06090265 CITY OF CUPERTINO da° e ,e.roe 'a•"xnf� +s�: `� - "` '
uuaofNG DIVISION PEgMIT CONTRACTOR INFO ATIQN
471
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BUILDING ADDRESS: AFFORDABLE WATER HEATERS —virr No.06090265
10115 CAROL LEE DR
OWNER'S NAME: PERMIT ISSUE DATE
BARNEY JAMES R 24707 SAN FERNANDO RD 09/28/2006
NE; SANITARY NO. CONTROL NO.
(661) 259-7131
ARCHRERIENGINEEA:
BUILDING PERMIT INFO
BLDG ELECTO OPLUMB PARCH
GO,�o LICENSED CONTRACTORS DECLARATION Job Description
! 1 hamkon 70 affirm Net 1 am licensedIrm rwas and
previsions of Chapter 9(commencing
with Section 7g1U)ofDivbia 3 of the Busirtas and Prafetioa Coda,and my lieens Is
a�d ipmllrarte,ndarc L REPLACE 50 GALLON WATER HEATER SAME LOCATION
j�_ Lucta Cl 3 Lic.R 60
Dau Gon DIEL
ARCHITECTS DECLARATI
E 1 undcnund my Phns shall M used as public records
5
aa Licensed Professional Q
7 OWNER-BUILDER exempt
DECLARATION /
AS Q S I hereby ahem that 11. emmpt from loc Canvas Co License taw for tire Q
3 p o following reason.(Saban 7 coon.!m.abors and Professions Code:Any dry or roomy
$ which rcauirta a permit ra coatrua alar,improve,demolish.t B repair any umm ure
ZSd that heor iuissuance.
ensedps6ant ra ros the applicant fat Coitpctor's iceulgoedroumen,
thathe pursuant tothc of Disionsof the eBuimus and PomLaeas Code)or Sq.Ft.Floor Area Valuation46
$
(commencing exe pt Section?and of bait for
she
alleged
cumtion.Any vi Cede)or
that he V stomps therelmm and the buss for the stared emmption.Any violation of
Section 7031.5 by any applicant(a'a permit subjew the applicant to a civil penalty of g5r Occupancy Type
not mart than A.hundred dollars(x500).
0 1,u Manor ortim property.or my employe"with warms as theirmle eompensNon,
will do thawait,and the mucture loom intended or offered for We(Sm.7044,Business Required Inspections
and Pralwasons Cade:The Convector's Limens Law dust not apply to an owner of 9 P
property who bui Ida or Improves Namon,and who does much work himselr m through by
own cmplayc",provided dist such Improvemeaty art not Intended reoffered fmaale.If.
however,the building or improvement la sold within as year afcaeptedoo.the awned
Wilder will have the harden of proving that her did tot build or improve for purpose of
ale.).
0 1,as owner of the property am exclusively eonmcung with licensed cunmmom In
consmut the project(Sec.7041.Business and Professions Cotler)The Cavaetor'Lb
cense taw does not apply to an owner of property who Wilds of impreves themon.and,
who mnuacufor such pmjecu with a momraaor(s)liansed pursuant re the Conu antes
Lucas law.
❑i sus msempt under See ,B d P C for Ibis reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby of on under penalty of perjury ane of tie fallowing dedmagimbe
I have atW Nll maintain a CuuOateof CanunHo mlblesurt far Warlues ComRn-
swan,as provided for by Section 3700 of Ne labor Code.(or the prof..of the
work for which this permit is issued.
O 1 have and will maintain Workels Compensation Insurance,as required by Scctian
3700 of the Lobar Code,for the performance of the work far which this permit is!sued.
My Wanes Compensation Idmrance carrier and Policy number am:
carrier. Then;4- micyNa.: 706-7898701 v
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('this salon need not Mcomplcud If the permlt Is faane hundred dollars($10(0
or leas)
I marry that in the pmitoomaa.of tlm wart for which this Permit u issued.I shall our
employ any person in my manarso as m became subject to the Woheei Compeaation
Laws of Califamia.Dam
Applicants
NOTICE TO APPLICANT,If.afar making this Ceni ica c of Exemption,you shouW
become subject to the Worker's Compematlan provuiona of the labor Code,you mug
,JO forthwith comply with such provisions or this permit shall be darned nevokcd.
.Zi y CONSTRUCTION LENDING AGENCY
I" 1 bemby will.that then I..aoauadnn lending agency for Ne perfurmence or
ai.moi me work for which this permit is ivad(Sec.3(197,Civ.C.)
W Q Lender's Name
fY Lender's Addie"
U Q 1 certify the,I have read this application and suss lost the above information is
amRCL I agree to comply with all city and county ordinances and gam laws relating to
OU building convection,and hereby authorirempreunutives of thiscityto enter upon me
W "hove mentioned propery for inspccuon purposes.
0. (We)agree to save,indemnify and keep harmless the City Of Cupcnina against
In liabilities,judgments.caro and expenses which may in my way acemc against std City
U 4 In eansqumee of the gr oo ng of this permit.
APPLICANT UNDER5S5557ANDS,/%yND WILL COMPLY WITH ALL NON-POINT Issued by: 6a Date
SOURCE REGULATIOf7�
`` �I- Z8`4_ Re-roofs
Signgum of Appli vConuaaor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will loo applicant or future building occupanumm or handle Incautious materiel
as defused by the Comedian Municipal Cade,Chapter 9,12.and the Health and Safety
Cade.Section 25533()7 All roofs shall be inspected prior to any roofing material being installed.
Gy'ea 0 N
Will the epplicect or future Wilding necupat nuse equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmardpus air conuminanu u de0ad by the Bay Asa Air Quality Mmagement 'all new materials for Inspection.
District?
OYes ON.
I have read the hvarda a maedala requirements under Chri ter 6.95 afde Caliran
me Hae"SdetyCade.Sessions 25505,25533 and 25534.1 undersand dist ifthe Wilding
da"nm currently hale a tenant g it u my ai
oesta hility ra iroufy los aaupan,of am
requirements;which mug there 'anui maara Ccnlfastear Ocapmmy. - Signature of Applicant Date
D Owner or au,hodyada IT DauAll roof coverings to be Class"B"or better
'
CITY OF CUPERTINO
om 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31623080 . 00
DATE ISSUED. . . . . . . : 09/28/2006
RECEIPT # . . . . . . . . . : 36238
REFERENCE ID # . . . : 06090265
SITE ADDRESS . . . . . : 10115 CAROL LEE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BARNEY JAMES R
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : AFFORDABLE WATER HT
CONTRACTOR . . . . . . . : LEONCE ROUX LIC # 26850
COMPANY . . . . . . . . . . : AFFORDABLE WATER HEATERS &
ADDRESS . . . . . . . . . . : 24707 SAN FERNANDO RD
CITY/STATE/ZIP . . . : NEWHALL, CA 91321
TELEPHONE . . . . . . . . : (661) 259-7131
'FEE 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 168 . 04 MASTERCARD
TOTAL RECEIPT 168 . 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
CITY OF CUPERTINO090
WATER HEATER
• CUPEkTINO PERMIT APPLICATION FORM
APN# 31 _0�3 _O so Date:
Building Address:
of 1 Card Lec pr.
Owner's Name: Phone#:
p,r ,o2� lot- Q 73 ' a
Contractor: Phone: License#:
rda b w U er ¢at C to b 1- J51 - 3 1 (od- 7 2 M
Contact: Phone: Cupertino Business License#:
Building Permit Info: —/
Bldg ❑ Elect ❑/ Plumb Mech c
Job Description:
l4l21G�LZ
Residential D,' Commercial ❑
Cost of Project:
1 I DU
' Strapped El On Platform 19 Bonded LIZ
New Location ❑ Replacement ®/
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMTTFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING
•