEkTINO Building Department JOB ADDRESS: 5 G W a\ PERMIT # (� c)q 6 L OWNER'S NAME: C.l 1 Ce, 3CA i E6 PHONE # -Q GENERAL CONTRACTOR: U rIS i (i imbl'nq # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS 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