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09050169 CITY OF CUPERTINO �r X BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 912 SEPTEMBER DR NEW AGE DESIGNS 09050169 OWNER'S NAME: PERMIT ISSUE DATE R KTTMARAJTATITTTT.T.TT eHONE: S A CONTROL NO. (831) 247-0789 ARCHiTEC iENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u0p LICENSED CONTRACTOR'S DECLARATION Job Description W p I hereby affirm that I am licensed under provisions of Chapter 9(commencing z vUi with Section 7000)of Division 3 of the Business and Professions Code,and my license is < in full force and ?7 Z/o REPLACE WATER HEATER, ADD EARTHQUAKE BRACING j Z Li,en ass - -r L Lie.N f 3 Da Contractor OV f ARCHITECTS DECLARATION ee< I understand my plans shall he used as public records DyU w H Licensed Professional n y< OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the a O following reason.(Section 7031.5,Business and Professions Code:Any city or county K which requires a permit to construct,alter,improve,demolish,or repair any structure n Zprior to its issuance,also requires the applicant for such permit to file a signed statement y _< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation yt- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 1 O O 0 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(M). 36214009 . 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.70",Business ns 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 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.). [11.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. ❑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 Workces Compen- sation,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 Worker's 11 Comp sation Insuran c carrier and Policy number are: Cartier. c Polity No.:/0 J 1A �D CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section meed not be completed if the permit is for one hundred dollars($100) or ICsa.) 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY F+�+ 1 hereby affirm that there is a construction lending agency for the performance of fx the work for which this permit is issued(Sec.3097,Civ.C.) WCL Q Lender's Name z Lender's Address U 0 I certify that 1 have read this application and state that the above information is Vw► correct I agree to comply with all city and county ordinances and state laws relating to 0 construction, building consction,and hereby authorise representatives of this city to enter upon the U above-mentioned property for inspection purposes. LL (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 c" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b�: Z r Ti i SOURCE REGULATIONS. 16140' Re-roof: Signpplicant/Comractor "c T of fZoof HAZARDOUS MATERIALS DISCLOSURE Type 411 the applicant or future building occupant store or handle harardous 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. C3 Yes g1te Will a roof is installed without first obtaining an inspection,I agree to remove ll the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new)materials for inspection. District? ❑Yes Nu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building docs not currently have a tenant that it is my responsibility to notify the occupant of the require mcns mull be met prior to issuance of a Certificate of Oc ancy. Signatur,of Applicant Date Owner res orncdagcnl �2 Date r All roof coverings to be Class'n"or better CITY OF CUPERTINO WATER HEATER CUPEkTINO PERMIT APPLICATION FORM APN # ,. Date- (0.2 ! �( ©©�l,' ed S � Building Address: Owner's Name: Phone #: Uh�t� ✓' U IV 6 4 • S l 7 - �?'O,PZ Contractor: Phone #: (p3i. _?41 M el�i Au S-( Fax #: �& 7/2- S--'2W Cupertino usiness Li ense #: Contractor State License #: Contact: Phone #: S)3 y7-0 7&36' 9 r 7 a& hqg tdk- Fax #: I-IJF Building Permit Info: Bldg 0 Elect 0/ Plumb Mech Residential ECommercial ❑ Job Deiscription: �Pp IQCe 064eft /lP t�/Z (J��/[0� `r�/� ��,� dr c,.�' i Strapped [ On Platform ©' Bondec ❑ New Location ❑ Replacement Valuation (cost of project): l®GO 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 af-11 WATER HEATER CITYCUPEi�T1NO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1 PCWHEATR Commercial plater B PCWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICOM Seismic Comr-zercial B p 1PRWHEATR Residential Water B PRWHEATR l HeaterNbnt 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission I,ee 1BSEISMICRE Seismic Residential B 1PPERMITFEE Plumbing Pernit P 1 TRAVDOC Travel & B Documentatic n 1 BUSLIC Business License B INPUT Resources EnLrgy IAQ�Health M.Indoor Air Quality and Finishes 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes OL-__ I 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 I N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 Total Points Available: 1 1401 130 57 Total Points Project Received. 01 OF 01 E/Zg1e J G:data/progs/gr.-enbuildingguidelines/remodelers/greenpointsfinal2.12.D4protected.xls