08010136 CITY OF CUPERTINO q pda4Ez!a='�a+3LE -; >t9'r3. ."
BUILDING DIVISION PE ,CONTRACTOR RMATIONm
n :mow Lc$ "INF,vL
aml.Qlr1�c,ATg RPERMIT NO.
ODRIGUES AVE ECONOMY PLUMBING 08010136
R'S yNAME: PERMITISSUE DATE
IF DAVID BAKKER 861 HINCKLEY RD 01/23/2008
PHONE: SANITARY NO. CONTROL NO.
(650) 637-5100
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O o LICENSED CONTRACTOR'S DECLARATION -
i 1 reNir
by m was 1 m ns licensed under provisioof Chapter 9(commencing Job Description
n<T W
with Section?010)of Division 3 ofthe Business anu d Professions Coda and my liceem REPLACE WTR HTR 40 GAL TO TANKLESS UNIT
< in full fora andeff�q, ^,Ij D q
> � License Clw ! Sr-Lic.N
0 DaeContoamr
ee ARCHITECTS DECLARATION
C I understood my plans shell W used u public rox rds
O
k G Licensed Professional
b OWNER-BUILDER DECLARATION
C 9 I WrtM sRrm that i 1. exempt from the Contractors License law for the
Coo following won.tendon On L3,Business and ve,der.ns Code:Any city m calory
S 9 which require a Permit ro constroct alar.W prove,h permit
u os e le a sig and swnure
i y palm to its licensed
p. ore to the ro applicant for sucCormurmil m forst, ave wtment
< Net he is linmed punuanuo the provisions of the Conuumr'and Profession,
ChapterCode)
Sq. F[.Floor Area $2700
Valuation
�g
(commencing Is exempt
pt Section nflan and
Ranof basis f r the
the eg eines end on.Any vi Cade)or
Nat he b uempt themtrom and Ne bub for me alleged exmpuan.Any violation of
Section 7031.5 by any applicant far a permit subjects the applicant to a civil penalty of Number Occupancy Type
ant mom than five hundred dollars($500). 3 6 9 0 4 0 4 7
D l,ummof Neprol".WmymployeuwRhmgesu Neirwkcompewdon,
will do thework,and de structure is notbmndetl or offered forsde(Sec.7016.Business
and Poefeumu Code The Contractors Licaue law don not apply to an owner of Required Inspections
property who builds m i mprovea thereon,and who does such weak himself or through his
own mployees,provided gut such improvements am,not intended mo@red forsale.It.
hammer.the Wilding m impmwmut Is sold within one year of mmpledon,the avres-
buildm MR haw tW holden of proving that W did rot Wild Or improve for purpose of
tole.).
D 1.as swam of the pmpeny,am exclusively compete,with licensed common s;to
comuuct tW project(Sec.7014.Bumnw and Pmfosalons Code:)The Conuumrs W-
cents law don not Apply m an owner of Property who Wilds or improves memon.and
who contracts for such projects with a conuumKs)licensed pursuant As the Conuacmr's
Lice.Law.
❑I m exempt under Sec ,B&P C for Nb wan
Dam
W ORAERS COMPENSATION DECLARATION
I hctcby drum miner penalty of Marjory new of the following declarations:
❑IMw and will mdnWn•CeNOnm of Comemtosel!-iuusefmWmkersCmpen-
sation,As provided for by section 3700 of the Lebm code,for the perfmrmance Of the
work for which this permit is issued.
D 1 haw and will maintain Workers Compensation Insurance,As required by Section
flip of the labor Code,for we performance of Ne work for which this permit Is issued.
My wmrk C°'t'lmwdon Inman.nosier and Policy number are:
Carrier.2ZZw. Pafcybin:COa Y% LDO):91'at- L,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This actin hood out W completed if the permit is for ons huff dollars IS 100)
or loss.)
1 malty,thin in the pmfarmeece a the work for which this Permit b issued,l mail Pmt
employ any person in toy mamer an As w become subject to the Workers'Cmp rnswon
Laws of c.frmem.Dam
Applicant
NOTICE TO APPLICANT.IL eller making this Certificate of Eumption,you should
Income subject m the Work"Compensation provision of N.Label Code,you mus
.J z foMwith comply with such provisions or this permit shill W demoted Odd ed. -
EZ ! CONSTRUCTION LENDING AGENCY
[.v 1 hmby affirm Na Dem is a comuucdon lending agency for the Performance of
IY
be,work lar which this permit is issued(Sem.3097,Civ.C.)
0 Lenders Nuns
.7. z Lenders Addw
UO 1 certify Na I haw mad this application and rate that twoabow Information is
ly ^. Conon.l agree to empty with all N% ordinances
and county and sum laws relating to
rU^ Wilding comuuction.and hereby Modm epwnutivcs of Nb City m coal upon its,
{37 show-mentioned pmperty for Inspection Purposes.
(WCL)agree to save,indemnify and keep harmlw the City of Cupertino against
„y N limilities,judgmcus.costs and expenses which may in toy my accrue agdrut aid City
t.>7 in consequence of the gmating of was Permit / n (�
r7 APPLICANT UNDERSTANDS AND WILL C MPLY WI LL NON-POINT .ISSUed by; Date CiJ
SOURCE REGULATIONS, /—'Z
/ 2 Re-roofs
SignstuMOf Applic MCanusctor= •Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII who applicant or future Wilding occupant score or handle huamow material
turned by Re Cupenino Municipal Code.Chapter 9.13,and the Health and Safety
.
Seed..255324)' All roofs shall be inspected prior to any roofing material being installed.
❑Yrs 8011.
Will the applicant or future building Occupant nsc equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.mit hovrdoue oar conuminants As defined by the Bay Area Air Quality Mamagem..t all new materials for inspection.
District?
Dy. 9-N.
1 have read the heurdwe mamrlab requiremrats under ChaPmr6.95ofthe Califm-
nb Health&Safety0nds.Savor 25505,25535 and 25534.1 wakos and will Rthe Wilding
dons Out cmo ntly have a mann dor It b my responsibility to notify dm occupant of the
mquimmentsw kh aaWmet to muamo,sof.c.nifaam of acapan'T Signature of Applicant Date
Zt- zg"� All roof coverings to be Class"B" or better
Owner thmisd sgcnl Dam'
CITY OF CUPERTINO
D' WATER HEATER
OF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
Dq 01+
Building Address:
/qy �� • �clYi <<c s ��c .
Owner's Name: Phone #:
Contractor: Phone #:
Ow i A,1 15 Fax #:
Cupertino Business License #: Contractor State License #:
Contact: 1 JI Phone #: .JDe -$p
Fax #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech ❑
Residential ® Commercial ❑
Job Description: t L,_- (uGt Gv 7�2
C TBGv1!� �c55 UA-
Strapped ❑ On Platform E�r Bonded New Location ❑ Replacement
Valuation:
02
�d
Green Building Check must be completed and attached to this application.
Green Building Points achieved:
CITY OF CUPERTINO
aw
WATER HEATER
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BSEISMICOM Seismic Commercial B
1PRWHEATR Residential Water B PRWHEATR
/ HeaterNent
1BSEISMICRE Seismic Residential B
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel & B
Documentation
1BUSLIC Business License B
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36904047 .01
DATE ISSUED. . . . . . . : 01/23/2008
RECEIPT # . . . . . . . . . : BS000003760
REFERENCE ID # . . . : 08010136
SITE ADDRESS . . . . . : 19978 RODRIGUES AVE
.SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DAVID BAKKER
ADDRESS . . . . . . . . . . : 19978 RODRIGUES AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : BELL LPLUMBING & HT
CONTRACTOR . . . . . . . : DAN GRIFFIN LIC # 29238
COMPANY . . . . . . . . . . : ECONOMY PLUMBING
ADDRESS . . . . . . . . . . : 861 HINCKLEY RD
CITY/STATE/ZIP . . . : BURLINGAME, CA 94010
• TELEPHONE . . . . . . . . : (650) 697-5100
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- --------- ---------- ---------
1BSEISMICR VALUATION 2, 700. 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 2'4..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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
---------------- --------------- --------------------
CHECK 106.56 #5297
---------------
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--- ---------------------------- --------
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518 WATER HEATER
•
Community Development
0 Torre Avenue
103
pOertinno CA 95014
Telephone(408) 777-3228
CITY Of Fax(408) 777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
r es POC,
OWNER'S NAME: 0 1 t e c ,— PHONE #t'(b - 3
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: G t
Signature Date
Please check applicable subcontractors and complete the following information
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 CoKe2vv7 V L 1 _
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owne ontractor Signature Date