08080171CITY OF CUPERTINO
��
'- BUILDING DIVISION PERNUT
N'F�U.RMA'Tr N '
�CUNTRAC�TOR
BUILDING A9g19US:
.'.06b25 SCOFIELD DR
AFFORDABLE WATER HEATERS &
PERMIT NO.
08080171 ,
NER'S NAME:
PERMITLSUE DATE
J.ARRETT FRANK L AND MARION A
24707 RAILROAD AVE
08/22/2008 -
PHONE:
SANITARY NO. CONTROL NO.
(661)259-7131
ARCHIECDRNGINEER:
BUILDING PERMIT INFO
n
BLDGELECT In MECH
0 0 0
LICENSED CONTRACTOR'S DECLARATION
I lercby I IicemN Cmpu 9
Job Description
affirm Nal w under provisions of r (aommcncing'
with Section 70001 of Division 3 bids, Business sell Profcssior Code, sad my li==ne t,
REPLACE 40 GAL. WATER HEATER
LlcenlCaforce�ad eR L
T 2.7a �yy
Us, g
Date cpnitsM'�
ARCHrTECPS DECLARATION
I undo nd my Plans rhW m used as public records
Licensed Ptef est ..I
OWNER -BUILDER DECLARATION
1 heathy =frim Lost I am ucmpt from the Conlnctofs License Law for the
Following mason. (Section 7031.5. Surfaces and Pmfessinm Code: Any oily or coutny
which requires a permit m consmeL aher, improve. demnlish, or repair any structure
prior m it, istumcc. sire requires the "dicast for such permit to fib asigncd st,em=m
Nat he t, licensed punuum, m the Provisions arum Com uses Lues Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 700(3) or Division 3 of the Business sad Prefectures Code) or
$1450
Nn an is memp thue0me and the hadis for ths alleged evmpuoe Any viokuen of
3 Number'
Occupancy Type
1Bon ]0313 by arty applicant (t subjects NN
bjece sapplicans a civil penalty a!
.
not more Burt fivehundred dolwn IS50p0
5910006 .
❑ I, as overt, of the property, or my employees, with wages as deb ask compensation,
will do the work and the muctum is not intended or offered for axis (See. 70/6. Business
Required Inspections
and Professions Cad. The Commerce, Llmnse Law don ret apply to in owner, of
Property who builds u improves thErmn, and who does such work himself u through his
own employees, provided that such improvement, sm not intended oroRere t for We. If.
however, the building or improsemenl is sold within am year of compkOon, one mover.
builder will have the hurtles of paving that he did not Wild or improve for purpose of
sok.).
❑ 1. as owner of the property. me saciusively contracting with licensed sanuanton to
.
commact the project (Sec. ]ON, Business and Prafessiom Code:) The Contractors U.
.
«nse law does not apply to an awher of property who bunds or improves Neaten. and,
.
tem eemaant, formals project with a conuxmr(s) licensed p.m te Ne Convacmn
LicetCa law.
I sum exempt undo See ,B k PC fu Lou wan
ser Dau
WORKERS COMPENSATION DECLARATION
1 money slam under penalty of perjury one of Ban, following detlaodons:
❑Iharo Drawled te Calfse,tumfarWmrmaCompen-
aCarreto
..ion, u for
far ecme37
3. 3]00 of tat lobo Code, for Ne performance of Loo
which
wah far which Nis prm0 is used.
this at school.
❑ 1 have and will maintain Woayers Compensation Immature, as required by Section
3700o1'de Lobar Code, for the performance of to worts rt, which t1m; .I, is homed.
'
MY Wmism's compewdomrlwrm carrier sand Policy number ase:
c.abo,GN 14 - 1 --Polley N.:
/
CERTIFICATE OF FXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
,
(This xcBon head not W completed lithe permit is forose headed! dollars ($101)
or less.)
1 ceNfy that In the Woromxnce of Bm wants fu which this permit is isroed. I shall not
employ any person in my manner an as he become subject to the Worecri Compensedon
Laws of California. Date
Applicant
NOTICE TO APPUCANT: IL safer making this Certificate or Exemption. you should
become subjeu to the Worker's Compensation provisions of the labor Cod. you mut,
forthwith comply with such prov(sirns or this Permit small he deemed m mYad.
CONSTRUCTION LENDING AGENCY
1 hereby sanies that, Loom is • eemuoednn loading agerry, fm tat Perf commao sir
-
the worse for which this permit is Issued (Su. 3097. Civ. C.)
Lenders Name
'
Landers Address
I certify that I hero read this sapplication and state due the shove let ..0. Is
comet. I yme to comply with all city and county mainstream and state lawn reining to
Wilding convection, and hereby antho im representatives of thu city m enter upon one
amm-mentioned property for inspeNon Pmletes
(We) agree to save. Indemnify and keep harmless the City of Cupertino against
liabilities, Judgments. costs am, expemu which may in any essay crave against said City
in consequence of the granting of this permit.
APPLICANT U STANDS WI MPLY WITH A NON -Poll
Ay.s
Issued by: Date I. VT
SOURCER
ONs. J
�i'Y
Re -roofs
,
Type of Roof
Signstureof AppliaaXonusanor Data
HAZARDOUS MATERIALS DISCLOSURE
WIII ere applicant or cem future Wilding aupant noor handle hamm Eamaterial
fined by the Cupertino Municipal ode. Chapter 9.13. and ftHealth end Safety
.Sc tion Y.25s3z(a)]lot
❑Yes No
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 Wilding occupant use equipment u devices which
ease m'raNnm air contuninanu u dicaped by the Bay Area Air Quality Management
all new materials for inspection.
D'Sill
❑Yes a
I have read to hours material requmensntsor&,Chapter 6.95oftheCsiifu-
& Sar
nuNation kSarmyCode,Savw unicameral.25533 and 25534.unicameralthat if the wilding
docs ret have a rem it u my respensihility m ouify Ne pent of Ne
regalremc ten resit, tayramarn<Ea.e J,oceay.
`' ?l fZDD/J'
Signature of Applicant Date
All roof coverings to be Class'W' or better
ownm aro armarixaag=nt
• aTv OF
T
CUPEI�TINO
0
0
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
^ 4n Gn Y -I
APN #
3s� �� d�r�.�
k.. � �., �
Date:
��31��8
Building Address:
Owner's Name:
Phone #:
Contractor:
Affordable Wa¢er 1}eafe r -s
Phone #: (, b- 1 -1 1 3 1
Cupertino Business License #:
Fax#: 461-.151- RSS�
Contractor State License #:
'- 6 kSU
67369
Contact:
Scott Li1'tleFielcl
Phone #: G f -�Sy- osa o
Building Permit Info:
Fax#: b61-4-S�j-9SS6
Bld ❑ Elect Plumb
Mech ❑`—
Residential �f Commercial
❑
Job Description:��,
�-t- ��c,i✓e'�L2�5
Strapped �f On Platform ❑ Bonded FYf New
Location ❑ Replacement
Valuation: 6 D �CJ7� "l�U
l
Green Building Check must be completed and attached to this application.
Green Building Points achieved:
L
i
ti_(cL,J
CITY OF
CU
PERJINO
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
Quantity
Fee ID
Fee Description
Fee
Grou
Permit Type
1PCWHEATR
Commercial Water
HeaterNent
B
PCWHEATR
BSEISMICOM
Seismic Commercial
B
5IBSEISMICRE
1PRWHEATR
Residential Water
HeaterNent
B
PRWHEATR
Seismic Residential
B
r
PPERMITFEE
Plumbing Permit
P
TRAVDOC
Travel &
Documentation
B
BUSLIC
Business License
B
JOB
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
I e I, lJ ✓ PERMTT ;() &o. g - U L'1 I
OWNER'S NAME: ft r i 9n1 715 rvr R PHONE # 0;_ i z1957 2/
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and comvlete the followine information:
er/Contractor Signature
/22�pjC
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
er/Contractor Signature
/22�pjC
Date
Al ITEMS OF 24
E
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35910006.00
DATE ISSUED.......: 08/22/2008
RECEIPT #.........: BS000005866
REFERENCE ID # ...: 08080171
SITE ADDRESS .....: 20668 SCOFIELD DR
SUBDIVISION ....... .
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: SylviaM
COPY # : 1
OWNER ............: JARRETT FRANK L AND MARION A T
ADDRESS ..........: 20668 SCOFIELD DR
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2962
RECEIVED FROM ....: EDDIE NALLEY
CONTRACTOR .......: LEONCE ROUX LIC # 26850
COMPANY ..........: AFFORDABLE WATER HEATERS &
ADDRESS ..........: 24707 RAILROAD AVE
CITY/STATE/ZIP ...: SANTA CLARITA, CA 91321
TELEPHONE ........: (661)259-7131
FEE ID
----------
UNIT
-
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
1E3SEISMICR
------
VALUATION
----------
1,450.00
- ---
0.50
---
0.00
-------
0.50
----------
0.00
1PPERMITFE
FLAT RATE
1.00
40.79
0.00
40.79
0.00
LPRWHEATR
UNITS
1.00
24.48
0.00
24.48
0.00
ITRAVDOC
FLAT RATE
1.00
40.79
0.00
40.79
0.00
'I'OTAL PERMIT
----------
106.56
----------
0.00
--
106.56
--------
0.00
VOICE ID DESCRIPTION
------ ----------------------------
51.8
------ ----- ----
51.8 WATER HEATER
•
VOICE ID DESCRIPTION