B-2017-0400CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0400
7551 DONEGAL DR CUPERTINO, CA 95014-5200 (366 16 067)
PURONICS SERVICE
INC
LIVERMORE, CA 94551
OWNER'S NAME: YAN JINGMING AND WANG 3CN TRUSTEE
DATE ISSUED: 03/10/2017
OWNER'S PHONE: 650-218-4591
PHONE NO: (925) 456-7000
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C36 Lic. #928595
Contractor PURONICS SERVICE INC Date 02/28/2019
X BLDG —ELECT X PLUMB
MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
INSTALL WATER SOFTENER SYSTEM
I hereby affirm under penalty of perjury one of the following two declarations:
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.
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
Sq. Ft Floor Area:
Valuation: $2300.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct. 1 agree to comply-with all city and county ordinances
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
36616 067
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 understands and will comply with all non-point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FRO SPECTION.
Signature: Date 03/10/2017
Issued by: MELISSA S
Date: 03/10/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
1. 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: 03/10/2017
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
2. 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
s. 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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject tthe
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 Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:,
APPLICANT CERTIFICATION
Date: 03/10/2017
certify that I have read this application and state that the above information is
T ND - CY
I hereby affirm that there is a c stru ' rr ending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
Lenders Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lenders Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARC'HITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
1 understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 03/10/2017
Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • building@cupertino.oCunmmorg misc
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APN # -,3
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E-MAIL
STREET ADDRESS ,5S i1
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CITY, STATE, ZIP
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FAX
CONTACT NAME JEFF RAINEY
PHONE510-427-4260
F -MAIL
jeffrey.rainey@att.net
STREETADDRESS 1069 EDGEMERE LANE
c wSTATE, ZIP HAYWARD, CA 945454
FAx510-783-1041
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT
❑ CONTRACTOR R CONTRACTORAGENT ❑ ARCHILECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME R) �� �'�
LICENSE NUMBER 9
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BUS. LIC #
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FAX
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STREET ADDRESS -7,7 (/
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ARCHITECTIENGINEERNAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF FD.DUPLEX ❑ MULTIFAMILY
BUILDING ❑COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECTIN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICULERHOME? ❑ NO
DESCRIPTION OF WORK Q 1���
TOTAL VALUATION: 3 oz�) -®
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on pro r s ve read this
application and the information I have provided is correct. I have read the Description of Work and v agree to comply with allapp- - local
ordinances and state laws relating to building constru Ionze esentatives of mei no to to e the above -identified property for inspection purpose .
Signature of Applicant/Agent: Date: 3//te, %
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SUPPLEMENTAL INF ON REQUIRED
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MEPMiseApp 201 Ldoe revised 06121111