06120069-1 ,I _ ,. ,+., I '!' a 1pef n installed wi;ho " t:r: t obta.ninp ar.:nsf•u't_oo, t uii, .c to ten:•_\C
C'ITYOFir-UPE — IIV01'dneHyf c -A�L�,.c,\-U ",,Ntmigs
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F®
C�NTRACT(1IINRMQTION
uuiLpwc D vlsloN�; Y'ERMIT
.
BUILDINGADORESS��fh' w-�a!d:an td,xtr h,t•:. -th ,:.
JI AFFORDABLE WATER .HEATERS
CPERMIT No 06120069
2'0117 7 `NORTHB a ' f't E"y',
sl
S o..fi IC f,:J
.PERMIT ISSUE DATE——' _._...___...
VgtO
e ° b''
LLOYD'«YAMADA'...in _w„
24707 SAN'
SANITARY.NO.__.—___. __ CONTROL NO._..___ .
-ntar• ._ ._ _
.I.tr 1, r!AI`+p tca•" 1" _n,.ln rr � pyo..
- (66-1).259-7131 -
'- - - ---
ARCHITECT/ENGINEER:- -
BUILDING PERMIT INFO
-
BLDG ELECT PLUMB MECH
0 0 0 0
' LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affnm that 1 am licensed under provisions of Chapter 9 (commencing
p
with Section 70(18) of Division 3 of dte Business and Professions Coda, and my license is
In fall foreeandT // b 1. r,
' REPLACE WATER HEATER
Liana classV Lie
Date 1 nb Comracmr / A 2
0&
ARCHITECTS DECLARATION '
I understand my plans shall a used Is public taprd,
Licensed Professional
OWNER -BUILDER DECLARATION -
-
. I hereby .('firm License Law for Nc
1 am exempt from Nc Connns;
i
Co :
reaso LA Business and Professions; deiom Cab: Any city or county
followingreason.a. (Sermon 7
on
-
which myviru a permit to enmwcL alter, improve, demolish, or repair any structure
o
$1300
poor iuissuance. aed mem
for such Permit Gtrisle ac Law(Chapter
Sq. Ft. Floor -Area
Valuation
dpursuant to prevision of w(Cha
Nvhhiscing licensed pursuant NC of Divinnso of
that he dic ftheBuiness and Professions
of Divisien3 Business and Profusions Codc) of
(cat xempt
tSerefromon
the al eged
Nat he is exempt therefrom and the basis for the alleged exemption. Any violation of
he is and
'
0
Occupancy Type
Section 7031.5 by any applicant for a permit subjects he applic inuo a civil penalty of0
Ro l m.I. pan E„a hundred dollars (s500).
t r\..
-
k ,l moil q 'UI Or- I^C;•L.. tt;tl J -_=i .r. 2:C'
UC,,.. t,
t] 1, u ow.ner of the proµny, of my employees with wages u their attic compensation,
I. r (LJ• IJ lwtU'IC" •, utu AH ltr'• .. "•. ...t:IL L't, ..
d
-- - -- Require Inspections__.---
will do the work. and the structure is not imcndcdor offered for sale (See: Business
-apply in
Pmfessiom.Codg7ne Cgntiacmri Literati . does not to: orner'bf
t
t�f —.^t 1 1JP ':14 x,54 C'y
pronm,Ihyo tprpvd imProssthinain,andvhodassuchworthmxitiNmugh hof
aw that tritendedo offered for
A '
1�'Qv}': �.,r,, LC'If3 I-y>1r .'If
mpmvrc cubs semenusrenol
however. theebvldiie or improvemcmissot mvref,
ever.tebuil building i
\I'I'
- t -
_
heiiinoncyearefuipmvEon.Neowncr-
builEv, wdl tt N Widen f p & I�ai he did nc�t budd cr imp for putpoac of,
Q,I. as mvner a iho pmp ny am uelusively coamting wM.hcenxd contrutots ta,
l lh i fma oro
notrty dsThevest-
cimse Lawor property
doesnotcpplyman owncrofpmpcny whoseddsorlmprosth Ncmon,and,-
apply o an owner
dhGigthess"c7-suck pmjecu-- aconuanor(s)IiccnxT pts---Nc Contractor's
oh.I.M.Crafor
--
n
El I Zin covernp, der sec -'— - --B&PC for Nsra..'
-- -- _ _...
r
�..o
u All -._ ... - ___Dao
,R_.,I'!Es ,-It.WORKERSCOMPENSATION DECLARATION
u,ilsv fvC PfI01(1,'O
I hereby affiml under penalty of perjury oa of the following deciaratiom:
I
1111" ELECT ; LUVAp !A[, H
I nsYe and will m,!nlaln 9 CCt11RWbef COnxm IO SCIf-in51eC for WOtkCff Compea.
pion: as provided porgy Section. -3]00 oONe Labor Code,'foo Ne performance 00 the
Job 1l('s C, 1ptlUn
work for,whieh Nis µ(mit is issued.R u:oca:^T aGaiutn,^, l-, m,.LvYli,.ura i<j
n wil'o I
❑,I hrthandor maintain Worker's C Imunnce,lirequiredby Section
ic-ofte-w
labor Code, for lbd µrfpimuiecbf Ne voik for which Nii permit is iaued.I
My WOINc
My War empenmtlgon insurance carrier e_nd Policy,nuasm•••bsscram�
Catrier'ni pl:t+} Il h: used --Policy Ne.i':c-- o ��aP
t7
—_ __CERTIrICATE OFEXEMPnON FROM WORKERS' --._--I
h
c nail I•m4rsinne: COMPENSATION INSURANCE
L•sN W I LR t.L L\YPTIN
.
I (ITu sen onnadnotawmPlexO Na µnnnis foo hu d
aol,oy
".1".1
) tv , t)
,
1 anl(v N t Nc performance of Nc ak po h ch Nss perm t b iav d Ilshall not
^iplbYa YPetsoITin Ronne actio., o Eecome subleelmllic Marken Co pc
Lawi fCabforr,d. Ods 1O'''t� I
a
------ --
.Sq. i. fis.Ur.il'BLY; Inutl0l?
Ap'piii4mlwrtnnc,
--
NOTICE TO APPLICANT If, ficrainCc10ato, Exept nYuabdbld-
W
mtecbho ahienmdidmkcr scomµnsat onm yd
1`y` L
rorNdsth e, pty IN suehpp sn sor this limit shall be Themed raked
I e' Ter n pro"""' � el b C h C "lI 111:Ten I
,
i- ,
!I d' ,Ir I,,CONS RUCf10N;LENDING.AGENCY
Cr dl hcmhy from Nat Nem soca swninn lcM gage cy lnr the perform. oaf
, -- - -- --'—'
_ _—;�,.q 111I od,Il peel 0119
lMe work fu, hch Nts prm, Ua Issued (Sec: JO9] C C) A i cl n. hilts
''t<
,a
andefi Address
'
O I'eelre Ndtl ova Nis
and c un and sure Nat
suite laws
'. plye
City
agree m comply With all city and county ordinances and
andrelating
relating tai
'
flaws
building construction.
building eonswnien, ant( hereby autborim;mprcxnmtiws of Nu city to cnmr,upnn Nei
vou;of city
oho Y call
<_ Y PTrees
R mcmn' t' ?IM
dTE
, , ourt,;ai t
p„f Wc) ag1W Ip ave, indemnify m0 kap humless'Ihe City of Cupert n0 agetmt
1 lab(tics JuTgmc b costs and cpcsca insichimay in anyway accrue against sod City,
,
'
mconxqucnccaf thegranongofNspermit,
APPLICANB UNo ST S AND. WIL COMPLY WITH ACL' ON -P INT
ER U
I' \- 11r:� G%-1;
Issued by: Date
iSOUR /p
--Re-roofs t l”. t,P INp
sign of ca t ter I °iC '
1, t m A
fl HAZARDOUS MATERIALS la, vdous I
p_ _
Type of Roof � "''pO h''_ ri I Ms
—''
tsSCLOSURE
r „ --Will Be Applicant m future butldmgeccupamsmrc or handle h
u.RuedbyitsCupertinoModel
r J
-- ---- - - -- -- --- -- -- ----. - .... _ -
ed1th and SifeiU
lCode'Ch pNr912 inti"Ne Helli(i,
n t A r u• Cy
r •f t-. 1
,SSretyl
Co'dTfSc tidn'25532(a) - u s Fvr tc .: n.,.
.uta. „o .L •. I ;, ,d ,
:;^i
All roofs shall be inspected prior to any roofing material being installed.
v,,;tr•. •.�n:::::tt n I:a,:'h, :. _. m.Ivrc, l;:'s,:c:.:d
One future building
If a roof is installed without first obtaining an inspection, I agree to remove
P
•,r sVlill applicant pr occupant toe equipment ocdevices which
it hazardom air,canmmirunts u dcOT,id by Be Bay AreAAir.Qua(ity management'
all new materials for inspection.
.ami+''�Ycs t-' � Pn!lLr M1r 'I
,...LSJ?i1C.1'kOL._d1R!:i_:5I
-'ihavhmadihc hvaNinu ma¢rhla icyoiremenu under Chaprtrd.95ofmc Califoi 11
la Hc.IN&Sof ty CTdcSccu m255U525S3J d255341 dcrmaMNt'INc hu (ding,
docs tpl C IIitC na l Nal It to Y Ie1Pnm,mllly to mi y the CCeupanl of IIIc
My n6 ich one tPH. rl sono ace Been, FaEIcy
SignatureofA (Toon[
d rl r nn qtLf/I
--' Pp —Date
i" 1 1 '.-Allxoof coverings to be Class f°B"or better' �,
rOraamnrarrd agent. p,rc I j
FYI^!`?1m hPpLt7L.+,-11 57 s.•.kln{.nti P..ltl.;t Fr l.:c if ;1 n. vdd ilr,il,i __ —.._. _ __ ____—_ _—:_.
N40
CITY OF
46UPEkTINO
E
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
1-77 eY�rcO (.c �Iv
PERMIT #
OWNER'S NAME: 0 mR /a
PHONE #
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors: ly4(/ l Z (l-�D (/
Signature Date
Please check applicable subcontractors and complete the following information:
•
Owner/Contractor S6ature
ate
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 S6ature
ate
om 7 of 7
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31639029.00
DATE ISSUED.......: 12/14/2006
RECEIPT #.........:.37051
REFERENCE ID # ...: 06120069
SITE ADDRESS .....: 20177 NORTHBROOK SQ
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ............: LLOYD YAMADA
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 3
RECEIVED FROM ....: AFFORDABLE WATER HT
CONTRACTOR .......: LEONCE ROUX LIC # 26850
COMPANY ..........: AFFORDABLE WATER HEATERS &
ADDRESS 24707 SAN FERNANDO RD
CITY/STATE/ZIP ...: NEWHALL, 'CA 91321
TELEPHONE ........: (661)259-7131
WEE
ID UNIT
-----------------------
QUANTITY
----------
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
BENERGY PERMIT 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
588.14
------------------
MASTERCARD
TOTAL RECEIPT
588.14
VOICE ID DESCRIPTION
VOICE
ID
DESCRIPTION
502 FINAL PLUMBING
ENERGY
506
GAS TEST
507 FINAL PLUMBING
•
0
a
CITY or
CUPE(,TINO
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
ow -09
APN #
Water Heater / Vent
BUILDING
Date: I ZI (� ( Dye
Building Address:
DI'1'7 �orYhb� ok-
S �w�e
BENERGY
Owner's Name:
BUILDING
Phone #:
L461 - 3' !s loI
LLu c.MaCAA
BUILDING
Contractor: Phone:
Icle 1
License #:
3> e
e ore UATe(s
a541 X13
Jqrfpf-ab
Contact: Phone:
labl
Cupertino Business License #:
coT
aln$SO
Building Permit Info:
Bldg ❑ Elect ❑
Plumb
Mech ❑
Job Description:
Residential Commercial ❑
-
e Uee go uo ,Lr ui 4errer
Cost of Project:
30D
Strapped ❑ On Platform ❑ Bonded
❑
❑ [R�
New Location Replacement
Qty. if
V7oe m
Fee Deccrintion
Fee Group
BPWHEATER
Water Heater / Vent
BUILDING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BENERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING