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06030169 CITY OF CUPERTINO BUILDING DIVISIONPERMIT 'T,CON,TRACTURINFORMATI©N g' ?9a+v,'M:.x sin>n.S::l�ws` 3 _.6[sd4w e7 .�affi?, BUILDING ADDRESS: PERMIT N0. 7 12 ELDERWOOD CT R'S NAME: PERMITLSUE DATE CARL DRESEL 970 E. MAIN ST, SUITE 200 03/29/2006 PHONE: SANITARY NO. CONTROL NO. (800) 835-5946 ARCHITECT/ENGINEER: BUILDING PERMIT INFO 4BLDO ELECT EC PO MECH O I o o LICENSED CONTRACTOR'S DECLARATION Job Des FV 1 hereby affirm don 1 am Restated under provision of Chapter 9(commencing with Section 7")of Division 3 of the Business and fealom Cn 0.an licrnseis b0t0fr ` WATER HEATER �,uaz ueenso ClCl3 I.ic. �oo� Dam Con ler M ARC all he DECLARATION U 1 underusedin my plans shall be used as public records e6 BUII.C�IIV =std Licensed Pmfeaional OWNER-BUILDER DECLARATION Zs E hereby affirm that I em exempt from he f ssins Co License Law for the S$ which ng reawn.Permit t ](131.5.Guiness and improve. Professions Code:Any city or county O O O which myulra•Permit re cares tho,alma rt farm den Permit, file repair any tatemurt _Zia^ metpd.he its l licensed p aemat to res dm eisionsm far Conarkmit to ccusc Law atvmmenl FF < (comms cingwdpunuan 7000)o (Chapter 9 Sq.Ft.Floor Area Valuation Y€ro that he (commencing with Section7000)ndth basis far n(theege camdon.Any Cade)ur $ that k b attempt therefrom and the bub(m dm Waged exemption.Any Holaron of ' Section 7031.5 by any applicant for a permit subjects this applicat in a civil penalty of Un um er Occupancy Type not more than 0w hundred dollars(SM ❑I.u owner of me property,or my employees with wage.as their sour tmmpturedon, will do the work.std the aruOum Is athmaked«offered for ask(Sm.7044.Budrca Required Inspections and Priesalam Code:The Carmel Les rotm ownere ns -am law docs apply an of q P Property w he builds or improves thereon,and who doea s uch weh himrel f ar through his own employees,provided that such improvements art oat Intended mofercd(orale If. however,the building or improvement is Gold within ane year of wmpletion,the owner. builder will haw the burden of proving deal he did not build or improve for purpose of sale.). 1,as Owner of the Property,am exclusively competing with licensed mnrecmm at consuuci the pmleci(Sec.7044,Business and Profession,Code:)The Comnctor's U. came law does not apply to in owner of proper y who builds or improves daemon,and, who contracts for such projects with a contractors)licensed Pursuant to the Contractors License law. em exempt under Sec ,B k PC lm this rtmon r Dam WORKERS COMPENSATION DECLARATION 1 hereby alarm under populated perjury,arc of the following deelaredanx 1hewendwillmainuinaCeNrimmof Cementwwtf.insumfm Wm esCunpcn. noon, provided fpe by Sation 3700 of the Mbar Code,Ise the perfannence a(the work for which this permit is IaneQ 1 haw and will maintain Werlmis Compemadan I...u required by Suedan 700 of the labor Cade.far the performace of the wah far which this permit is luted. My Wm ',Comps s d n lnaunnm cerricr and Policy number aro: Caller. .Policy No.: ERTIFICATE OF EKEMPnON FROM WORKERS' COMPENSATION INSURANCE Crib amort head not W completed if the permit Is for arc hundred dollar($100) on lean) 1 certify that in the performance of the worts for which this Permit is banned,1 shall not employ any person in try mannerso u n become subject to the Worken'Compernmork Laws of Califomia.Data Appllcat NOTICE TO APPLICANT:If,a0cr meting Nis 001170 m of Eaampaim,you should become subject m the Worker's Compensation pmvWoa of the lahar Cede,you most rJ 0 fordewim comply with such provisions or this permfuMll be deemed doused. - zM CONSTRUCTION LENDING AGENCY [-+� I hereby afirm that then is a construction lending agency lar the Pcrfurmence of Chi,7 the wort for which this Pamir Is issued(Sec.3097,Civ.C.) Wti A Lenders Name , z lenders Address U0 1 certify the.1 have read this application and some that the above information is R. correct.l since to comply with all city and county onlinames and sum laws relating in 0U building construction,ad hereby anborine mpresemnives of this city to enter upon the W vWvementim.d pmpcny for inspection panmses. (We)agree m saw,indemnify and tecP n armlCIS the City of Cupertino against req IbMlides,ludgmenu.cats and expenses which may In my my same sgalmt aid City Ina me. eo of UmgronOn thispermi - L AOPPL ♦!NO I S AND L COMPLY WITH A NON/-POINT Issued by: Date �/ta Re-roofs Signuurt of ApplicaHAZAR cmr Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII y t applicant or(Mune building e.Chapter or auntie Health material Bred by the Cupertino Municipal Code,ChaPmr 9.11.and the Health and Safety .SoNam 35532(4)7 All roofs shall be inspected nor to an roofing material beim installed. ❑Yes Zrne� P P � Y g 8 Will the applicant or future building=upon[use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit haurmus air conuminanu u tier by the Bay Area Air Quality Maagcmcht all new materials for inspection. District? 0Ycs u I haw mad the hnaNws mamrialsraquimmenuunder Chapmr6.95 olive Califar- sia Hcahh&Salc yCade,Sued=25505.35533 and2S534.l examined!Ostrava building i w does not corm swemn that phlyto mfy or sue camquirtmrJ ( �da Signature of Applicant Date Owner or authadsed agent Dam All roof coverings to be Class"B"or better • CITY OF CUPERTINO Item 3 of 3 PERMIT RECEIPT OPERATOR: suem COPY # : 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35929028.00 DATE ISSUED. . . . . . . : 03/29/2006 RECEIPT #. . . . . . . . . : 33787 REFERENCE ID # . . . : 06030169 SITE ADDRESS . . . . . : 7612 ELDERWOOD CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . OWNER . . . . . . . . . . . . : CARL DRESEL ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4327 RECEIVED FROM . . . . : BONITA JENKINS CONTRACTOR . . . . . . . : MCGEE, PAT LIC # 18986 COMPANY . . . . . . . . . . : WATER HEATERS ONLY ADDRESS . . . . . . . . . . : 970 E. MAIN ST, SUITE 200 CITY/STATE/ZIP . . . : GRASS VALLEY, CA 95945 • TELEPHONE . . . . . . . . : (800) 835-5946 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGYPERMIT 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 252.06 VISA TOTAL RECEIPT 252.06 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -----_______________________ 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 �PEkT�NO Fax(408)777-3333 rC ISI Building De artment JOB ADDRESS: /2 r �� PERMIT# tX a {00301 (� OWNER'S NAME: PHONE # tJ 6 —3 F--7 GENERAL CONTRACTOR p FAX# p I am not using any subcontractors: t .o%- 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 WATER HEATER CUPEkTINO PERMIT APPLICATION FORM APN# 2� d/ Date: 3 �9/O b Building Address: 7617- Owner's 61ZOwner's Name: ( ori.+p (1 Q Phone#: �q6 -3F-2- g Contractor: ry PhRne: License#: a.2�� n ?W F35-59t/6 3 7 u s 7 3 Contact: Phone: ` Cupertino B s 9 ss License ense#: 11?Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech - *❑ Job Description: /ey- A Residential 0 - CommGerrcial/❑�t Cost of Project:Adik Strapped On Platform Bonded New Location ❑ Re lacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING I PPERI P=E Plumbing Permit Issuance PLUMBING I BENERGY Energy BUILDING BUSLIC Business License BUILDING •