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03090005lZ 'n4 f�W aLL�' °3 coo $� �26 �FO 22 CITY OF CUPERTINO 'A ror77777-777777 x BUILDING DIVISION PERMIT CONTTtACTOR+INF,ORMATION „ BUILDING ADDRESS: 10614 N WATER HEATERS ONLY PERMIT NOO 3090005 WNER'SNAME: TIM MAN 970 E. MAIN .SII', SUITE 200 PERMITLSSUEDAR NE: (800)835-5946 SANITARY N0. CONTROL NO. ARCHITECOENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing Jab Des bbb �n� A s C® with Section 70M1) of Division 3 of the Business Pmfcssio M my licen s a ■ Pai�LE Lcchbf,doCleandcrful� .- (� Gn . —*c� "— PLACE WATER HEATER SFP 9 2003 ARCHTIECPS DECLARATION 1 uMerstand my plans shall W used M,.hit, records BURDI G Licensed Professional OWNER -BUILDER DECLARATION Law for am 1 hremo .(Sere that 11. tBumpt from the Cssions oat: Any L3, Business and Professions Cook:Anycity or county followingmason. my ortentn710 which roquima a pmmil re cnres,the alter, improve, d.mWih or sig any Atcemmi Permit a signed srokm.m prior m its issuance, ruse requites the applicant fon such permit m rite Sq. Ft. Floor Area Valuation License theprovisionsoftcComr,inam nProftaw(C Wc)or (comae cingwitpSectio 7 and Professions Code) or (commencing with Semon 7000) of Division 3 of the 'Al .0 that ha is eacmpt therefrom and to beau for the .Ilcged eumption. Any violation of Hoped r41ni i on APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects to applicant to a civil penalty or not mon than five hundred dollen (5500). - - - - - - -- - ❑ 1. m owner of the property. or my employees with wages as their role compensation. 101 - FOUNDARAgad Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7014, Business and Profwlona Cade: The Contractor's License Law does not apply m m owner of pmpeny who build.orimproves temon.and who dos such work himself or trough his 102 - PIERS own employees, provided that such improvements an not intended or offered formic. If, 103 — UFER however, to building or improvement Is sold witin one year of completion, to.worn builder will have to burden of proving tet he did not build or improve for purpose of 104 - REBAR saM.I. 10 5 - ANCHOR BOLTS 1. M owner of the property, am exclusively contracting with licensed contractors m construct he project(Sec.7044, Businw and Pmfusmns Code:) The Contractors Lt. 106 _ — SEWER & WATER come law does not apply to an owner of pmrany who builds or improves Lemon,and, 202 — UNDERFLOOR PLUMBING who contracts for such prejecu with a c.nuactor(s) licensed pursuant to to co ... cloru License Law. 203 - UNDERFLOOR MECHANICAL ❑ 1 am ,mropl under Sec. . B A P C for this moon 204 - UNDERFLOOR FRAME net WORKER'S COMPENSATION DECLARATION 205 - -UNDERFLOOR INSULATION Ihereby afinounder penalty ofperjury one orthe following ill 301 - ROUGH PLUMBING Ihave.nd will maintain a CCNhcok of Consent 1. .1 binsuro for Works,ru Cw.,xm- 302 — TUB & OR SHOWER talion, u provided for by Section 3701) of the labor Code. for the performance of the 303 - ROUGH MECHANICAL work for which Nis permit is issued. 304 - ROUGH ELECTRICAL. ❑ 1 have and will maintain Worker's Compensation Insunna, u required by Section ., 3700 of to labor CMa, for to performance of to work for which this perm it is Issued. 3055 — FRAME My Worker's Crmpewtion Insurance carrier and Policy number am: 306 — HOLDOWNS Grticn Policy him: CERTIFICATE OF EK EM PTION MOM WORKERS' 307 - INSULATION COMPENSATION INSURANCE 308 - SHEETROCK (Thusectiounced rmtbecomplclMume permit is troops, hundred d.ilan(SIM) 309 - EXTERIOR LATH or less.) 1 certify ten in the performance of tc work to, which tis permit Is issued. Ishan nut 310 - INTERIOR LATH. employ any pcnon in any mariner an u w become subjec0o the WorkeW Compensation 311 - SCRATCH COAT vv canalirnrnia.Data 313 501 - ROOF NAIL - FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT. Ir. after making this Cenificate of Exemption, you should become suhjen to to Workers Compewti.n previsions of to tabor Cecile, you mut forthwith.rmply with such provisions., this permit.hidl be deemed revoked. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I bereby.M. that ten is• construction leading agency lm the pofummceof 504 - FINAL BUILDING ENERGY ft works fur which to permit is issued (Sec. 309'1. Co. C.) 4Mers Namo 505 506 - FINAL ELECTRICAL - GAS TEST Looders Address 1¢niry that l have read tiupplication andmk that the.bow infommiun is conte 1 agree to comply with all city and county ordinances and sok laws relating to 507 - FINAL PLUMBING Wilding convection. and hereby.uthoim representatives of this city to enter upon the FIN MEC CAL .1bove-mentlmled property for Inspeeb.n purpose. (Ws,) agree to arc, indemnify and keep harmlem the City of Cupenino against O 9 F I li.bililles,judgments.costs end expenses which may in any way seems against mid City 5 NG in mnsegama nr t. , sang nnni, reel n. APPLICANT UND ANDS COMP y.VITH�kLL NOy.eglrrr Issued by:5 C WORKS Date SOURCES U Re -roofs Type of Roof % 03 F/a-- Signewre of Applicu Da HAZARDOUS MATERIALS DISCLOSURE Will to epplicam or fMuni building or handl h Health and m dcMeO by the Cupertino Municipal Cods,. Chapter 9.13, m0 the Health and Safety e. Chapter ' e. Section 355324)7, All roofs shall be inspected prior to any roofing material being installed. ❑ Yea tm If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant Or future Wilding acupant use equipment or devices which it ha'mrupon air cWtaminanu as defined by the Bay Amo Air Quality Management all new materials for inspection. isuict7 El Yes t 1 have read the huardrus materials requirements under Chapter 6.95 of to Cali for. nia Halt&saretyC ccdau25505,355 d25534.1undcmmdtstifthc building docs not currently h renyi4 t y sponsibil o nMl'g the occupant.(tc rim requirements i or g c pan Signature of Applicant Date +11. All roof coverings to be Class "B" or better own.,mauth.n.d.gcol CITY OF CUPERTINO in 1 Of 2 PERMIT RECEIPT Sec: Twp: Rng: Sub: Elk: Lot: APN ........: 31643011.00 DATE ISSUED.......: 09/02/2003 RECEIPT #.........: 22984 REFERENCE ID # ...: 03090005 SITE ADDRESS .....: 10614 N BLANEY AV SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: euem COPY # : 2 OWNER ............: TIM MAN ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-6039 VOICE ID DESCRIPTION 101 FOUNDATION 103 UFER 105 ANCHOR BOLTS 202 UNDERFLOOR PLUMBING 204 UNDERFLOOR FRAME 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 305 FRAME 307 INSULATION .309 EXTERIOR LATH 311 SCRATCH COAT 501 FINAL ELECTRICAL ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 7 FINAL PLUMBING 9 FINAL GRADE 4 FINAL PUBLIC WORKS VOICE ID DESCRIPTION 102 RECEIVED FROM ....: 104 BONITA JENKINS 106 SEWER & WATER 203 UNDERFLOOR MECHANICAL CONTRACTOR .......: UNDERFLOOR INSULATION MCGEE, PAT LIC # 18986 TUB & OR SHOWER 304 ROUGH ELECTRICAL 306 COMPANY ..........: 308 WATER HEATERS ONLY 310 INTERIOR LATH 313 ROOF NAIL ADDRESS ..........: FINAL PLUMBING ENERGY 970 E. MAIN ST, SUITE 200 FINAL BUILDING ENERGY 506 GAS TEST 508 CITY/STATE/ZIP ...: GRASS VALLEY, CA 95945 SE TELEPHONE ........: (800)835-5946 ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC •NEW BAL ---------- BENERGY ----------------------- PERMIT FEE 1.00 ---------- -------------------- 23.10 0.00 23.10 ---------- 0.00 BPWHEATER PER HEATER 1.00 9.99 0.00 9.99 0.00 PPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 TOTAL PERMIT ---------- ---------- ---------- 68.61 0.00 68.61 ---------- 0.00 VOICE ID DESCRIPTION 101 FOUNDATION 103 UFER 105 ANCHOR BOLTS 202 UNDERFLOOR PLUMBING 204 UNDERFLOOR FRAME 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 305 FRAME 307 INSULATION .309 EXTERIOR LATH 311 SCRATCH COAT 501 FINAL ELECTRICAL ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 7 FINAL PLUMBING 9 FINAL GRADE 4 FINAL PUBLIC WORKS VOICE ID DESCRIPTION 102 PIERS 104 REBAR 106 SEWER & WATER 203 UNDERFLOOR MECHANICAL 205 UNDERFLOOR INSULATION 302 TUB & OR SHOWER 304 ROUGH ELECTRICAL 306 HOLDOWNS 308 SHEETROCK 310 INTERIOR LATH 313 ROOF NAIL 502 FINAL PLUMBING ENERGY 504 FINAL BUILDING ENERGY 506 GAS TEST 508 FINAL MECHANICAL 510 FINAL PLANNING ' I a 1A1^'f\ � I ICITY OF CUPEkTINO CITY OF CUPERTINO WATER HEATER PERMIT APPLICATION FORM 0,3�/��G�ZS^ APN # ec- it 0 Date: 6� Building Address: /C14 n n _ Plumbing Permit Issuance Owner's Name: ,,�� ` /�/ Phone #'4!0 -?73? Conty�ct9r: G/4 Phone; l�'o .x,30 274-3001 License #: .3 7-'/573 Contac Phone- Cupertino Business License #: Building Permit Bldg ElElect Info Elw� Plumb X' Mech ❑ Job Description: -,9 0-V Q.41 �fN`a-C.t.� Residential X Commercial ❑ Cost of Project: /O M , Strapped ❑ On Platform Bonded ❑ New Location ❑ Re laceme t Qtv. if Apt be Fee ID Fee Decrrintinn Fee Cirnnn BPWHEATER Water Heater / Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING or