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B-2016-1946 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO;B-2016-1946 10250 JOHNSON AVE CUPERTINO,CA 95014-3812(375 25 06 1) CURRO PLUMBING INC GILROY,CA 95020 OWNER'S NAME: HU DAVID A ET AL DATE ISSUED:05/16/2016 OWNER'S PHONE:408-693-9967 PHONE NO:(408)847-7704 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC36 Lic.#537264 Contractor CURRO PLUMBING INC Date 08/31/2016 X BLDG —ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: EXTEND GAS LINE TO FRONT OF GARAGE I hereby affirm under penalty of perjury one of the following two declarations: r. 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. z. 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. Sq.Ft Floor Area: Valuation:$2200.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 375 25 061 representatives of this city to enter 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant un rstan nd will comply with all non-point source regulatio er the perti nicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 5/16/2016 Issued by:Abby Ayende Q!N% Date:05/16/2016 LCALL OWN ILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:5/16/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cuper ino Municipal Co hapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the'Health&Safety Code,S ons 255 255 ,a 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:5/16/2016 I certify that I have read this application and state that the above information is CONST U IO ENDI G AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there' 'construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 5/16/2016 Professional GENERAL_PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildingCcDcupertino.org MISC CUPERTINO APLUMBING ❑MECHANICAL []ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 9 � Ni ,I'� APN# OWNER NAME I>Aoi p�i�'1/YV PHS�A��// e/� E�VAC STREET ADDRESS o��c �e?� -7 CITY,STATE,ZIP - V •$ems FAX CONTACT NAME g/J, /Jw PHONE o /}� ^ ` E-MAIL STREET ADDRESS 0g �.j_ CITY,STATE,ZIP, ®�✓V FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER�RAGENENT/X�CCONN'TRACTOR ❑CONTRACTOR AGENT ❑ ARCHrrECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME (�� LICENSE NUMBS / LICENSE TYP � � BUS.LIC#;( j 7-` a6l�� COMPANY NAME Y'v � ` � E-MAIL (J�' I STREET ADDRESS //s� CITY,STATE,ZIP!g� PH�y +�i�ry ARCHITECT/ENGINEER NAME 41 ��LyyFF�y(f(Jp1 LICENSE NUMBER U BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD.r DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK � �� n✓�"�.© / �_ ,� � �' � �" TOTAL VALUATION: �Va RECEIVED$Y '. x r By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correA I havSrfad the Description of Work and verify it is accurate. I agree comply with all applicable local ordinances and state laws relating to b ing cons . I e representatives of Cupertino to enter the above-i ntifi property for inspection purposes. Signature of Applicant/Agent: Date: r� LENKNTAL INFORMATION REQUIRED -11 OFFI USE oplLx OYER"fHE COUNTER s E 0`EXPRESS "v 0 STANDARD F0. 0 LARGE MEPMiscApp_201 Ldoe revised 06/21111 r COMMUNITY DEVELOPMENT DEPARTMENT � � BUILDING DIVISION-CUPERTINO ;-5 )V S. _ APPROVED C>a�peuf-i This set of plans and specifications MIDST be kept at the job �itc�durin6 construi,tion. It is unlawful to make any changes or alterations on same,or to deviate Axnw therefrorim,without approval from#n®Building Official. A420 f Vx 5I pcc The stamping of this plan and specifications SHALL NOT . ` be Heid to parmit'or to be an approval of the violation, C, of any pnrovislons,of any City Ordinance or State Law. f4agal t0BY ®�r '71 DATE 5pC,¢ I L' 1 - PERMIT N Of I LI ii 510 '.' . 6yugnA4 aC6 IWO 2 -wo FFICE . CPY,o", ;� � � �k