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10050176 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20488 STEVENS CREEK BLVD#2050 COr TRACTOR:TBD-TO BE PERMIT NO: 10050176 DETERMINED 'NER'S NAME: STEVENS CREEK COMMERCIAL DATE ISSUED:05/24/2010 OWNER'S PHONE: 4154011525 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class•"-? 1 - 3L'Lic.# INSTALL COMMERCIAL ELECTRIC WATER HEATER Contractor 1 Date 1 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation:$1000 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:36953999.2050 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issiied b Date: granting of this permit. Additionally,the applicant understands and will comply y' with all non-point source regulations per the u ertino Municipal Code,Section _ 9.18. ��T RE-ROOFS: �atur ate ``f�'' (J All -oofs shall be inspected prior to any roofing material being installed.If a roof is instilled without first obtaining an inspection,I agree to remove all new materials for insl ection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I h:[ve read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three ma ntain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&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 ma serial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. wil maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 5,25533,and 2A534. Section 3700 of the Labor Code,for the performance of the work for which this Om ner or authorized agen 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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I h(reby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. wo Vs for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Le ider'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 i the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION .;mnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RE2EIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: LDt : APN . . . . . . . . : 36953939 .2050 DATE ISSUED. . . . . . . : 05/24/2010 RECEIPT #. . . . . . . . . BS000010469 REFERENCE ID # . . . : 10050176 SITE ADDRESS . . . . . : 20488 STEVENS CREEK BLVD #2050 SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : STEVENS CREEK COMMERCIAL ADDRESS . . . . . . . . . . : 20488 STEVENS CREEK BLVD STE 2 CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CARY WING PLUMBING CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 000 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICO VALUATION 1, 000 . 00 0 . 63 0 . 00 0 . 63 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0. 00 1PCWHEATR UNITS 1 . 00 25 . 00 0 . 00 25 . 00 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 224 . 63 0 . 00 224 . 63 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 224 . 63 visa --------------- TOTAL RECEIPT 224 . 63 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCO T _ CTOR LIST JOB ADDRESS: PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: 'fO UT41 BUSINESS LICENSE# ADDRESS: , f`f LDT I CITY/ZIPCODE:S , V *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. �- I am not using any subcontractors: — gnature 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO WATER HEATER CUPERTINO PERMIT APPLICATION FORM 3c 9 53 ct (7'7. 2-05-v ( d1 -Z APN # Date: Building Address: Owner's Name: ►rC�S �� 'Y11�-e►2� Phone #: Contractor: Phone #: 1-d (�--CW Fax #: f SZ ;4,�-- .�- Cupertino Business License #: Contractor State License #: S(,Tr Contact: r Phone #: Fax #: Building Permit Info: Bld ❑ Elect ❑ Plumb Ef Mech ❑ Residential ❑ Commercial Job Description: 'AJ�TA.L Strapped ❑ On Platform ❑ Bonded ❑] New Location ❑ Replacement Valuation (cost of project): k 6D Project Size: Express ❑ Standard ❑ Lai ge ❑ Major ❑ Green Building: Please complete relevant portio::i 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 03/10/10 CITY OF CUPERTINO WATER HE ALTERCUPEt �T]NO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1PCWHEATR Commercial Water B PCWHEATR HeaterNent 1BCBSC Cal Bldg Standard B ALL PERMIT TYPES Commission Fee 1BSEISMICOM Seismic Commerc.al B 1PCSWHTR Commercial Solar B PCSWHTR Thermal Water Ht 1PRWHEATR Residential Water B PRWHEATR HeaterNent 1PRSWHTR Residential Solar B PRSWHTR Thermal Water Htr 1BCBSC Cal Bldg Standarc.s B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel & B Documentation 1BUSLIC Business License B L -