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10060087 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDREf;S: 7524 HEATHERWOOD DR CON TRACTOR:VILLA PLUMBING PERMIT NO: 10060087 3401.ISHIMURA APT 1 DATE ISSUED:06/15/2010 OWNER'S NAME: CHRIS CHU PHONE NO:(408)848-4102 lNER'S PHONE: 4088484102 GILF OY,CA 95020 JOB DESCRIPTION: RESIDENTIAL COMMERCIALS Ra LICENSED CONTRACTOR'S DECLARATION D� WE.TER HEATER REPLACEMENT License Class Lie.# Contractor Q Date___& I hereby affirm that I am licensed under the provisions of Chapter 9 (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 Valuation:$800 performance of the work for which this permit is issued. Sq. Ft Floor Area: 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 APN Number:35928046.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPI SIF WORK IS NOT STARTS correct.I agree to comply with all city and county ordinances and state laws relating WITHIN I YS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter 1g0 DA M LAST CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Iss ued by: Date: / J granting of this permit. A tionall ,the applicant understands and will comply with all non-point source a ulati per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Si nature Date / At roofs shall be inspected prior to any roofing material being installed.If a roof is g ins tailed without first obtaining an inspection,I agree to remove all new materials for in!pection. ,J OWNER-BUILD ID CLARATION Si;nature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 1,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&Professions Code) HAZARDOUS MATERIALS DISCLOSURE I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). I lave read the hazardous materials requirements 25533rChapter and 25534.91 willhe California Health&Safety Code,Sections 25505, 25533, hereby affirm under penalty of perjury one of the following three n aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: H ealth&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's n aterial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the a 1contaminants ontami maintain compliance as defined d bythe Bay th the CupertinoArea it Quality pal(Code,Chapter Management District and performance of the work for which this permit is issued. t ie Health&Safety Code,Sections 2 05, 533,and 25534. 1 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 Owner or authorized agent: Date: permit is issued. 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm hich at this is is issued construction(Secl309'7,Cgen)for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. sender's Name APPLICANT CERTIFICATION .ender's Address 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 to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION 'emnify and keep harmless the City of Cupertino against liabilities,judgments, cs,and expenses which may accrue against said City in consequence of the [understand my plans shall be used as public records. granting of this permit.A ditionally,the applicant understands and will comply s per the Cupertino Municipal Code,Section Licensed Professional with all non-point source egulat 9.18. Signature Date /S//� CITY OF CUPERTINO WATER HI�ATER CUPS R.T1NO PERMIT APPLICATION FORM APN # 0'4 Date: f� / Building Address: 1 �6 2-,41 Owner's Name: Phone # 0e232 3 Contractor: Phone #: 4P �j�{ y[ -0Z V�q-fk, Fax : �iO( } .�a, 33J Cupertino Business License #: Contractor St e License #: -$ qy (Do t Contact: Phone #: ,41 peb &+3 q 13 Z Il-k n- Fax #: -4-13 3 J rBl ding Permit Info: ct❑ Elect ❑ Plumb Mech ❑ Residential Commercial ❑ Job Description: Lklq TvA A/V A-16,et 4C 16 44 �' T Strapped On Platform [ Bonded New Location ❑ Replacement Valuation (cost of project): a() C) Project Size: Express ❑ Standardyj Large ❑ Major ❑ Green Building: Please complete relevant portio a of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Buildi rig Points achieved: Revised 03/10/10 CITY OF CUPERTINO •' WATER HEATER PERMIT APPLICATION FORM UPERTINO Quantity Fee ID Fee Description Fee Permit Type Group 1PCWHEATR Commercial Wat-Ir B PCWHEATR HeaterNent O 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICOM Seismic Commercial B 1PCSWHTR Commercial Soler B PCSWHTR Thermal Water F[tr 1PRWHEATR Residential Water B PRWHEATR HeaterNent 1PRSWHTR Residential Solai B PRSWHTR Thermal Water Iltr 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residen ial B I1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel & B Documentation 1BUSLIC Business License; B Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: -75-2 tt, .1 PERMIT# O 0(- 60t? 7 OWNER'S NAME: etV (�147Zt S PHONE# U-?� ZS'Z o O GENERAL CONTRACTOR: BUSINESS LICENSE# O ADDRESS: 14 CITY/ZIPCODE: 41 G *Our municipal code requires all businesses working in the city to have a City of Cupertino busi ess license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUB NT ACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. ` I am not using any subcontractors: lv�-L /Zj:/l Signature Date Please check applicable subcontractors and complete i:he 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 Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35928046 . 00 DATE ISSUED. . . . . . . : 06/15/2010 RECEIPT #. . . . . . . . . BSOOOC10631 REFERENCE ID # 10060087 SITE ADDRESS 7524 f:EATHERWOOD DR SUBDIVISION . . . . . . . CITY CUPER"INO IMPACT AREA . . . . . . OWNER CHRIS CHU ADDRESS 7524 HEATHERWOOD DR CITY/STATE/ZIP CUPER'CINO, CA 95014-5841 RECEIVED FROM VILLA PLUMBING CONTRACTOR JIM MORENO LIC # 30989 COMPANY VILLA PLUMBING ADDRESS 340 KISHIMURA APT 1 CITY/STATE/ZIP GILROY, CA 95020 TELEPHONE (408) 848-4102 FEE ID UNIT QUANTITY AMCUNT PD-TO-DT THIS REC - NEW-BAL- ---------- ------------- ---------- ---------- 1BCBSC VALUATION 800 .00 1. 00 0 . 00 1 . 00 0 . 0 1PPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1PRWHEATR UNITS 1 . 00 25 . 00 0 .00 25 . 00 0 . 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 -- --- - ---- ------ ---------- ---------- TOTAL PERMIT 110 . 00 0 . 00 110 . 00 0 . 00 METHOD OF PAYMENT AMOUNT-- -- REFERENCE NUMBER ----------------- ---------- - --------------- CHECK 110 . 00 :.0065 --------------- TOTAL RECEIPT 110 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- -------------------------- -------- ------------------------- 518 WATER HEATER