060500100z
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CITY -OF 'CUPERTINO
*� "'' .4�a"'
BUILDING DIVISION PERMITkCONTRACTO
INFm
ORMATION,,
BUILDING ADDRESS:
AFFORDABLE WATER HEATERS &
PERMIT N006050010
10411 STERLING BLVD
ER'sNAME:
FERMfr ISSUE DATE
CHARLES CHAFFEE
[ON
24707 SAN FERNANDO RD
05/01/2006
PHONE:
SANITARY NO. CONTROL NO.
(661)259-7131
ARCHITECT/ENGINEER: -
BUILDING PERMIT INFO
BLDG ELER PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am li¢naed under previsions of CluPmr 9 (commencing
with Section 70010) of Division 3 of me Bush. and Prolamin. Code, uW my Beene is
nmurarteanaerr
s-
REPLACE 40 GALLON WATER HEATER (SAME LOCATION)
Liccnm Clazs L'm.N 1. a
Dam Conuxtor
- ARCHITECTS DECLARATIO
® p e
1 understanJ my plan shall he taxa u puM1lie ae rat
.
FI'�`�•�//A�'!LE
Licensed PmfessioNl
OWNER -BUILDER DECLARATION
1 hereby affirm that I em exmpl from Ne Canlnnars License law for the
following action. (Section 7031.5, Busincu and Professiuu CWe: Any city or county
II IN 0 2006$1300
Which requires a permit to consumer. alar, improve, demolish. m repair any ssmclum
-
prior to its issuance, also,equires the applicant for such permit to file a signed statement
S Valuation
Jut he u licensed pursuant o be provisions of the Contractor's License Law(Chanar 9
f
(commencing with Section 7000) of Division 3 of the Business and Professiau Code) or
that he is comm,, therefrom and the basis for ma alleged asemption. Any violation of
—
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penally of
Occupancy Type
not more Nan five hundred dancers
P Y YP
❑ Lu owner, the property,amy wployces withwages ampevimeas
Required Inspections
r ic( (Sec.a.
formic mn
Wall dodmed.n. Code:
anifismila,
and so as, of
Cade: The Camara, Liaise Law dna not appy lf an owner
ha CoreYMlNLice a do apply 0 a
9 P
is
property who proves thereon, and who does such wart M1imselr car though his
property who bis ills or
e d ortiffanal far aaw If.
Intl ear
owneer
the prsuchimproid witments hin atcmpledo. Ne
builder , Ne building or improvement is sold within ane year ori
prove for
builder will have the burden of preying But he did wt Wild or improve for puryaa of
pose of
tab.).
❑ i, as awmr of Ne property, am exclusively conuaming with Raved conuamms m
coram t the projem (Sec. 7064, Business and Pro(essiou Code:) The Commemrs Li-
crue law does not apply at an owner of property who builds or improves menton. and.
who contracts for such projects with a conrxm((s) licensed pursuant to the Convacmh
LKCRY Law.
1 am attempt under Sec. . B & P C for this wan
Data
Per WORKERS COMPENSATION DECLARATION
1 heaby afrum under penalty of perjury tine of me following declarations:
❑ 1 hum and will maintain a Cenifhaue of Cartier to self-imure, for Worters Compen.
=son, m provided for by Section 370, of dm Labor Code, for the performance of the
work for which this Permit Is issued.
❑ 1 ban and will maintain Workers Compensation Insurance, as required by Section
3700 of the labor Code, for the perfomance of dm wort for which this permit u issued.
'
My Workers Co an human aria and Policy nu art:
W I ,
Cartier. Q F 1 a` Paliry No.: Qb?a _I 7✓
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
.
mdamsvm need rant he completed if me Permit is foto. hundred dollars (5100)
v
or less.)
I «nth that in the performance of the work for which this Permit is issued. l slWl not
employ any person in my manner so as m become subject to the Wortrss' Compensadon
Laws of California. Dam
Applicant
NOTICE TO APPLICANT. IL a0er making this Certificate of Emre,mm. you should
Weame Subject in the Woher's Compansadan provisions of the Labor Code, you am
forthwith comply with such provisions or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that thea is a comuucton lending agency for the performance or
the wort for which this permit Is issued (Sec. 3097, Civ. C)
Le names Name
I<eders Addw
1 c mify that I hast read this application and state than the above information is
cmact I agree M comply with all city and county ordination and sum laws relating to
building construction. and hereby authorize mpnuemarins, of Nis city to cmerupon be
ahovcros,judgedproperty far purposes.
exismeon
(We) agree to save, indemnify and kap hamhleaz the City Of Cupcniam against
us.tic cons; and espenus which they in any way corm against tilt City
aconsequence,
. f
in consequence, of the granting renis permlt
04Date
APPLICANT UNDERSTA S AND WILL COMPLY WITH ALL NON -POINT
f
Issued by:
SOURCE REGULATIONS.
S I -N
— (��;7 -
Re -roofs
Type of Roof
Signature of Applicant nuamar V Dam
DOUS MATERIALS DISCLOSURE
Will the applicant of future Wilding acupsmsmm or handl. hazardous material
as defined by the Cupertino Munfeipal Code, Chapter 1, 11, and to Health and Safe,
Secti. 25532(.)7 .❑aN.
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant tax equipment car devioa which
If a roof is installed without first obtaining an inspection, I
g agree to remove P
mail ha ardour air contaminants as defhncd by the Bay Am Air Quality Management
all new materials for inspection.
District?
1]Yu
I have mail the hararJrws mamrialsrcquianuenta underehapmr6.95 ofthe Califo(-
niaN kb&Sn%ay Cod Scream 25505,25533 and 25534.1 indcntand thatifthe building
does not cwrently ha tenant Ihet it u my aspouihility m .ufy the oampanl of be
myvirermnu wNchm theme prior to issuance ads Cenifmamof cupanry.
S�_p
Signature of Applicant Date
All roof coverings to be Class "B" or better
owa ,mmthor'. reagent D,m
2 of 6
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37526001.00
DATE ISSUED.......: 05/01/2006
RECEIPT #.........: 34203
REFERENCE ID # ...: 06050010
SITE ADDRESS .....: 10411 STERLING BLVD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: CHARLES CHAFFEE
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: suem
COPY # : 3
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
E
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
PERMIT #
OWNER'S NAME: C-kv I eS --pep
PHONE # yo - 5-3 - (,-7SD
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ ontract r Signature
r' / 01,
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
Owner/ ontract r Signature
r' / 01,
Date
CITY of
CUPERTINO
ocpo 50010
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
APN # � �
3�5-aco—
Water Heater / Vent
Date:
y. �9-ob .
Building Address:
Plumbing Permit Issuance
10111 Sierl�n� f31vd,
BENERGYEner
Owner's Name:
BUILDING
Phone #:
0-1,O.rlo
BUILDING
`4-35-3—(o7SD
Contractor: Phone: (-Q
License #:
hr&rJ66Je Wove-c,-re-rs aSl -213 1
loa-7 3 be
Contact: Phone: &bl
0coV LilTid'
Cupertino Business License #:
6A 5 -b7au
aL,�1So
Building Permit Info:
Bldg ❑ Elect ❑� Plumb
Mech E�-
Job Description:
ReQIGCe e/O N¢ATQr
(Sqme Joe 0.TDn
Residential Commercial ❑
Cost of Project:
13 uOv
Strapped E] On Platform ❑ Bonded
011,
❑
New Location Replacement
Qty, if
Applicable Fee ID
BPWHEATER
Water Heater / Vent
1K V1VLL
BUILDING
PPERM1Th"EE
Plumbing Permit Issuance
PLUMBING
BENERGYEner
BUILDING
BUSLIC
Business License
BUILDING
•