08030028 CITY QF CUPERTINO r a, s x�-:r• •.Ta a t '" ' p6 '
BUILDING DIVISION PERMIT CONrRACTr,OR,I. FORMATION
PERMIT NO.
B I""TtT6Dp�RESbA _SC0 GNE DR - _ AFFORDABLE WATER HEATERS & 08030028
OWNER'S NAME: PERMIT ISSUE DATE,
WILBUR SHARPE 24707 SAN FERNANDO RD 03/06/2008
ONE: SANITARY NO. CONTROL NO.
ARCHI'IECf/ENGINEER: BUILDING PERMIT INFO
REPLACE WTR HEATER BLDG ELECT PLUMB MECH
,00 LICENSED CONTRACTOR'S DECLARATION Job Description
u F I thereby affirm dust 1 an Boomed uukr provisions of Chapter 9(commencing
'i iN Section 7")of DiAm.h 3afJm Business and Profeniav Code,md my Reacts is
! H in full force and ffwL .
,q3 Z
License Cl s Lic.N Gy '73fifl
Doss Contractor ✓A A
ARCHITECTS DECLARATLONT—
1 understand my plans shall W used as public records
U
a a Licensed Pmfcssional
OWNER-BUILDER DECLARATION
OC 1 hereby.Rose that 1 i. exempt(rum the C.sion Coals:a License Law(or Na
O 0 which ire moron.(Section 7(1313, t,ailicu and Professions h,oAny city or aunty
9 which rtquirus a e.also to construct,alley,Improve,h Permsh,ore pair any mucturc
t-r^
prior tuits issuance.also Outdoes the Applicant for such permit to tilt aligned statement
ANal heuliccnxanude
licensed (Janco (CTap
Lawtt9 Sq. Ft. Floor Area Valuation
u
(commencing with section 7000)of Division 3 of the Businasand Professions ewe)or
$ that he u exempt thuefrou and We basis for die allegedae
amption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of APN Number Occupancy Type
not mart Nm five hundred dellass($500).
❑Lasowncrofthe property.army employe"with wag"as thsksoccomPetudw,
will do But wark,md oheswuurt is not intended osuffered Waste(Sec.7044,Business Required Inspections
and Professlmu Code:The Crmpactors Lt.=Law do"oro apply u ns an owner of q P
propeny who builds mimprov"Merton,and who doessuch wmk himsel(or through his
own=play=,provided that such improvements m not ineaMe l maQcrtd fmsale.If.
however.We building or improvement Is mid within one year of completion.One owner-
builder will haw Je burl"of proving that he did not Wild m fmprow for puryou of
sale.)
❑1.u warcr of the property,ma exclusively wruacting wioB BamW mnuacmn to
cownct the pmjeu(Sac.7064.Business and Professions Cade:)The Comas Z Ll-
wase Law does out apply to an owner of property who Wilda or bnprovea thchow.and,
who ameacu for such projects with aamractor(s)licensed Panamint to the Contac m's
License Law.
El I am am."under See ,B&PC for this mann
Owner Dau
WORKER'S COMOECLAR
PENSATIONATION
1 hereby aliirm mater Penalty of perjury ane of the,following deciaradons:
1 have old will rmhuam aCutifiae of Conant uself-invert fm Warkch Compcn-
anion,as provided for by Section 3700 of the Labor Code,for the performance of the
wmk for which this permit is board.
I haw and will maintain Workers Compenutian Insurance,as required by Section
37W.(the Labm Cade,(ar the performance of the work for which this permit is inue-0.
My Wmime,Cconpemadan fins arta caries and Policy nnuum/b�er are: r
Cartier. ce-ti 4 Polley No:_y b7 ?6
CERTI CATEI�PrION FROM WORKERS'
COMPENSATION INSURANCE
(This section reed not W completed If the permit Is for one hundred dollars 05101)
less)
1 modify that in the performanca of the work for which this permit is issued,l shall am ,
employ any Person in any manarso as an became subject in tW Worlean'Compertadon
Laws of California,Dau
Appliant
NOTICE TO APPLICANT:IL after making this CeNfiau of Exemption,you should
become subject w IM Worsens Compensation provisions of site Lab.(Code,you must
2 forthwith comply with such provisions or this pemnitah ttl W decreed rtwkmd.
zO CONSTRUCTION LENDING AGENCY
f+ I herthy oDirm thus them is a conavuninn lending agency for thepmifortrm.of
�
i the work for which this permit Is Issued(Sec.31197,Civ.C.)
W Q Lt.&,'s Name
.7 z lenders Addrtu .
V O 1 certify that 1 have read this application and sue that the above information is
W F-' coven.I agree to comply with all city and county ordinances and sue laws relating to
O V building convection,and hereby authome rcpreacnutives of this city to enter upon to
W movementioned propenY for inspection purposes.
py (We)agree to save,mccronify and kap harmless the City of Cupertino against
rFi h liabilities.judgmcnu,costs and expenses which may in my way accrue against said City
U z in a ism,amea of the germing or this permit.
'-' APPLICANT U RSTANDS AND WILL COMP WITH ALL N -P0d6 Issued by: Date
SOURCE U TI fl.�s—r A`///—/A/V%//' t//
Re-roofs
Sitnatum of ApplicanVCoARDOr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIIl y the C icam or future Wilding mapanl atorc or handle Health and Safety
az dcOncd by the Cupertino Municipal Cade,Chapter 9.11.roti the Health and Safety
Cale.Section 155314)? All roofs shall be inspected prior to any roofing material being installed.
❑Y" 04.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.rah havardnusair conurninanu u fined by she Bay Arta Air Quality Management all new materials for inspection.
DisuiaT
DY" Nu
Ihaveread their cid smacnals rtr uimm5pla umderehapur6.95ofthc Ctlifor.
nice Health&Safety Cadc,Seedons25511} I'mNj55J6.lundersundthetiftho Wilding
docs not currently have nasal r y(/5nsibililY so nodl'Y Be Occupant of the
requirements wme Wm ' rata aof.CmryReaeor2 an Signature of Applicant Date
X61,4 All roof coverings to be Class"B"or better
Owner or mlborind agent Dom _
CITY OF CUPERTINO
4 ITEMS OF 32 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37531015 . 00
DATE ISSUED. . . . . . . : 03/06/2008
RECEIPT #. . . . . . . . . : BS000004096
REFERENCE ID # . . . : 08030028 -
11 .11
, SITE ADDRESS . . . . . : 10675 GASCOIGNE DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WILBUR SHARPE
ADDRESS . . . . . . . . . . : 10675GASCOIGNE DR
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, 600. 00 0.50 0. 00 0.50 0. 00
1PPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
1PRWHEATR UNITS 1. 00 24 .48 0. 00 24 .48 0. 00
ITRAVDOC FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 106 . 56 0. 00 106 .56 0. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- --------------------------- ------- ----------------------------
518 WATER HEATER
S
--, � CITY OF CiIPERTINO
k WATER HEATER
CITj'tlF
CUPERTINO PERMIT APPLICATION FORINT
APN # U Date:
-75-3 to
Building Address:
106-15-
r^SCu"� n� f1r.
Owner's Name: Phone#:
W%' 1lrjlnr S kNrp.z �{od-- 45-3 - b-II
Contractor: Phone#: (,bl- l51 - 713 1
RFFordable Wafer' (-Sea+e.rs
Fax #: gfft-
Cupertino Business License #: Contractor State License #:
Contact: Phone #: (,G1 -jjSj- a Sd-o
$cost Lifi-i-l�Frelcl
Fax #: (ob! -Esq- gsSb
Building Permit Info:
Bldg ❑ Elect Plumb Mcch
Residential Commercial ❑
Job Description:
Strapped S On Platform ❑ Bonded R� New Location ❑ Replacement
Valuation:
ikcn '
Green Building Check must be completed and attached to this application.
Green Building Points achieved:
CITY OF CUPERTINO
WATER HEATER.
CUPERIFINO PERMIT APPLICATION FORM[
Quantity Fee ID Fee Description Fee Permit '.Type
Grou
IPCWHEATR Commercial Water B PCWHEATR
HeaterNent
BSEISMMICOM ' Seismic Commercial B
1PRWHEATR Residential Water B PRWEEATR
HeaterNent
BSEISMICRE Seismic Residential B
PPERMITF.EE Plumbing Permit P
TRAVDOC Travel & B
Documentation
BUSLIC Business License B
Community Development
10300 Torre Avenue
F J Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
SUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
�G-7 S� Gm5do 502
OWNER'S NAME: ;az r 5 ha ip- PHONE # qv r 2s 3- 62-t
GENERAL CONTRACTOR.,a-wh p a FAX # j1§50@W G 6/-25-,-91-L
Ff '�?A4c LJA4-1_�
I am not using any subcontractors:. 3/ G /110J1
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
Owner/Contractor Signature Date