08080168 CITI OF CUPERTINO v.w •'Av° x: *"`�
BUILDING DIVISION PERMIT <,COI�FTRACTQRII 'URMATISN
,ham
BUILDING ADDRESS: PERMR NO.
:?2436 RANCHO DEEP CLI DR AFFORDABLE WATER HEATERS & 08080168
NER'S NAME: PERMIT ISSUE DATE
RPM 1-'TNN 24707 RAILROAD AVE 08/22/2008
PHONE: SANITARY NO. CONTROL NO.
(661) 259-7131
ARCHnELT/ENGINEER: BUILDING PERMM INFO
BLDG ELECT PLUMB MECH
0 0 0 0
30o LICENSED CONTRACTOR'S DECLARATION Job Description
rd 1 hereby afRrm Wt 1 am IimmN unJcr pmvisiom of CMPur 9(canmencln,
,+1 with Section TIXIU)ofDmdoo 3ofthe BatincuveM Pmfesdam Code.and my license is REPLACE 50 GAL. WATER HEATER
^ in full fame andef(ec Llo.t bZ�3�P'
fig: 4 mmCam
S Deis ContractorARCHITECTS DECLARATION
S I underwna my ptmts shall he used u public mmrda
] U
g tad
Licensed Professional
51 OWNER-Bu11DER rn the CATION
9 i 9 1 hereby.(sm i this 1uempt from Ju Gmims Cal license Law far Ile
O C following recon.(Salon 7031.5.construct,
Butlne. and ere.durum Cale:Any city or only
9 which requires n permit re enna,rucl.dint improve,do permit
t or e&sig ed motion,ecal
i y prior m its limmana,dm mquiw th,applicant for sorb p,ner'S Rm Law summent
�< mane allanmdpmen.mmdmpm.idaion3nf aflumcmrat.anmt,wsCode) 9 Sq.Ft. Floor Area Valuation
O lh:L M Is
with Station $2200
, 000)nf Division of the 0ud.asand Psofwiom Code)
i<9 Section e,M ts esampl therefrom and Ne bub for be dieted eanmant to Any l peation of
am theas by any reddon,far•permitmbjecu the spplicanllmacivil penally of Number Occupancy Type
ant roam m.n five hundred aurum fssam. 3 5 6 0 2 053 .�
❑Luawn.of de the mu gummy wplay,es with sum(Sm.
mmpe.ssnm,
will do thework.maim Th.Commeams mat mndcdaranemdfantapply.an an Owner of Required Inspections
and PmfwioW Cade:The Conmcmn,and
Law does not apply ir m owner is - q p
pmperty whomploye Ls,proarimpmatichi reprove Who anneufriend L orllmRar dYOY{h lila
awnemploys,prog or Improvement
each impmwmmtsinaniIntendedmpletied for sale Ir. . .
Witcar me Wilding athnpmvammtU=to withinoneyour of mmove for meowner.
of
Wilder MB hew tie burden of proving Nu k did Out build or improve far purpose of
ale.).
❑1,as owmr of Ile pupa",am conclusively conufmin{with 0anmd mntraman m
moment the project(see.Tao.Business and Pmfoud.0 Cade:)The Cmhmnrs U-
eema law does not apply man own.of Property who builds ar impmw merean,and,
who contracts for such projects with a amanuensis)licensed pursuant in Ne Commusar's
License law.
Iamuemptmdm See .Bd PCfm Nbmamn
Our Dau
WORKER'S COMPENSATION DECLARATION
1 bu eby alliin under penalty of perjury oro of Ne following daluatimls:
antio❑I Mm and will maintain a tion amu of Cement m seH-Imum(or Workeh Campeo-
work f r provided far mi S.,lon 3200 of the lab.Code,for the performance of the
work for which Nis permit is issued.
❑1 have and will maintain Worhnes Compenudan IuWana,as maluired by Session
3MOf me labor Calc,far the parfarmana of Ne vM far which this permit is issued
My WOW.Cumpanum..Wurana owner and Policy number am:
Grder.�i�l"'•�L' Poliq No.:Z�fa� f�70.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sectim need mtbacampleud If the permit Is foram hundmddollan($100)
or leu)
1 unify W,in Ne Perfowamm of Ih work Tor which our Permit IS issued.l roof not
employ,any Parma in my manner an as to became mbjeel in Ne Workcri Compenutim
Lewsaf Caiifomia.Dam
Applicant
NOTICE TO APPLICANT:If.after making this CeniOuu of Exemption,you should
become subject to sire Worker's Compemition provisions of the lab.Cade.you aura
0 0 faMwidn comply with such prm odsi. ar this Navoi shall he a.mW rooked.
Z M CONSTRUCTION LENDING AGENCY
[ti► I hereby Blinn Jin Neu iso ccs don lend!.,spray for Ne parfumameof
C' the wart for which Nie permit Is lssuc l(See.3097,CN.C.) '
W Landers Name ,
nz Lenders Address
V 0 1 madry than I have mad this appliwion aM suis that the above informsdun B -
Ip, cannot.I agree to comply with all city and marry on inmms and sum laws relating as
0 Wildln,canst sed...and hereby saltation representatives;of Nu city to enter upon the
tL7 above-mentioned property for inspection purposes.
gy (Wm)agree to use.indemnify and kap hmemall Ne Cly of Cupertino aVlmt
r/) liabilities,judgm,nu cow and amasses which may In any way amu,again,said 01,
V 7 is crosequerce^f Ne iram'ni of Nis permlc
•7 APPLIC61,7)UND ANDS AND WILL COMPLY WITH AL¢NON-PAINT Issued by: Date
sou/g/n?E/REGu /
sign arApPRcanUComrmmr � /D 4 Re-roofs A/
HAZARDOUS MATERIALS DISCLOSURE Type of Roof /v
Will ae applicam or fut.o building ammpant nare arhandle huudous meudd
dcRrlW by the,Cupenino MurficippiCcale.Chapter 9.12.and the Health and Safety
°"e ❑Yes Ne•sa"ianzs332(')+ All roofs shall be inspected prior to any roofing material being installed.
Will fact applicant or future building ottupant use equipment or deviva which If a roof is installed without first obtaining an inspection,I agree to remove
ami[harard^n, it cmtsmimnts es de1i 2(y Ife Bay Area Air Quality Management all new materials for inspection.
Distrito
pyre
Ihew matl thehe] ,mmaedebmqu1nmmu.IderChapmr6.93ordeCalifor-
nialYaldtASafctyC S,aw2sws.2ssnawus3..ImaemlmdN.tifthebuilding
Does Out current trout.Nu It u my responsibility in edify Ne a.vpan,mf de
mgaiymnts mm, prior mmuanceohOcnlfe.marOc Signature of Applicant Date
2 Z/i�
Owner or summand agent oam I All roof coverings to be Class'W'or better
C1*TY OF CUPFq RTIN0
WATER`IFEATER
CUPEkT[NO PERMIT APPLICATION FORM
DR6
APN# Date.
3.SC0. �2 G.�3 �-Z2 Dib
Building Address:
Owner's Name: Phone#:
Contractor: Phone#: &61- 1!�q - 7 131
Affordable Woife—(- Hea+erS
Fax #: bbl -01- 9SS6
Cupertino Business License #: Contractor State License#:
4.,6 t5b 64-736of
Contact: Phone#: ! &1 <3 6-9- 0 5'd-0
• �co1't Lii-filQField
Fax #: 6bl -J-61- 16-5-6
Building Permit Info:
Bldg Elect Plumb Mech ❑
Residential Commercial ❑
Job Description: ��ag—6O .�
G-' M 1B (.a VUr )
Strapped Ef On Platform ❑ Bonded Yr New Location ❑ Replacement
Valuation: ^�
Green Building Check must be completed and attached to this application.
• Green Building Points achieved:
f CITY OF CU'PERTINO
WATER HEATER
CITY or•
•
CUP EkT.INO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
BSEISMICOM Seismic Commercial B
1PRWHEATR Residential Water B PRWHEATR
HeaterNent
BSEISMICRE Seismic Residential B
PPERMITTEE Plumbing Permit P
TRAVDOC Travel & B
Documentation
BUSLIC Business License B
Community Development
10300 Torre Avenue
-to
Cupertino CA 95014
Telephone(408)777-3228
CIN OF Fax(408)777-3333
*CUPEPTINO
Building De artment
JOB ADDRESS: PERMIT#
ZzLl 3G ZAP C1-0 7 Nip c1 ; F1- I O a-a
OWNER'S NAME: 9,�Pr FI 0 IPHONE #
GENERAL CONTRACTOR: PF66,z e- I FAX #
I am not using any subcontractors: Vz Z lq�
Signature Date
Please check applica,ble subcontractors and complete the followinginformation:
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
Q ITEMS OF 24 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35602053 . 00
DATE ISSUED. . . . . . . : 08/22/2008
RECEIPT # . . . . . . . . . : BS000005866
REFERENCE ID # . . . : 08080168
SITE ADDRESS . . . . . : 22436 RANCHO DEEP CLI DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RITA FINN
ADDRESS . . . . : . . . . . : 22436 RANCHO DEEP CLIFF
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
0 TELEPHONE . . . . . . . . : (661) 259-7131
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-— ------------- ---------- ---------- ---------- ---------- ----------
1.13SETSMICR VALUATION 2 , 200 . 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
1.TRAVDOC 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 .
-------- ---------------------------- -------- ----------------------------
51.8 WATER HEATER
•