B-2017-1404CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1404
10503 PERALTA CT CUPERTINO, CA 95014-6568 (342 60 018) ECONOMY ROOTER
SANTA CLARA, CA
95055
OWNER'S NAME: ANG CHYE HUAT AND SIEW H
DATE ISSUED: 08/22/2017
OWNER'S PHONE: 408-722-6891 I I PHONE NO: (408) 249-4922
License Class f, --W Lic. #592D48
Contractor ECONOMY ROOTER INC Date 05/31/2018
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:
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
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
and: state,ilaws 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 indemnify and keep harmless the
City, of�Ciipertino ag 'nst liabilities, judgments, costs, and expenses which
may accrue against id City in consequence of the granting of this permit.
Additionally, the a' c nt understands and will comply with all non -point
source regulations - t e,Cupertino Municipal Code, Section 9.18.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following;two reasons:
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 construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three declarations:
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.
2. 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.
3. 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
I certify,that l 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 indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 8122/2017
BUILDING PERMIT INFO:
X BLDG —ELECT X PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
(1) 50 GAL WATER HEATER-;
Sq. Ft Floor Area: l Valuation: $900.00
APN Number: Occupancy Type:
342 60 018
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF 'PERA' ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Jasmine Archbold
Date: 08/22/2017
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 8/22/2017
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I have read the hazardous materialsxiquirenieuts under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533; and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) shouldlstore or handle hazardous
material. Additionally, should I use equipmeutlor devices which emit hazardous
air contaminants as defined by a Bay Area Air Quality Management District I
will maintain, wit
Cupertino Municipal Code, Chapter 9.12 and
the Health &Safety e'ctions 25505, 25533, and 25534.
*A. authorized agent:2/2017
CONSTRUCTION^L'ENDINQ AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public -records.
Licensed
Professional
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTING (408) 777-3228 • FAX (408) 777-3333 - building a�cupertino.org
U - 20 t -I -- I `( v4
PROJECT ADDRESS
C6
/
APN n
V i,'f I�
l V 5'0
C
OWNERNAME�
PHONE
V
Vo? 7Z?
STREET ADDRESSCITY,
1 Lo Sb � c-4ieAL�
S ATE, FAX
Cu r".1,. cA Sn 1
CONTACT NAME
PHON!} �� 2_-Y9 C, -72Z
E-MAIL
STREET ADDRES
y 9 �lJ
n'
CITY, STATE, ZIP
S 'A - 95-/3 a
FAX
ERAGT
❑ OWN ❑ OWNER-BUII-DER 13OWNETN
ER
��,/�
f/� CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTIRACTORNALIC
ENSE t, LICENSET)p
BUS. LIC n
G t
z
COMPANY NAME
E-MAIL
FAX
�nJ
.O Nom- /6 lei 2
STREET ADD r l,L J hN �x
T"
CITY, STATE, ZIP �—/
PH O,LIF Z (% [ z Z
ARCIIITECT,ENGINNEERNAME
LICENSENTUMBER
BUS. LIC#
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi -Family
PROJECT IN WILDLANND
PROJECT IN
❑ Commercial
URBAN INTERFACE AREA ❑ Yes ❑ No
FLOOD ZONE ❑ Yes ❑ NO
STRUCTURE:
❑ SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
�U�OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS:
KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATIq1Q�
70,C--,:)
DESCRiPTTUN OF WORK
cSb��
,
ii vs Le -1. A. -�-� -0. C_ -4 w
' RECE D'
n k
�k'Y
By my signature below, I certify to each of the follow'
g: 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 co a t. I have read the Description of Rork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building constru
'o authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent:
Date:
SUPPLEMENTAL INFORMATION REQUIRED
USEOIVLI..
OFFICE
>:❑ O\7ERTHE,COUNTER
n ;
� ❑ STAT'DARD �
3aY� t a
PV4pp_2011.doC reldsed 03/16/11