05110064BUILDING DIVISION PERMIT
10421 CORTE DE SEV
W NER'S NAME:
1 SYLVIA GALLEGOS
ARCHITECTIENCRIEER:
e 1Y. — License Clue Lk. P
4S Dam Contachar
ARCHITECTS mDECLARATION
I understand my plana shall W used u Wblic records
Licensed Pmfesdnw
k� Oat I am c mptfrUER mDECLARATION
5 1 masa shim on I m uemPr from the Comrlosdo emr! : MY C taw for tiro
p o following mama (Schon ]0313, Business and Pm. de om Code: My city ar county
which requires s permit m emOes do simr, Winton. demmW, or c a sir ed uruerum
�rtw prior m in issuance- al., equire tiro Applicant forwch permit an Olcasigned summem
gg Nal he is licensed rumor in the provisions of the CmamearsLicenm Law (Chapter 9
2�$
(commencing wish Sean 7000)of Division the 3 of Business And Profesa(on, Code)of
Nat he is asunpr therefrom and the hub for the alleged exemption. My violation of
Section 7031.5 by any applicant for a permit Wbkeu the applicant On A civil penalty of
net more than, Rw, hundred Mian (35flm.
❑ I,uawner of rhe maDertY.erreY wDloym with M{nuthetrmm emnpemtion.
and P1111does Code- The ConUCIMt I.kenm few doer not aPPly 0 N owner of
properly who build, or improver thereon. and wha does suchwork himmJf or through his
own employee, provided thetsuch imp ornmenu an, notimnded oroRned forsale. If.
hawawr, the Wilding or Improwmcnt is old within ore Year of eormPWGon, the awner-
builder MB haw the Wrdm of proving that he did not WW or Improw for purpose of
sale.).
❑ I. as owner of the property am exelueiwly cnnhudng with Iimmed contrunau to
WNtmel the project (See. 7(114. ButineY and ProfessioN Code:) The ConaKLLe'a U -
onto law tines sot apply to an comer of prommywW Wilds or Improves themon. and
who cameo for suchcls with a can )Ikomdpununrlathe Cantrotots
Lice. Law.
p�y�\e
fl lam eaempumu lest . Bd:PCfm Ni,maws
mien, an provided far by Section 3700 of the Labor Cade. far the perfmmoo of the
work for which this permit is issued.
❑ I Mw and will maintain Workers Compensation hwnnm, as required by Section
7700 Mme labor Cade, far the perfomanee of the work for which dib permit Is bused
My Workers composition Wumme carrier Wed Policy number am:
PLUMBING
631
(408)364-2143
064
maldn4112'LCaaY:Yrr
NO. CONTROL NO.
Job Description
REPLACE WATER HEATER RAIAL®
N , A10V e-,3 2005
mOb seetimt need Out W completed tithe permit is far one hundred dollen ($100)
or lens)
1 comfy that In the perform e file e c e W, his permit is blued, I Nall no
employ person onl
o nyw m Am tbje u dm Warkare Compeuadon
Law"ofny ersi am
Apps ret
NOTICE TO PLD If, r m g Cen m of Exemption, Cod you should
bconme rvb b Ne W " peed tion Pravifi of Ne labor Coda you mon
.,O fmthwithoan h vista r bpemit IW demed mwked.
ti cnCONSTRUCrION LENDING AGENCY
[.r 1 hereby a111m the Oren is a construction kndin{ agency fm the perfumance of
gi i cite work fur which this pond, Is issued (Sec. 3097, Cl, G
W� Q Lendces Name
a z Lender, Address
U O 1 certify that I haw toad this application and sum flu the aWw Information b
ly corrin I apse m comply with,ll cilyand county oWi" and sore law, minting W
bu(16in{cpuNmtion, and hereby othudn mpreacera ms of this city u enmruPnn tiro
i77 aWw-mentioned proply for inspection purpoma f`\
(We) agree to an, indemnify and keep hamlesr the City of Cupertino a{aier
CA liabilities, judgments. cons and expenses which may in say way theme agaiml said City
U in cmmluence of hn{ofthb it.
O'^ APPLIC�fIf'gNANOMPLY WITH ALL NON -POINT Issued by:
Required Inspections
Date
{s,
Re -roofs (/
Si{nue n nummr Dam
H OU MATER DISCLOSURE Type of Roof
1 plkant or ulldln{ac ¢ppt nom or handle hroNoun material
as defined by the Cupertino Municipal Cade, Chapter 9.13, and tiro Health and Safety
Lade. Section 253324)7 All roofs shall be inspected prior to any roofing material being installed.
OYea W�
Will the applicut or future Wilding occupant no equipment a devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit huamnus air wnuminuu u de0rmd by ere Bay Area Air Quality Management all new materials for inspection.
District?
❑Yo Na
hamdmu materiels requirements under chapter 6.95 of the Cali for-
tle, 'e 137(13 5577 .Ilq,lundenund Nullthc WlWing '
e a ere the I y r pa bllillrgp oril'y tiro aceupul of the
an dor or cc of Occupancy. Signature of Applicant Date
All roof coverings to be Class "B" or better
CUPEkTINO
CITY OF CUPERTINO 0G) l o 0cp j -
WATER HEATER
PERMIT APPLICATION FORM
APN# 375-= 0 5- o11
Date: /Vpv. 8� 2ooS
Building Address:
/ PPERMITFEE
1042/ CDRTt= De r L L E. C v p 59Ti,v0
CA 15014
Owner's Name:
Sy L✓%A GA LL EG- or
Phone #-
«0$) 9 -3? -7(.7(.
Contractor: Phone:
License #: (. 3 r] 2 4 $
NEW 57RvGTvRB Lvme;m6— C 364-114.?
BUILDING
Contact: Phone:
Cupertino Business License #:
60-57A 408 4- 1-a70
2605 L
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ®
Mech ❑
Job Description:
1qGpLA c.E WATER NEAT R
Residential ® Commercial ❑
Cost of Project:
$ 800
Strapped El On Platform 13 Bonded
New Location ❑ Replacement
Qty. if
A TTIt/�OII�P FPP
Fee Description
Fee Grout/
BPWHEATER
Water Heater / Vent
BUILDING
/ PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BENERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING