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08030027 CITY OF CUPERTINO BUILDING DIVISION PERMIT CL11aITRA.CRINORMr1.TIOlY s,...,,-.w.. ....+ _ PERMIT NO. BUILDIZNcj9§TSEATON PL AFFORDABLE WATER HEATERS & 08030027 NER'S NAME: - PERMIT ISSUE DATE ,NEWS NAME: , JACK WELLS - 24707 SAN FERNANDO RD 03/06/2008 ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO REPLACE WTR HEATER BLDG ELECT PLUMB - MECH Oa LICENSED CONTRACTOR'S DECLARATION Job Description ce 1 kmby affirm Net 1 am licensed under p avisians of Chapter 9(commencing sexnt with Section 70M)of Division Sof thd Business and Professions Code.aM my license is '?H in full fame and N ••a License Cllas Lie'at 27% F• Dalc GanlDECL a ARCHITECTS ad DECLARATION 1 understand my plans shall k used as puhlic rtcardsj, , 'a0 u H Licensed Pmfcssianel ' l y 3 Oat I am a mmpa(r DECLARATION I hereby affirm that 11. ucmpl Item the Cssions a License Law for 0te !CC following won.(Section 703 1.5,Business and Professions Cade:Any city or acuity 1$ which requires a Permit he construct.alter,impmvc.dcmnlish,or repair any machine Ze prior m its issuance,also requires Ne applicant Tor such Permit o file a signed statement •xx Nat he is licensed rotational to did previsions of Me Conuummu r's Licc law(Chapter 9 Sq.Ft.Floor Area Valuation (commencing with Section 7000)of Division 3 of Me Business and Pmfanicns Cade)ur j $ that he is exempt Ncmfrons and Me baso for the alleged exemption.Any violation of Section 7031.5 by my applicant far a permit subjects the applicant m a civil penalty of APN Number Occupancy Type not mom Nan flax hundred dollars ❑Lu eworl,and de,$",.mmy emplayces wlN wagesrr NGir sele campewuses will do thewmk,anal:he Commences License ns Law de d snot apply to an Basin's Required Inspections and Professions Code The Connecters License law docs rot apply lf an owner is q P property who builds or ed Out such improvements maed who we nauch wmk Mmselfar formic his awneer,Me uilding r improvement Notsuch improvements are nal intendedaraQercdfmOwnIr- huwevrA Ne building or enofpis old within tete year or mproe for the owner- builder will have Ne burden of proWng Nal k did tet Wild or improve for purpose of ale.. ❑1,as owner of the property,am exclusively connecting with licensed conaacmre to _ construct Me pmjea(See.701 Business and Profeuions Code:)M Conneemb Li- - roue law dose at apply be an owner of property who Wilds or improves Merton.and who contracts for such projects with a cummesor(s)licensed pursuant m the Canweatel License Law. ❑I and exempt under Sec .B&PC far Nu won he Date WORKERS COMPENSATION DECLARATION 1 hereby offan under penalty of perjury ane of the following declamdoo: I have and will maintain a CeNEmm or CoadentaxlGinsum fawmkafs Campen- eadon,a provided far by Section 3700 of the Labor Cade,for Ne performance of the work for which this permit is issued. ❑I have and will maintain Worker`s Compensation Insurance,a required by Schon ]]00 of the labor Cade,far to performance of the work for which this permit is issued. My Warkera Campenssall�n I�mumnct carrier azW Policy number am1:� 4�0 Cartier. Z�-� `Xl/'- policy,..: �-0tl7 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (rho section need not k completed if ate permit is Inroad hundred dollars(SIM) or less. 1 coolly Net in the Parr.m.use of the work for which this Permit is issued,I shall not employ any person in any mantra as us amend subject he the Woriddi Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If.after making this Cenifcate of Exemption,ymt should became subject m the Waher's Compensation provisions of the Labor Code,you mise O forthwith comply with such provisions or this permit shall W deemed revoked. z v~�a CONSTRUCTION LENDING AGENCY [•r Ikreby affnm Net there is a construction lending agency lar Jen performance of CL> the work for which this Permit is issued(Sec.3097,Civ.C.) ALender's Name ' z Lcadcr`s Ammsa U Q 1 certify Nal l have rod this application and state Net Ne above information U IL correct.I agree m comply with all city and county ordinances and mile laws misting in 0 U building construction,and hereby authorize mprcunaeves of this city to enter upon the r W shove-mentioned property for inspeeuon purposes. (We).,me to ave,indemnify and kip harmless Me City of Cupertino against F h liabilities,judgments,costs and expenses which may in any way amour against aid City ��rr U Z in consequence of Ne granting of do rmIt. Date Oma` �•'^ APPLICANT UNDERST DS D ILL COMPLY WITH ALL BION IPOINT Issued by: SOURCEREGULAT S / /C d( i / l I // Re-roofs !r Signererc t on - Dam HAZ OUS MATERIALS DISCLOSURE Type of Roof Will Me applicant or future building accupantsmm or bandit hamrdous material as defided by the Catania Municipal Code,Chapter 9.12,and Ne Health ad Safety lio ds Suedan 25532(x)7 / All roofs shall be inspected prior to any roofing material being installed. ❑Yu y u Will the applicant of future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove is haardnus air comaminants as do ncit by the Bay Arca Air Quality Management all new materials for inspection. strict? ❑Yes o I have read the hvardnus mmerialsmquimments underCh rater6.95 of Ne Califco- Health&Safcty Cod,Sections 8505,25533 and 25534.1 untkrsmnd thalif the building es not edy hvw ten t.dal it is my mspamihility m notlly axupanwf Ikuirarm ,b mtq�etPound,imenmarecdrdficaleargap�.r Signature of Applicant Date �1 / ° All roof coverings to be Class "B" or better Owner or amhoriecd agem Date ® CITY OF CUPERTINO 4 ITEMS OF 32 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32619134 . 00 DATE ISSUED. . . . . . . : 03/06/2008 RECEIPT # . . . . . . . . . : BS000004096 REFERENCE ID # . . . : 08030027 SITE ADDRESS . . . . . : 21880 EATON PL SUBDIVISION . . . . . . . , CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JACK WELLS ADDRESS . . . . . . . . . . : 21880 EATON PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : EDDIE D NALLEY 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 ---------- ------------- -- ------ ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 1, 100. 00 0.50 0. 00 0 .50 0 . 00 IPPERMITFE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00 IPRWHEATR 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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 852 .48 MC --------------- TOTAL RECEIPT 852 .48 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------- --------------------------- -------- --------------------------- 518 WATER HEATER -� CITY OF CUPERTINO �� 0 OZ-1 ,: '' WATER HEATER CUPEkINO PERMIT APPLICATION FORM APN # � f I bC) Date: Building Address: l a Irmo Owner's Name: Phone#: fehCk- weirs yo$,- 4a-, yp9fr Contractor: Phone #: 6 61- 451 - 7131 fqFFordcable w4f r (}eaf�rs Fax #!: fofol -�Sy - 955 [. Cupertino Business License #: Contractor State License #: '.bfrSO 6�73�8' Contact: Phone #: (�b 1 - AS-1 0 Sd-0 Scott LitfileFielcl Fax #: !ob!-aSq- gsSb Building Permit Info: Bldg M Elect Plumb Mech Residential rd Commercial ❑ Job Description: �.e�loce Wti"rer Nee,T2r- Strapped On Platform ❑ Bonded New Location ❑ Replacement Valuation: 1 �� Green Building Check must be completed and attached to this application. ,,,Green Building Points achieved: CITY OF CUPERTINO WATER HEATER CITYCUPEITINO PERMIT APPLICATION FORM Quantity Tee ID Fee Description Fee Permit Type Grow IPCWHEATR Commercial Water B )PCWHEATR Heater/Vent BSEISMICOM Seismic Commercial B 1PRWHEATR Residential Water B ti PRWH.EATR Heater/Vent BSEISMICRE Seismic Residential B / PPERMITFEE Plumbing Permit P TRAVDOC Travel & B Documentation BUSLIC Business License B �s. Community Development 10300 Torre Avenue i ' )� Cupertino CA 95014 Telephone(408) 777-3228 OCCITY OF Fax(408)777-3333 UPEI,TINO Building De artment TOB ADD'ZRESS: �D t �o n PERMIT#� 3 6 0 '-L--1 OWNER'S NAME: 5',1ck we-05 f PHONE # (ab q2(-- qf5, GENERAL CONTRACTOR: R FFo romlA — FAX # (cGf - 259�.gsrt I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation: 21 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 I � Owner/Contractor Signature Date