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B-2017-1047CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1047 21275 STEVENS CREEK BLVD STE 510 CUPERTINO, CA 95014-5719 (326 27 999) TAO MECHANICAL LTD LIVERMORE, CA 94551 OWNER'S NAME: 190 WEST ST JAMES, LLC DATE ISSUED: 06/29/2017 OWNER'S PHONE: 408-261-0303 PHONE NO: (925) 447-5220 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic. #5Z3327 Contractor TAO MECHANICAL LTD Date 07/31/2017 X BLDG _ELECT _PLUMB X MECH RESIDENTIAL X 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: ENZO'S - REPLACE 100 GALLON BOILER- ROOF I hereby affirm under penalty of perjury one of the following two declarations: 1. 1 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. Vz. 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: $100.00 permit is issued. 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 326 27 999 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 regulatio per t e e i Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 6/29/2017 Issued by: Jasmine Archbold OWNER-BUILDER DECLARATION Date: 06/29/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RF.-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is t. 1, 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) 2. 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: 6/29/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 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 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 Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Cod tions 550,5,-2S331, and 4. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent` C' APPLICANT CERTIFICATION Date: 6/29/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a 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 6/29/2017 Professional CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(alcupertino.org ❑ PLUMBING ❑ MECHANICAL ❑ELECTRICAI MISC n MISCELLANEOUS ✓S * `I /)70A PROJECT ADDRESS( :a c 2'7t S Ty ✓ _5'�1 S CR �� V� APN #ry �JZ(p' 2-1 ' J IER N.AA4E OW CoE� r S T -4n *E L �� PHONE ^ V f _0W E-MAIL STREET ADDRESS % i 10 �„�.'C7 j G eej� V�V J C Y, STATE, ZIP � \ FAX R 1 CONTaC AMF U'S���T�W^`lw' Rl� oY PWR 2 6 1- 030 E-MAIL STR 6S ADDRESS � 0 I Ci r�SON-r P n6—a-'s�j C 1 J S C FAX Ai s ��o IQ C ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR PCONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 0 LICENSE NUMB R � -7 3 LICENS YPE �- 3 BUS. . LIC # S F� "" k COMPANY NAME C5 /_?-I) E-MAIL FAX i STREET AI)DRES� l f 1 [t �G ( J I� {� t/ CITY, I T&A T Z ©Q G /'< t 1 '1 c' PHONE —*7 " _S,-)aCi ARCFIITECTT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT 1N WILDLAND ❑ YES PROJECT IN ❑ Y -Es IS THE- BLDG AN ❑ YES BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WOR C 0 J ` TOTAL VALUATION: RECEIVED BY• 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 correct. ad the D cription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build' g cons cri ze re ntatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER -TETE -COUNTER ❑ EXTRESS U w ❑ STANDARD U ❑ LARGE d ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 Sean Hatch From: Lucy Oberholser <lucyo@taoltd.us> Sent: Thursday, June 29, 2017 2:47 PM To: Sean Hatch Subject: JPT Water Heater Replacement Sean, =zo17-1b4-4- Tao gives JPT the authorization as our agent to apply for the permit to replace the water heater at Enzo's Restaurant. Our contractor's license number is 573397. If you need anything further please let me know. Office M11na2er -Tao, Ltd. 136 Wright Brothers Avenue l.,.ivermore. CSA. 9455:1 925-447-5220 ext. 119 (Phone) 925-447-5636 (Fax) The information in this e-mail and in any attachments is confidential, privileged, and the property of Tao, Ltd. If you received this message in error, please destroy this message, delete any copies and attachments stored on your systems and notify the sender immediately. Any further distribution or copying of this message is strictly prohibited. Please consider the environment before printing this e-mail Total (control Patiel To: sea.�:ili;rr;culxrtvic:>.<.szg From: lucyo@taoltd.us Message Score: 15 My Spam Blocking Level: High Block this sender Dlock taoltd.us This message was delivered because the contentfilter score did not exceed yourfilter level. 1 High (60): Medium (75): Low (90): Lo(gin