11010062 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10333 PALO VISTA RD CONTRACTOR:FAST WATER HEATER PERMIT NO: 11010062
OWNER'S NAME: KERNS JOHN N ET AL 12601 132 AVE NE DATE ISSUED:01/11/2011
OWNER'S PHONE: 4082532826 KIRKLAND,WA 98034 PHONE NO:(800)4548955
L LICENSED CONTRACTOR'S DECLARATION r F r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# r— r
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE/REPLACE GAS WATER HEATER
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area:0 Valuation:$850
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:35703023.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I 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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date:
9.18.
Signature Date
RE-ROOFS:
OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
P Health&Safety Code,Sections 25505,25533,and 25534.
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 Worker's Owner or authorized agent:
Compensation laws of California. If,after making this certificate of exemption,I Date:
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
and expenses which may accrue against said City in consequence of the
ng of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
w,tn all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
F CUPERTINO BUILDING PERMIT MED PERMIT NO' 11010091
CITY O oR:
CONTRACT n DATE ISSUED-01/18/2011
BUILDING ADDRESS: 10424 PARADISE DR PHONE NO:
FRENCH 1O13N S AND SALLY R C�7
OWNERS NAME: PLUMB r
5 BLDG� ELECT -*IER'SPHONE: 408257605 BUILDING PERMIT INFO
RESIDENTIAL COMMERCIAL
LICENSED CONTRACTOR'S DECL ION
1ViECH
Lie.#` � NO RE-ROOF&NO
License Class a „Date / JOB DESCRIPTION:REMODEL KiTCHEN(162SQ);
Qj(4�7 hapter 9 STRUCTURAL
Contractor rovisions of
i hereby affirm that i am licensed under the p
with Section 7000)of Divisina eff��a Business&Professions ++SEE NOTES**
(commencing license is in full force a
Code and that my two declarations:
penalty of perjury one of the following
1 hereby affirm under p for the
have and will maintain a certificate of consent of self-insure C�WOor the valuation,�0�
1 ha provided for by Section
Compen�ce oI asp permit is issued. provided for by
performance of the work for which this ensation Insurance,as Sq,Ft Floor Area:
erfornraIns Insurance,
the work for which this Occupancy Type:
1 have and will maintain Worker's Comp
Section 3700 of the Labor Code,for the p APN Number:35916027.00
permit is issued.
APPLICANT CERTaFICAthe TIOai F`7`/ORK IS NOT STARTED
at 1 have read this application and state o�dinancbes and state laws relating RES I CE OR
I certify that i with all cityauthorize representatives of this city to enter PERMIT EXPI
correct.1 agree to Comply (We)agree to save F PERMIT ISSUAN TION.
to building construction,andcfor inspection purposes- ud mems, WITHIN 180 DAYS .r CALLED INSPEC
upon the above mentioned Property of Cupertino against liabilities,) g S FROM
indemnify and keep harmless the it against said City in consequence 11�they 180
I D �.)
costs,and expenses which may the applicant understands and Section • Date:
granting of this permit. Additionally,Per the Cupertino Municipal Code,
with at non-point source regulations p Issued by:
9.18. /
pate
Signature Q REQ installed.If a roof is
prior to any roofing material being
ected p ection,1 agree to remove all new materials for
OWNER-BUILDER DECLARATIONwithout first obtaining an insp
installed
am exempt from the Contractor's License Law for one of All roofs shall be insP pate:
affirm that 1 enation, inspection.1 hereby es as their sole come
the following two reasons:or my employees with wag 7044, licant:
for sale(Sec• Signature of App
1 as owner of the property, „A„OR BETTER
Willi do the work,and the structure is not intended or offered COVERINGSTO BE CLASS
Business&Profession Code) contracting with licensed contractors to ALL ROOF CO
l as owner of the property,am exclusively
construct the pr°Jelt(Sec.7044,Business&Professions Code). ATERiALS DISCLOSURE
penalty of perjury one of the following
three HAZARDOUS M ter 6.95 of the
affirm under p requirements under Chap
1 hereby 1 have read the hazardous,material req
declarations' Safety Sections Code,Chapter 9 12 and the HealiliI will i&a
d California Health&
m liance with the Cupertino Municipal Code,
r b Section 3700 of the Labor Code,for the o mit hazardous air
I have and will maintain a Certificate of Consent to self-insure for Worker's c a should i store or handle hazardous material.
enation,as provided Y errsit is issued• P Section 25532( )
Comp rovided for by Safety Code, ui ment or devices which a anagement District 1 will
Performance of the work for which this permit
Insurance,as should 1 use y P Area Air Quality o Chapter 9.12 and the
Additionally, the Bay unicipal Code,
erformance of the work for which this contaminants a�rance w th the Cupertino M
I have and will maintain Worker's Comp and 25534.
Section 3700 of the Labor Code,for the p I shall maintain compliance
Sections 25505,25533,
Permit is issued• permit is issued, Health&Safety
performance of the work for which this sect to the Worker's 4 /
1 certify that in the p exemption, riz nt:
person in any manner so as to become subject ON, r or all Date:
not empl°Y any P this certificate of exemp
Comp enation provisions of the Labor Code,l must aCwf
Compensation laws of California. If,after making � S NSTRUCTION LENDING AGENCY
become subject to the Worker's Comp Perm
shall be deemed revoked, C0 erfonnance of w
with such provisions or this p agency for the p
forthwith comply
I hereby affirm that there is a constru3097 lending C)
APPLICANT CERTIFICATION ve information is for which this permit is issued(Sec,
that l have read this application and state that the abo Lender's Name—
1 certify and county ordinances and state laws relating
correct•I agree to comply With all city iesentatives of this city to enter
authorize rep We agree to save Lender's Address��
to building construction,and hereby for inspection purposes.
(We) g TiON
upon the above mentioned property of Cupertino against liabilities,judgments,
harmrless the City against said City inconsequence of the ARCHITECT'S DECLARATION
indemnify and keep accrue ag public records.
^its,and expenses which may the applicant understands and will°Setion plans shall be used as P
iting of this permit.Additionally,per the Cupertino Municipal Code, 1 understand my
'Ah all non-point source regulations P Licensed Professional_
9.18. Date_��
Signature