06120067 1 a t +tt Ir Ic
I .lhtdc
CI CY OF CUPERTINO IkitP�etYfi� v n'i'Y«"-' YtxS9i +. 7 r l I 1 ill tIISt tf''
uuaolnaDrvlslory PERMIT C�1VT CT0QNI'O.I2MATSON
1DIMC IIIISIOr ur.,C, ..re..n.r...E m .,vr. 3.. ...>a',.°✓�ix @9, L..w'k$rai,#.,s.� 1
Bun:Dine;nDDREss:=:'P:u7rr;;�,Pyr:nl"l;.m;,!;tis�,�.,3,,,�aar.rr:.n�nu.r„ I AFFORDABEEI'WATER''!IHEATERS PERMITNO. 06120067
ti
aemr:,
10806% CRANBE --
OWNERSNAML o�a txtru Ips v^✓+F•4ff 1 J t:C,ld,�j PERMIT ISSUE DATE
"".•}PAUL CHAR�i1Sa " i`"':,ilii =..'S),'F1124707 SAN FERN _ 12 /14 /2006
NE.c r a +' 1 s c. Nli r f n4 s - SANITARY NO -"CONTROL NO:---
(661Y259,7131:-
BUILDING PERMIT.INFO _
-'.�• : - T-'-.�._- ,r - LDo.. ELECT PLUMB MECH...
' ,txf.f,:,t•).;:I'_C.,.:...,.o;r:.-.,n•<. ,.:^.;,.:_n1:c.,.pt`;";4..:Sr,Ir: .1 - .. - .' •.• .., _ _- —. _ C7- !� ;-� '�
:0 o ! LICENSED CONTRACTOR'S DECLARATION - -
I u P 1 hereby affirm that I am licensed under provisions of Chapter 9(counteract, Job Description
;aw with SomionTWO)of Division 3 ofthc Bicaresaad Professions Code ad yliccnsais - -
>>„ in full force andeffe �Z REPLACE WATER HEATER
adz Li an CI ¢ Lic.x ff
�F p Dole Contractor r /�6�
CHITEC'S DKLARLMON
I understand my plans shall be used as public records
JyU
•LLO vl-i Licensed PmfCSlianai
g OWNER-BUILDER DECLARATION -
Ia E 1 hereby affirm that 1 am exempt from the Comment's License law for be ,
:pit following munn.(Section
TBI.S.Business and Professions Code:Any city or county
which requires a permit to construct,almc.improve,demolish,or repair any structure 1 Z O O
prior to in issuance,also coquina dm applicant for such permit to file a signed statement
-�< that he is licensed pursuant to the previsions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
is (commencing wiN Section 7")nf Division3ofthe Businassand Profrssions Cade)or
Was he is exempt tMacfmm and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a warnit subjects the applicant in a civil penalty of '• r. Occupancy Type
not more Nan five handled Call...(165(10). P Y YP
t ::,calico ., rlayea,,..._ e=t'tr.. . ._ .. _.. +•.a.v, vat
❑Lewwneraf the property,car Imy Snoti oyces with wages az Neir.mle compensation, _
will daN t and Nehst'Crebtix's Lnacaoiaw it fnotapply TOM owner off -l-
r Na P fess on¢cox,;'n1e Ca uamar¢Lt«roe La aaearml apply to an adMr aft _ - —Required-Inspection
Ispections-
.ropey ho bis ltlso impro c th on and wh dac such work h,mself or Nmugh Ms jl `C W- '('y1' 1' ;f tSO \,( t' �.
ownemployeespmvsxd Nalseehl improvements ot' tiRed aF.Rerecifoland.If.!; )7 ill ylt e_
I, blwave(Ne bullxngor imptovemenn¢¢oldvnN one ei of tom leton.Ne own •1 • f r _ W r ',t L 'IU '.'..t.tJ C'.-A f,
builder
add,
the WMen of proving Nat he aid not build or irnprbve far puryau o "—_ ---- -� --- -- -----' ------ -
. t.. U l„idi`:'1 r 'vi ..
l . I
I cense Lawxcsmi6 [ mapim eidusiv,lycontractingwith licensed contractors to� i___-_____------------------- -.-----
D.I,aa owtar-of Nepro +
I wns,I sbd i a at(Sec. an Businev and r,whoops Cade:)The Contncto/¢Li! F!ig}UT d!'!i DP.Tr.
ppy. own escinun�Upmperiy-wcananddsorimprovcs Ncdoame.'
hncommcu fit kuch pmjecu iNaconuanor(s)hamcd puisuam lo,thc Conuacmrs __ _ _ _
r IxenY fa ... s., f I'I J. C RU
IIF dlam exe de 5e "',B&PCfo Nis rear � ��', q, , ,Sf^;!I
owner'
__
RCI :C+ ORKERS COMPENSATION DECLARATION
I hereby a(nrm under penalty of perjury one of the following xclauti :Ab:'N
ons: I B:.LG I'19f9' MI) _
— -
--- -�— -
�. _W_
ave an0 will mainlainaCesdfiomafCovcnttoedf-insum for Wmkcr'sCompeni _—�--_ ----- -'-'
smion,as Provided frilly Section 3700 of the Labor.Codal'far Ne performance oLNe JUG li3SCY1 r111 011
i't? workfonwhieh'.Nis permit is iswed.^.,,e,r+s_:✓J i'rare•sir-s foes.spa m;hr;nzis
' I
y I',CI wilrinsidcun Wmkcr's Compensation Insurance,az required by Section
3760.1the labor Cox:far Me per(orminma(Ne workrorwbicW this ranuit isiumd:
My Waf eac,dara .d. nsunncG Gins- nQPofcy,numbcr
/> Cartiv.11 ' .v , . "Ice>•d as Polity No.:”'
ERTIFICATE OF EX F1d PILON FROM ORKEAS'__-._--_
"I.'iwa cl Pm,,t acne: COMPENSATION INSURANCE
" OWN, r HJILI)1i1.::6C1.4.fiQ IUN '
lI mos accurst need not becanpleted if the permit is forum hundred dollars(SIM)
1O�', nr ICs¢_) .(} )(Pl L a( 'C A.,1; ""'t
.f
1 Ali fv vh+ Nc'perl'ormS'�ec of+hc w rk fit In h N s pem R s issued I'sh II not
< p y ypc se '1 ray mann rsnaztu
became to tM WofkcS Compensafibn �, la 1:Its+Jr hTr9
T Lws oPCal tornaDm' ' t 1 tI �'-I
l-
Z.
a
> NOTICE TO APPLICANTIf,after miking this Cer rat lc of Eacmpton you should
lice. a al lect b the Worker s Compen5at a pro S orf of Ne rotor's L'nd yp 'maill+;,y ,yp,, --
Dz f.M 'th comply w+gsueh pm s ns o this Permit shall the deemed m ked , .J,
ZQ5 ur nllcP " I . .. h :, aU , num rod I
N i f v 11'/ r n CONSfRUCr10N LENDING AGENCY c Britmn I '- ---- -- -'_ "' '-'- --'— - - ----
„flhmCWY !firm xtNcasac ¢wmmn Ica gogc_cY.lnr Nc pc fm nm f •''rte
1'� dm wort 1. hch+hu peril smucd lScv3097 C C) _I, <If u v hh t - - c - -
1
,J Q IPoT`I ttn,fy That I'h a read Nrs Spplicaiion aria¢u¢''Nst Nc above info:inatfun ii t -� l -
y '-' Brc PY Y Y
rclatin B .- .
cormct.1 a c 1.cam I with all cit antl taunt ardinamxs anJ sum laws in I
Wf•t bwlaing cpnywnion,,yW gcmby•uNorivc rtpresenutims of Nit city menmr.upon the
above mem u ed progeny far ripe q n purposes t ry 1 n c C r -e_u�I I :-� ..
LL I+(Wc)agrte Ir save, nacmn fy dad keep ham,lea'.Ne CITY of.Cupcn
in.against
% Iubldes ludgmc ucos¢ande pc which may ne y yaceruc agelnsI Sot L
,,,)7 conmqucncc of Ne Bram Nls Pcrmil." ._._. __ I _. __ - - -NT,d••
APPLICANT UN N N AND WILL C/�LY.WITH ALL�,N POIf�T, Issued by: I Date'
� %' /Z)s Re-roofs
Signature of Appl,cant/Contractor '_"' --- -' Dam : l
,l y. HAZARDOUS MATERIALS DISCLOSURE mt I Type of Roof B' - '•''aJ, b
Will Nc ipplictiter And.Wilding Occup tss rc lib ndlc M1a ardors...out
as'xfinctlby the Cpen oMumajpal Code:Chapter 912 dit HcaW and Safety,
my - tj f'+e:�, rIlO3
s Cax!Sart. 25532(a)r'e^ re r aF P race
p 'le+wpttap „a+lri¢t C1,1 rd , - .. ,I All roofs shall be inspected prior to any roofing material being installed,
'hw n m ;rl vice 6f m.m e'id a""t If a roof is installed without first obtainingan inspection,I agree to remove
Y„ pp, gree pantumcgmpmgnto xn¢s arch P
u hararanus a conlaminan8 az N by the Bay A ca Air oualdy MinagcmirL cell new materials for m$peCIIOn.
D'slria7 1
.atei..•❑Yes . nl Nu lE,} �- - It
'Iha aJ Nelwr�rdnus ate dlsregd retncnksu x ChapmrW 95 of Ne Calif�r
/ I n HcaIN&S�my Code Sttdotu 25511525577 and255J41unticrsund Not fNc buuldin6
1 I h
Jas of hrt Oy ha that
h s-M'y r .math ty I dty Nem pant fdle
eyu rem s h e t p o m ss utce of C cam
f nof Oce p - Signature of Applicant 'Date
.JAlbf blass "Bwn OUNr>ed.pal or
better
i _.,•
> li♦ me•t*+'Ohi✓! YTnf.'•,a1 t 15.1 +d .,n. t no.c'dl�h: rlbl Jn...,utt! __._..-.- ..- _-_
!01
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
4JUPERTINO
Building Department
JOB ADDRESS: PERMIT #
2
OWNER'S NAME: Pnckce- PHONE #
GENERAL CONTRACTOR• a rp P FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
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
&m 5 of 7 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36202008 . 00
DATE -ISSUED. . . . . . . 12/14/2006
RECEIPT # . . . . . . . . . 37051
REFERENCE ID # . . . : 06120067
SITE ADDRESS . . . . . : 10806 CRANBERRY DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PAUL CHAR
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
4kEE 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
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
CITY OF CIJPERTINO
WATER HEATER
CITY or
CUPE{�TINO PERMIT APPLICATION FORM
APN #
Building Address:
p , r.
Owner's Name: Phone#:
ChCtI0 - IOAS-,- 17
Contractor: Phone: t<te i License#:
jeffD( ab e ore- ec,Ters a*5` - 113 I teal 3b8
Contact: Phone: (Pbl Cupertino Business License#:
cOV LiiTle(�OA 5 - 07au 1� (01�So
Building Permit Info:
Bldg ❑ Elect ❑ Plumb d Mech ❑
Job Description:
Residential Commercial ❑
e Uee o no ref ScNMe IOcc.ri or =
Cost of Project: I"D
• Strapped ❑ On Platform ❑ Bonded ❑
New Location ElReplacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY EnergyBUILDING
BUSLIC Business License BUILDING
•