06120031CITY OF CUPERTINO
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INFORMATIQN
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
WATER HEATERS ONLY
PERMITN0. 06120031
OWNER'S NAME:
PERMIT ISSUE DATE
OL PAUL BINGENHIERMES
970 E. -MAIN -21 SUITE 200
12/11/9006
NE: ,
SANITARY NO. CONTROL NG.
(800)835-5946
ARCHRECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
I barely affirm that I am limned under provisions of Chapter 9 (commencing
P
with Section 70(10) ol'Division 3 ofthe Bum ear aM Profession Code. and my licenses u
imm�prime andeffect, 6 7 S73
Licca. Ci. C:3 Lc. a
REPLACE WATER HEATER 40 GALLONS
Dam 1.1 1- 00 Contractor u
ARCHITECTS DECLARATION
I ondersund ity p eshaltoe used u gp,li ands A S� 6
fvY LI F'
Licensed Prufcssmeal
OWNER -BUILDER DECLARATION
I hereby aRrm that I am exempt from the Camaxtor's Leon. Law for Um
fallowing reason. (Section IID 1.5, Business and Professions Code: Any dry or county
which .,of. a permit m cm,wmcl mon. Improv, &mulish. or spur my svomum
$1000
prior m its issuance. thou lCquires f spplicantfor such permit to file a signed suuinenl
that be is licensed purcho0o the provision of the Common's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Scotian 7000) M Division 3 of the Bunt... and Profassion Code).
Nat he u exempt therefrom and the basis for the alleged =empdm. Any violation of
r
Occupancy Type
Section 701.5 by any applicant for a permit subjects the applican m a civil penalty of
amt mote Nan fsw hundred donut (3500).
I, as owner of the property. or my employees with wages u Ne'v sok compensation,
Required Inspections
will da dre work and she swnure k not im¢Med or offered for ale (Sec. 7044. Buuness
and Ptafea iana Cade: The Canmcmrs Lkeram Law does real apply m an owner of
Property who builds or i mprovu thesmn. and who does each work himself ar through his
own employees, provided that such impmwments are not intended aroffered for sale IL
hmaewr, the building Or improvement u sold within one year of compleuon, the owmr-
builder will haw the human of proving that he did oat build or improve for p lopom of
sale.).
0 1, as owner of the property, am =elusively commuting with licensed contractors to
contract the project (Sec. 7044. Business and Proficuu is Code:) The Clu orator's Ll-
emote law does not apply m an Owner of property who builds Or improves thereon, tnd
who contracts for such projects with a conoractor(s) limned pumWm m the Gon4Myarr
Lic— La-
0lom=ema,anderSam . B A P C for this mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
10 1 hereby affirm under penalty of perjury ane of the following dmlamtion:
I hart` aid will mNatam a CemReateOf COnenl m self -Ina. ror Warltets Compete
cation, as provided for by Section 3700 of the labor Code. for me performanm of We
work for which this permit is issued.
❑ 1 haw and will maintain Worker's Compensation Insurance, m required by $notion
3700 of the Labor Code.for the pcdo.. of the wart for which Nu permit u issued.
'
My Workers Com ensauon Insamvee narticr and Policy number ase:
vs 03- 0 v y
Cordate P ..e Policy NO.:
CERT KATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not be cmnPieted fide permit is fmone hundred dollars (3100)
or Ices)
1 ccnifv that in to performance of me work for which this permit u issued, I shin not
employ any person In my manner. as in become wbkxt m do WOrkuta' COmpeneadon
Laws of California. Dale
Applicant
NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you should
become subject m the Worker's Compcn¢uion provisions of the labor Code, you mor
comply with such provisions or this Permit shall W deemed rewind.
CONSTRUCTION LENDING AGENCY
I hemby.M. that ft. iso eommuctinn lending agency for the Perfurmancoof
the work for which ma Parted Ire htsned (Sea 3097. Civ, C.)
Lender's Nene
Lender's Address
I certify that I haw mad this application and cute that the about informatiun is
COrroat. l agree to comply wit all city and county ordinances and mite laws misting m
building construction, and hereby authorix.pn,tenutiws of this city to enter upon the
aWvc mentioned pmpcny for inspection PuToses.
(We) .,me to saw, indemnify and keep canal. the City Of CopeNnO annst
–
liabilium,judgments. costs and expenses which may in any way seem qunt.id City
in O of the grarrifirg of t
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOppgqCE REGULATIqq��f1�;
Issued by: Date
Y
Re -roofs Z=-
,rh��• /� -rr- d E
' Signamreof ApPlicvNConuacta Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant stare or handle hanrdoo material
ss diluted by the Cuperoin0 Municipal Code. Chapter 9.13, and the Health and Safety
Code. Benton 25532(a)7
MY. ��Flo
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant uequipment or deviwhich
devices
If a roof is installed without first an inspection, I agree to remove
P $
emit havallon air conuminants as; dc0ned by Nes Bay Arts Air Quality Manageent
m
all new materials for inspection.
P
District
❑Yrsu
I have mal the hvard,ws materials requimmcnu under Chortler 6.95 ofdan Califor.
nu Health k StfetyCode, Section 25505.25533 au125534. 1mthrsued that ifdc building
t currently haw a tenant. Nat it is my maponsibility m notify the necup., of the
mai mtswhknmuvbcm piarmissamuearacmtirteamarampamy.
Signature of Applicant Date
i9 -a-00
All roof coverings to be Class "B" or better
Owner W amhomad ,or D,te
1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Elk: Lot:
APN ........: 31632005.00
DATE ISSUED.......: 12/11/2006
RECEIPT #.........: 36994
REFERENCE ID # ...: 06120031
SITE ADDRESS .....: 19731 AUBURN CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: quem
COPY # : 3
OWNER ............: PAUL BINGENHIERMES
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2403
RECEIVED FROM ....: EDWARD GREGORY
CONTRACTOR .......: MCGEE, PAT LIC # 18986
COMPANY ..........: WATER HEATERS ONLY
ADDRESS ..........: 970 E. MAIN ST, SUITE 200.
CITY/STATE/ZIP ...: GRASS VALLEY, CA 95945'
TELEPHONE ........: (800)835-5946
OE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW.BAL
BENERGY PERMIT FEE
1.00
34.86
0.00
34.86
0.00
BPWHEATER PER HEATER
1.00
10.79
0.00
10.79
0.00
PPERMITFEE FLAT RATE
1.00
38.37
0.00
38.37
0.00
TOTAL PERMIT
----------
----------
84.02
0.00
----------
84.02
----------
0.00
METHOD OF PAYMENT AMOUNT
-----------------
NUMBER
------------
OTHER 84.02
-----------______-
M/C
TOTAL RECEIPT 84.02
VOICE ID DESCRIPTION
VOICE ID
DESCRIPTION
502 FINAL PLUMBING ENERGY
506
GAS
TEST
507 FINAL PLUMBING
•
I am not using any subcontractors: �y aL /a-/(- OG
Signature Date
Please check applicable subcontractors and com Tete the followin information:
JOB ADDRESS:
aflyor
Community Development
10300 Torre Avenue
OWNER'S NAME: 7ov -17?,'A) Y.? A ; e.-✓ e v
Cupertino CA 95014
Cabinets & Millwork
Telephone (408) 777-3228
6JPEkTINO
Fax (408) 777-3333
Cement Finishing
Building Department
I am not using any subcontractors: �y aL /a-/(- OG
Signature Date
Please check applicable subcontractors and com Tete the followin information:
JOB ADDRESS:
PERMIT #
BUSINESS NAME
OWNER'S NAME: 7ov -17?,'A) Y.? A ; e.-✓ e v
PHONE #
Cabinets & Millwork
GENERAL CONTRACTOR: q or4t, l
FAX #
I am not using any subcontractors: �y aL /a-/(- OG
Signature Date
Please check applicable subcontractors and com Tete the followin information:
Owner/ ontractor Signature
1a - r1- DG
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal .
Sheet Rock
Tile
Owner/ ontractor Signature
1a - r1- DG
Date
an of
• CUPEI'TIN0
F
0
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
APN # 6 3 ---�2
6�0-5—
BUILDING
1
Date:
Building Address:
X BENERGY
Energy
BUILDING
Owner's Name:
Business License
BUILDING
Phone #:
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Off- 5-
Contractor:
Contractor: /
Phone:
/ 530-.
3w t
License #:
3 71/ s 73
e. 84 lt�s
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Contact:Phone:
Cupertino Bus_me s License #:
50.1,s
s
Building Permit Info:
Bldg ❑ Elect
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Plumb
Mech �(
Job Description: , , 7
/fieLC%41,
12 e17le"
Residential
Commercial ❑
Cost of Project: �y
Strapped 17 On Platform
Bonded Er
❑
New Location Replacement
IK
Qty. if .
Applicable Fee ID
Fee Description
Fee Group
X I BPWHEATER
Water Heater / Vent
BUILDING
X PPERMITFEE
Plumbing Permit Issuance
PLUMBING
X BENERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING