08080173 CITY OF CUPERTINO � +' `a ,�1; -r �� ' ` *� '•fi
BUILDING DIVISION PERAUT CONTRAGTQR INFORMATION
BUILDING A DRESS: _ - - :. PERMIT NO.
/')8� h;RI:N WAY AFFORDABLE WATER HEATERS & 08080173
NER'S NAME: PERMIT ISSUE DATE,
/',.NUN IIANDADY 24707 RAILROAD AVE 08/22/2008
PHONE: SANITARY NO, CONTROL NO.
(661) 259-7131
ARCHr1ECTlENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
000 LICENSED CONTRACTOR'S DECLARATION -
in
wiNS1 hueby affirm that 1 am lkmnsed under provisions of Chapter 9(commencing Job Description
wim7IXa))ofDivision3ofNcBusin.sasodsproressimuCodaandmylicenseu REPLACE 40 GAL WATER HEATER
^?y in full force and efc r
p�2 license Chis '+ Lim
.♦
=� DamConvector A
HITECTS DECI..RATION
W< 1 understand my plus shell be used u Whlic mcnrds
Dy
so C Licensed Professional
3 OWNER-BUILDER DECLARATION
1 herehy sIrm that I am ewmpl from the Contractors License Law for the
w following moan.(Sedan 703 U,Bus( and PMfo OM Code:MY cilY or coumy
which mquiocs a prmhit m construct.alter,improve.demnluh,or repair say structure
5_y prior an its issuance.also mqulmi the applicant for such permit in file a signed stauncent
p <
that kislicensedpunwotto the pro,ampasoftmCentimeter's U..Law(Chapter 9 Sq.Ft. Floor Area Valuation
s(�$ (commencing with Section 7000)o(Division 3 ofthe Business and Professions Code)or $1350
`<
that M is exempt thertfrum W the buds for the alleged exmption.Any violation of
Section 7031.5 by any applicant for a perch subjects the appfhcanun a civil penalty or �,p�7 Number Occupancy
mal moso
re n five hundred toilers 35921025 .'rfU' P Y Type
I,nowmaof Om property areryemplo ces with wages u Wehsole compensation,
will do the wok,and the svuuum u not immndcd waRernd rmsele(Sec.7014,Busbmss
and Professions Code:The Contractor,Liceme Law CW sal apply in N ow=of Required Inspections
property who builds or impowu thereon,and who docssuch wok himself or trough his
own employ=,provided that such improvements ere not intended oroRered for sale IL
bowewn.the Wilding orimpmvement is sold within one year of completion.the owner.
builder will low the bWdm of proving that he did ant build or improw for purpose of
sale.).
0 1,as owner of tha property am commaiwly convscting with licensed mnosmn an
....I hhc project(See.7004,Busm.and Pnefecdou Code:)The ComtraeWrs U. .
tensa Law does not apply to an owner of property who builds or impow i thereon.and
who contracts for such projects with a emvanor(s)licensed pursuant to the Convenors
License Law.
Isee
udSe .B&PCfmddosm
icer
Dau
WORKERS COMPENSATION DECLARATION
I hereby aRrm under Penalty of perjury ane of the following declarations,
❑Thaw aha will mainuiv aCenif roof Cansem Wxlf-insure far Workers Compo-
sation,as provided for by Section 370 of the Labor Code.for the Performance of the
wan for which Nis permit is issued.
0 1 have and will maintain Workers Composition Insurance,as required by Section
37Wof the Labor Code,for the performance ofthe work fmwhich dna Permit is isswd. '
My Workers Compensation Insurance artier and Policy number am: p
Cartier 2e"la f"' Polity No:�b7� I �7 I .
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This scrim reed not W completed fiche permit is fe romo hundred dollars($IBM
or m3Q
1 CMify thal in the pnfmnanee.1 WC work for which Wi.prtnih is issued.L shall ant
employ any pawn in any manncrw as M become subject W the Workeas'Cump.nsadon
Laws of Caiiromia.Date
Applicant
NOTICE TO APPLICANT.IL after tusking this CeuiRcem of Baemption.you should
become subject m the Wonars ComPeosaton provisions of me Labor Code,you must
., z forthwith comply with such poviainns Of Nis permit shall be dcemed revoked.
z2 CONSTRUCTION LENDING AGENCY
i•+4 1 hereby affirm than there I,.construction mading.gchhc,for the perfunnance of
a> six wan for which this Permit Is Issued(sec.won,CTI.C.)
WM A Lenders Nam.
z Landers Address
V Q 1 certify Nat 1 have read this application and sou than ton show information is -
mnett 1 agree W mmply with all city and county ordinances and sum laws relating W
C) Wilding conswecon.and hereby1.0hrice rtpmeematives.f this city m enterupnn We
4 show-mentioned progeny for O.,,ro n purge••.
(We)ag.1.saw,indemnify and kxp harmless the City of Cupertino some
I,IZ i.,...a,fudg.f thoosumd es Pensosrmit. may in anY waYamtm against said City
U z inconsCANT UNDER-in DS thisD mit.
APPLICANTUNDER D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG LAT(ONS. )
Re-roofs
Shgmwm ofpliaData
HAZARDOUS
S ildhi, ALS DISCLOSURE a Type Of ROOF
Willy t e CuPcnt mforum building occupant atom w handle Health
material
defined EY the Cup:nihm Municipal Code.l7upmr 9.13,and the Health and Safety
ode.o u zss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
Will me. licant or future Wilding aces If a roof is installed without first obtainingan inspection,I agree to remove
Pp g pant taw ea Air Qu m devices which P
cDuva7vdnos air cmuminantsudefiwd by the Bay Area Air Quality Management all new materials for inspection.
0 Y.
1 have maul the baraodats m ommotoquimmenls md,,Chapmr6.95 o(tte Ulfor-
niaHcafth&sdetyCadc.Sretions 05.25533 and25534.1 understand thuifthe building
don ml cunenit low. 1 u my mapeammility u Wary the Occupant of the
myvircmcnuwhich loos piar�ora Ccniftpm zr - pyy Signature of Applicant Date
Owner aumcsnnxlagcm /D,m!/ All roof coverings to be Class r .a�or better
CITY OF CUPERTINO .
`PATER HEATER
CITY OF
CUPERTINO PERMIT APPLICATION FORM
Pb �() 17-3
APN # Date:
5 cl 21 025- w Date:
13110 -
Building Address:
1560 ?i✓ in
Owner's Name: Phone #:
Contractor: Phone #: 1,61- AS-1 - 7 13 1
Flffordable WcA}tf- PP-afers
Fax #: 6bI - lsy - 9666
Cupertino Business License #: Contractor State License #:
a68SD 6�-7369
Contact: Phone #: (,6 - A5-1- p 5-d.D
• $cot-t LittleFiel�1
Fax #: 661 -4-61- 963-6
Building Permit Info:
Bid ❑ Elect [ Plumb Mech Is—
Residential Nf Commercial ❑
Job Description: ID o1, 46, �� 5 �C(7vl INCL
Strapped �] On Platform ❑ Bonded New Location ❑ Replacement
Valuation:
Green Building Check must be completed and attached to this application.
• Green Building Points achieved: .
-� CITY OF CUPERTINO
CcD:' WATER HEATER
CITY OF
CUPEI�TINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCW11EATR Commercial Water B PCWHEATR
HeaterNent
BSEISMICOM Seismic Commercial B
I 1PRWHEATR Residential Water B PRWHEATR
HeaterNent
r BSEISMICRE Seismic Residential B
PPERMITFEE Plumbing Permit P
•
/ TRAVDOC Travel & B
Documentation
BUSLIC Business License B
Community Development
( 10300 Torre Avenue
M1 w4�' Cupertino CA 95014
Telephone(408) 777-3228
PEkTINO Fax(408)777-3333
�U
Building Department
JOB ADDRESS: PERMIT #
5150 iP-jwe 0jz� &-J/ -2 3
OWNER'S NAME: 14tutjNd7 PHONE # Yfi-r6417— 61147
GENERAL CONTRACTOR: n wA FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
60 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
!2 -2
Owner/Con actor Signature Date
• CITY OF CUPERTINO
4 ITEMS OF 24 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 35921025 . 00
DATE ISSUED. . . . . . . : 08/22/2008
RECEIPT # . . . . . . . . . : BS000005866
REFERENCE ID # . . . : 08080173
SITE ADDRESS . . . . . : 7580 ERIN WAY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ARUN HANDADY
ADDRESS . . . . . . . . . . : 7580 ERIN WAY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
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
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- ------------- - --- ---- ---------- ---------- ----------
IESEISMICR VALUATION 1, 350 . 00 0 . 50 0 . 00 0 . 50 0 . 00
IPPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1PRWHEATR UNITS 1 . 00 24 .48 0 . 00 24 .48 0 . 00
7.TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
-----7- -------- ---------- ----------
TOTAL PERMIT 106..-56 0 . 00 106 . 56 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
---- --------------- --------------------
CREDIT CARD 639 . 36 MASTER CARD
---------------
TOTAL RECEIPT 639 . 36
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
- ---------------------------- ------ -------------------------
57.8 WATER HEATER
•