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06070121�C a`> aG UC UC OU. F p U2 C TY OF CUPERTINO CJ �ty''" C NTFOR' " Tit, BUILDIP(G DIVISION PERMIT o^ V� ' L'A' V s� s - BUILDING ADDRESS: AFFORDABLE WATER HEATERS p"""NO.06070121 18790 NEWSOM AVE OWNER'S NAME: FEENEY ISSUE DATE VIOLET BUTLER 24707 SAN FERNANDO RD 07/19/2006 NE: SANITARY NO. CONTROL NO. (661)259-7131 ARCHr1EC (ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB NISCH O O O 0 LICENSED CONTRACTOR'S DECLARATION Job DCSCfIpLIOn 1 bumby afOrm that I me licensed under provisions of Chapter 9 (commencing with Sued. 70M)) OfDiAslon 3 of the Business and Promssfoas Coda, And my Iicenm 4 I" full saf�d e'ff�ect ) �273(0� REPLACE 40 GAL WATER HEATER SAME LOCATION L Lteg Date �r++Conlncenr far vvDOe� ARCHRECI•S DECLARATION I understand my Plans shall he used an public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Conuaaoes License Law for the fallowing mann. (Section NO 1.5, Business and Profession Cade: Any city or county $900 which mquhet a Permit W cm11NK4 Aller. borrow. denmllah, on mpelr Ny eWame Sq. Ft. Floor Area Valuation Prior In its issuance. Wu rcguirn the appilearl forsuch permit on Ola A signed statement the Crouacurs lice=law(Chapter 9 that he u licensed pursuant en the provismes of (commencingwork Seafm7000) of Cheat and PmfAny Cade)air beengf3of -d mo tits he ta exempt drse(mm and she Gula for Rha akged eaempUon. Any viotaufan at AYN Mirtiffer Occupancy Type Section 7031.5 by Lay Applicant for a Permit subjects the apptinnl in A Civil pmsky a( Act roam than five hundred datas ($500). ❑ 1, an owner of the property, or my employees with wages As than role comPemadon, e ns Required Inspections will do the work. And the structure b Am intanded or Alrered for ask (Sm. 704/, Budrcaa oat apply W An ownof and Profesaou Cad. The Contravenes License Law don s q p property who builds m improves therasn. And who dues such work himself ar uhmugh his own employees, provided that such Imprmemenu are not intended oroRerad (mule. If. however, to building or Impmwment 4aold within am yeas of completion, the owner. builder will have the burden of proving that Its did rot build or Improve far pur oic of =In.). ❑ 1, as Owner of the Property, am exclmively contracting with licensed conwetms in construct the pmject (Sec, 7044, Business and Profession Code) M Contractor's LI - coni law don rot apply en An owns of property who builds or Improves demon, and, who contracts for such pmjeela with A conuxenr(s) Banned pursuant in the Contractees License law. ❑ Iamnemptunder See .B&PCfor thismuon Owner Das WORKER'S COMPENSATION DECLARATION I hereby affirm under Penalty of perjury one of the following decletadorw I here and will maintain ACaNOCau ofConswl W sslf-imure for WorkelaCompen- ssum, ss provided for by Section 3700 of the labor Cade. for the perfierm rce of the work for which this permit is iumd. ❑ 1 haw And will munuin Workers COmpemuion Iuurance. ss mainland by Seedon 37000f Ne labor Cade, In, the performance of the work for which this palmi, I. Wmd. ' My Workeea Compeuadon Insurance Cantu and Policy monism. Calder. 2N 1-l� Polity No.: O J CERTIFICATE OF E%EMFnON FROM WORKERS COMPENSATION INSURANCE (Thu motion mrd lent An, completed If the permft is for one hundred dollars 1$100) or less. 1 cenlfy that In the performance of the work for which this petmh 11 fund, I shall Out employ anyperron In my manner so as en became subject to the Workerf COmpensadon Laws of California. Dae Applicant NOTICE TO APPLICANT: If. After mating this CenlBmu of Exemption, you should meome subject u the Wofkues Compmwdon provisions of We labor Code you am forthwith comply with such provision Or the permit shall he deemed rooked. CONSy,UC170N l.ENOlNC AGENCY scdco tending Agency for the performance of I herebyha the then, there isn ernw the wars for whichich Nis permit 6 issuW (Sec. 3097, Civ. CI ' 1 Name L mlces Lenders Addm.. j I certify that I haw read this application and sum the the Abow information is torten. l Agree in comply with all city and county aNiname n and sum Ire relaung to building construction, And hereby•uthodm representatives of this city to enter upon the show mentioned proper for inmection purports. (We) agree to sew, indemnify And knp hatsnku the City of Cupertino against j limiliun,judgments, emu and expenses which may In my way acme against aid City In eonaegmme of the granting of this Permit t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N -POINT Issued by; Date / < SOURC�Qfjy7f9N,�. ,. n Re -roofs Type of Roof C-y�-y/z-� 6�.rJf/�, �`7�G / Signature of AppliCUUCanuaaor Dam HAZARDOUS MATERIALS DISCLOSURE WIII the applicant or run= building Occupant stare or handle humdou material an deBmd by the Cupertino Municipal Cade. Chapter 9.12. And the Health and Safety Coda, Section255324)7 / All roofs shall be inspected prior to any roofing material being installed. ❑Yes �IAe If a roof is installed without first obtaining an inspection, I agree to remove WIII the applicant or future building occupant use equipment or deHcra which emit haeardnn air commitment As denned by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes 1 haw and de haradoes,M 6215 reguiremems underChapmr6.95ofthe Califor- ntaFualth&SaetyCede. 25505, 23533and25334. Iundammdthnifthe building does rot currtnit h t. u my trap ahili,y m Artery the amman, of the Pnmy/ require- °r to. u'"' f. rmam7/ Signature of Applicant Date � All roof coverings to be Class "B" or better Owner air ambadyed Agent am� CITY F �JPERTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 , Building Department JOB ADDRESS: o XLewsc Y� yl-,-- PERMIT # 6D 7 O /2 / OWNER'S NAME:- \J ' Jo a' 3w l c ✓ PHONE # 4oS-- Z 52 - 21i07 GENERAL CONTRACTOR;/ " 6�- L,, tA FAX # r L I am not using any subcontractors: 6 ' — % / % /6 4� Signature Date Plaaca rharlc Annlirahle .c»hrontractors and complete the following information: Owner/ Contractor Signature Date _ 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 1 of 2 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37530014.00 DATE ISSUED.......: 07/19/2006 RECEIPT #••••.....: 35309 REFERENCE ID # ...: 06070121 SITE ADDRESS .....: 18790 NEWSOM AVE SUBDIVISION ....... CITY .............: CUPERTINO. IMPACT AREA ....... OWNER ............: VIOLET BUTLER ADDRESS ..........: CITY/STATE/ZIP .... , OPERATOR: amyw COPY # : 2 RECEIVED FROM ....: AFFORDABLE H2O HEAT CONTRACTOR .......: LEONCE ROUX LIC # 26850 COMPANY ..........: AFFORDABLE WATER HEATERS & ADDRESS ..........: 24707 SAN FERNANDO RD CITY/STATE/ZIP ...: NEWHALL, CA 91321 TELEPHONE ........: (661)259-7131 IWEE ID UNIT QUANTITY BENERGY PERMIT FEE 1.00 BPWHEATER PER HEATER 1.00 PPERMITFEE FLAT RATE 1.00 TOTAL PERMIT VOICE ID DESCRIPTION 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING C� J AMOUNT PD -TO -DT THIS REC 34.86 0.00 34.86 10.79 0.00 10.79 38.37 0.00 38.37 ---------- ---------- ---------- 84.02 0.00 84.02 VOICE ID 506 GAS TEST DESCRIPTION 0.00 0.00 0.00 0.00 07/19/2006 06:36 66122599556 AFFORDABLE WATER HET PAGE 04/06 CITY OF CUPERTINO UOM n 121 WATER HEATER • CLP�ICTINO PERMIT APPLICATION FORM • 0 DPN# 315- 30- pJ� Water Heater / Vent nye. Building Address: Plumbin,g Permit Issuance I8'7R b BENERGX Owner's Name: BUILDING Phone #: i 12.-r f6till ¢.r BUIMING D8- a-.5!� - A i0 7 Contractor. Phone: We 1 License #: fiffDrdeMe- uJotwtrs &5'1'713 I (Pal 3b8 Contact: Phone: iobl Cupertino Business License # coli L-iIr1ef�e1 0540 at�eso Building Permit info: 1/. Bldg❑ Elect U Plumb Mech f5� Job Description: ReQIGee `/V a�lon WA►Qf H2allr ($gyne joCaTlan Residential Commercial ❑ Cost of Project: 900— OnrStrapped Strapped On Platform Bonded LF ❑ New Location Replace ment Qty. if Annlicable Fee ID Fee b-Mription Fee Group BPWHEATER Water Heater / Vent BUILDING PPER.MI TU= Plumbin,g Permit Issuance PLUMBING BENERGX Energy BUILDING BUSLIC Business License BUIMING