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08080172 CITY OF CUPERTINO BUILDING DIVISION PE RIVIIT CO '' R CTORINFURMATIaN BUILDING ADDRESS: PERMIT NO. 10; /7 COI:,D IIAR13OR AVE AFFORDABLE WATER HEATERS & 080801.72 EWS NAME: PERMIT ISSUE DATE f�ilCli l3LLE CHEN 24707 RAILROAD AVE 08/22/2008 7AROMITECUENGINEER: E: SANITARY NO. CONTROL NO. (661) 259-7131 BUILDING PERMIT INFO BLDG ELECT PLUMB MECH (� t� too LICENSED CONTRACTOR'S DECLARATION I hereby arfum Wt 1 son licensed under provisions of Chapter 9(miumwcing Job Description ZWmC withSection]OLI(y)ofDivisionn3aftheBusinesssndpmfcssiunsCode.andmylicensee REPLACE 75 GAL. WATER HEATER 313 Limman lass d cf(ee L Lie. k, Da¢ Contract w ARCHITECrs DECLARATION 6 U 1 undersand my plans shall he used as public rteards sod Licensed Professional 3 Oat I am eU rept train DECLARATION 10 I thereby slum that I am exempt from the Cam ms;Co t.iccne Law for the p o fallowing won.Permit i ]oacco Business and Pro.de oli Code:Any city or wunry $�a which its Wo•permit ro etres thati alcor,improve.h Permit 1 a repair any Wwmre Z 'priors itsissuance,alsom to the Neappnecia far suchpermtuofile Lacdmaamcnt thaemandenscd nnauant mthenmeisisio of Ne Co BosticandPneetaw(Chapter Sq.F[.Floor Area Valuation $ that he is era pt therefrcer om and th basis 3 of al egad co and on.Any Cade)o $1500 S — that Section u exempt therefrom end the Per it Ibj alleged exempaion Any violation of not mo than by any applicant for a permit abjccu the applicant ro.civil penalty of Number Occupancy Type ,rot mart than An huedrtd dollen(SSW} 36910003 �t� p y YP I,as owner of aim property,or my cmploycns with wages u their sine compensation, will do Newark sad the .to.is not intended or offered rar sam(Sec.7016,Business and Prefealons Calc:The Contractors License law does het apply Is an owns,or Required Inspections property who builds ter improves theroon,and who does such work himself ter through his own employee,provided that a ch improvements tie not intended ter oRered formic.If. ha amt,the building or improvement is sold within am:you of o mpleuon.the owner. builder will lure IW WNrn of proving that W did nor Mid in improve for purpose,of sale.). ❑1.as owner of the property,am exclusively contracting with licensed m.=I..on ....10.project(sec.7060,Business and Parretti.Cade:)The Contractors U. , cease law does not apply m an owner of property who Wilds or Mproves frton.and. who contracts for such projects with a concractor(t)licensed pumwnt in the Contractors Licmue law. Inmuemptunder See ,B&PCrwthureason r Date WORKER'S COMPENSATION DECLARATION 1 hnmby arfum order penslty of perjury sox of the following declarations ❑I ban and will maintains CertiOeau of Conant in selRlmum for WorkeOCompem union,an provided for by Section 3700 of IW labor Code.for IW performance or the work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as required by Societe 37Waf the Labor Coda,far the performance of the wart for which this permit is Issued. My Workers Compnuau raw Insurance canis and Paltry numher'J�^ (^(y Carticr.�•Gum.ya' pole,No.:ZV to /F 1 I CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Mis cocaine rcN net W completed trust permit Is finenc hundred dollen(5100) or thus) 1 certify that in Ne performance of tW wart for which Nis permit is based.I shall net employ anypenon in any maancrso a in become subject to the Worken'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If.after making this Cerlifiaa of Exemption,you should became subject in the Wekcrs Campevidon provisions of Ne labor Code,you mus .J O TaMwith comply with such provisions m Nu permit shall W dccened invoked. N CONSTRUCTION LENDING AGENCY I-a IWreby.M.this dere is acmumactinn andingagnay far the ncrfonnance of a the wok far which this permit is issued(Sec.3091,Civ,C.) WM Q Lender's Nene Z lenders Add. V C) I certify Nat I have mad this application and sea that the above information is W ^. wren I agree In comply with til city and county ondinances and sum laws relating to SV' Wilding convection,and hereby audience rtpresematima of this city to cher upon Ne W aWve.menumrcdpmpcny rorinspenion purposes �" gy (We)agree ro an.indemnify and kcal,harmless tie City of Cupertino sgdnst res incoiaimplare of the wring of the expenses which may in any way ettrw against said Cily V Z in conx�CgEEu�eRfrec of the groaning of the permit, ^" APPLICANTRSD(NDS AND WILL COMPLY WI�ISN�1.,� 'T'- Issued by: Date SOUR EGU 'IFr STN / /I/ON-V Y Y Signature of npplicantaContrxwr Data Reproofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will y t e Cupant o forum bottling a.chaps core a handle ReadIn an maeriu Once by the Cupertino Municipal Cade.Chapter 9.11.and the Ha1N and Safety .Seeuar 7.5532(1)] pYes All roofs shall be inspected prior to any roofing material being installed. e Will the applicant or future Wilding ocupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air cwuminana a cud by the Bay Area Air Quality Management all new materials for inspection. District?❑Ya u 1 have read Ne huudeco m merials reqs ire menu under Chapter 6.95 cilia Cali for. ria He.MiS Surety Cade,Smdcros 5x05,35533 and 25536.1 uMnsand thnifi a Wilding don rot currently haw a meant.Nu it u my re-spemihility m notify de occupant or de regor 01whic1mugWmelpri mannounce of.Cedreamar Signature of Applicant Dale owdtarat6, mdagent Dow v. All roof coverings to be Class'As'or better CITY OF: CUPERTINO ;(C . WATER NEATER CUCITY OF PEIQTINO PERMIT APPLICATION FORM APN # Date: Building Address: IN-11 U Ij Owner's Name: Phone #: Contractor: Phone #: (o b l- AS-1 - 7 1 3 1 iWordabla Water Pea+ers Fax #: lobI - ,l Sy - 9;-;- Cupertino SSCupertino Business License #: Contractor State License #: Contact: Phone #: Sco-rt LittleFielck Fax #: Building Permit Info: Bld ❑ Elect ❑' Plumb Mech ❑�� Residential N] Commercial ❑ Job Description: �_„j�� ,��•, � ,", C� ,�y,, � �!„ _I rivl�l ��C c� (C:�"L(�'��C�VY �, (it��'/•� '+�/Y Strapped �] On Platform ❑ Bonded Mr New Location ❑ Replacement Valuation: • Green Building Check must be completed and attached to this application. Green Building Points achieved: CITY OF CUPERTINO WATER HEATER 0"or CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1PCWHEATR Commercial Water B PCWHEATR HeaterNent BSEISMICOM Seismic Commercial B 1PRWHEATR Residential Water B PRWHEATR HeaterNent BSEISMICRE Seismic Residential B i PPERMITFEE Plumbing Permit P TRAVDOC Travel & B Documentation BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 � �UPE(�TINO Fax(408)777-3333 Building De artment JOB ADDRESS: PERMIT # 1027,-) <�o 1.1 V411%4-1, 0 &-0 61?2 OWNER'S NAME: C cni PHONE # ' o?a6. 32)- �5N6 GENERAL CONTRACTOR: OW,Ap FAX # I am not using any subcontractors: <i712 i4a% Signature Date Please check applicable subcontractors and complete the followinginformation 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/Contractor Signature Date CITY OF CUPERTINO 4 ITEMS OF 24 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36910003 . 00 DATE ISSUED. . . . . . . : 08/22/2008 RECEIPT # . . . . . . . . . : BS000005866 REFERENCE ID # . . . : 08080172 SITE ADDRESS . . . . . : 10277 COLD HARBOR AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MICHELLE CHEN ADDRESS . . . . . . . . . . : 10277 COLD HARBOR AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3329 RECEIVED FROM . . . . : EDDIE NALLEY CONTRACTOR . . . . . . . : LEONCE ROUX LIC # 26850 COMPANY . . . . . . . . . . : AFFORDABLE WATER HEATERS & ADDRESS . . . . . . . . . . : 24707 RAILROAD AVE • CITY/STATE/ZIP SANTA CLARITA, CA 91321 TELEPHONE . (661) 259-7131 REE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- ---- - --- - ---------- --- - -- ---------- 1_13SETSMICR VALUATION 1, 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ?.PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00 1.PRWI'IEATR UNITS 1 . 00 24 . 48 0 . 00 24 . 48 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 106 . 56 0 . 00 106 . 56 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ---- ------ ---------------- -------- ---------------------------- 51.8 WATER HEATER