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CITY OF CUPERTINO
I,,CNFORMATIOIV
-
BUILDING DIVISION PERMIT
'NTRACTRORwI,
BUILDING ADDRESS;
AFFORDABLE WATER HEATERS 6PERMrrIvo.06050013
7834 ORION LA
ER'S NAME:
PERMIT ISSUE DATE
FLAVIN PATRICK AND KATHLEE
V24707 SAN FERN
PHONE:
SANITARY NO. CONTROL NO.
(661) 259-7]-31
ARCHI'IEC rENGINEER: -
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job De$CilpUOn ®®® ones
1 ionby a)Brm Nal 1 am IfCemed under of Chapter 9 (commencing
l lithe
with Sectionby
Professions
Business Psionions Code,and mylicenseis
Division3of and
�'�����
to inn tame ane er@e�j a 3'
REPLACE WATER HEATER
License Cin g
,
Dem N Contractor
ARCHITECTS DECLAAAT ds
I dull E used n mcnrds
f•Iiat [1
4 tJt`/a 2006
understood my plain public
Licensed Pmressional
OWNER- camp ER DECLARATION
I thereby aRno Nm I R-eumpl from the AT License Law far Ik
r e
■
BUIL
fallowing mason. (section 7(131.5, Business aM Professions Codc: Any city or county
Vp 6 a�lryf'
a7^*
which mquires a permit m Conswct. elm,, improve, demolish, nr repair any structure
�✓
poor to its cast..... aISU?Qnires the pplicNlfor such Permit to Rlc a signed statement
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisimu of me, Conuacones LJCene Law (chapter 9
(commencing with Section 7(00) of Division 3 of the Business and Professions Code) or
dint he is exempt therefrom and the basis for the alleged exnnption. Any violaJon of
3 AW R9xFr-U?5—Occupancy
Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more man five hundred dollies (5500).
1, n owner of Ik propcny, or my employees with wages as their sole compensadon,
Required Inspections
will do the wok add site structure U not Ntendes or offered rOtaale. (Sec.7W, Imah.
and Prof ..kus' Cade The camrxwrs Lima law arca eros apply m sn owner of
property who Wilds orimpmvesthercon, sued who 0afsuch work himse forthrough his
own employees. provided thatsuch improvements are not intended aro@red forsale. IL
however, the Wilding or improvement issold within arc year ofcompleuon, the Owner.
buildcr will have dtc When of proving mal as, did ret WiW or improve for purpose of
sale.).
❑ 1, as owner of the wopeny am exclmivcly conning with licensed m... to
cmutmn the Mica (Sec. 7014, Business and Professors Cade:) The Convenors U.
come law dues not apply m an owrcr of property who Wilds or improves dmmon, and .
who contracts for such projects with a conoactods) licensed pursuant m use Conuactoh
License Law.
El 1 sin exempt under Sec . B k P C for mu reason
Date
Fear
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
Ej I Im e t nd will maintain a Curtificam.f Oncum to self-imum fm WoftesCompcn-
.her. as provided for by Section 3700 of dea LaWr Code. for the perform. of the
were for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance. as required by Section
37W of the labor Cade, for thc perrarmvrce of the work, for which mu permit is issued
'
My Workers. Compensation Insurance Carrier and Policy number are:
Cartier. I I.Q 7'C'.n'-t Policy No.: �D�%e�% /t%I
CERTTF�FDON FROM WORKERS'
COMPENSATION INSURANCE
,
(Thu section need net k complemd if [be Permit is fortune hundred dollars (SIW)
a
len.)
I Certify mal in me performance or me work for which this permit is issued. l shall on,
'
employ any person in any manner so as he kcamc subject to the Workers Compmudon
Taws of California. Dam
APDllcutl
NOTICE TO APPLICANT: If, after making this CeniBcam of Exemption, you mould
bmome subject to to Worker's Compensation provisions of me labor Codc, you most
' forthwith comply with such provisions or this permit shall k dcomcd revoked.
j CONSTRUCTION LENDING AGENCY
' 1 hereby that mert is cmmmc. lending agency for the performance of
which this
dm work for which mu permit u issued (See. 3119'1, Civ. C.)
s 30
LcM[rS Name
Lenders Address
I certify that I have mad this application and sate thus the above information is
' eomee 1 agree m comply with all city and county ordinances am sum laws muting an
Wilding construction. and hereby amhori z represemtives of this city to enter upon the
above-mcmiuned property for inspection purposes.
(we) agree to save. indemnify and keep harmless the City of Cupertino against
itabllldn. judgments, Casts Nd I.N. which may in any way.. .0., old City
in conseimme of me S. n (this permit.
' APPLICANT UNDERSTA S AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS S /,U
Re -roofs
Type of Roof
b
Signature of Applicanl/C tractor pain
DOUSMATERIAIS DISCLOSURE
Will the apps tofuturt Wilding aavpantuomorhandtCharardousmaerfal
as delisted by the Cupertino Municipal Cade. Chapmr 9.13, and this Health and Safety
Cole,Dy. 13533(x)? EW(r'
Yo
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit haeardeus air contaminants n deli by use Bay Ama Air Quality Management
all new materials for inspection.
District?
❑ Yem a
I have mal the hvardmu mamrialsrequirtmenu under Chap erg.95 of the califar-
niaHCalthhSafelyCodeSmCcs 5X1'255 awss534.1 un1rwnd tharifdm Wilding
Does ,rot curtentlY hoe • mnanL sal u m risibility m notify me occupenl of the
mquuemenawhich must beh arm armeofaCerdncamar«euparcy.
Signature of Applicant Date
roof coverings to be Class "B" or better
Owner or awhoriud agentAll
Dam'
5 of 6
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Elk: Lot:
APN ........: 36220013.00
DATE ISSUED.......: 05/01/2006
RECEIPT #.........: 34203
REFERENCE ID'# ...: 06050013
SITE ADDRESS .....: 7834 ORION LA
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: suem
COPY # : 3
OWNER ............: FLAVIN PATRICK AND KATHLEEN V
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5001
VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
VOICE ID DESCRIPTION
506 GAS TEST
RECEIVED FROM ....:
AFFORDABLE WATER HTR
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
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
VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
VOICE ID DESCRIPTION
506 GAS TEST
y
CITY OF
�UPEkTINO
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
'1�39 Of;oV. LP �
PERMIT #
OWNER'S NAME: tilt ; ( k- I q v
PHONE #
GENERAL CONTRACTOR:
FAX #
Io L S
I am not using any subcontractors: - / -06
— / Signature Date
Please check applicable subcontractors and complete the following information:
21
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
OwnerZOontractor Signature
, f &
Date
•
0
a
CITY OF
CUPEkTINO
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM OW50013
APN #
36b2 -;2o -0/3
Water Heater / Vent
Date:
Building Address:
1ff3y (�r;on LP -
Plumbing Permit Issuance
Owner's Name:
Pti7�;`1� Flov�n
BENERGY
Phone #:
L(o,-a53- 0.10
Contractor: Phone: (^(r 1
BUSLIC
License #:
Affnr&bJe u -re M -re rs aSti •113 1
(P a1 3 L8
Contact: Phone: lobi
Cupertino Business License #:
coV L1710'�eld 451-65,41?
at�BS�
Building Permit Info:
Bldg ❑ Elect Plumb f�
Mech
Job Description:y45
ReP1GCe �r��"11 a�lon 007er NeAT2r
CSA me loC0.TZn
Residential Commercial ❑
Cost of Project: 1000—
000.Strapped
strapped On Platform 11 Bonded ❑
❑
New Location Replace ment
Qty. if
Applicable Fee ID
Fee Description
Fee Grout)
( BPWHEATER
Water Heater / Vent
BUILDING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BENERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING