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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
`CONT=RACTOR IN'E�O,RIVIATION 4.
BUILDING ADDRESS:
PER"" 0605001%
10424 STERLING BLVD
NAME:
FERM f ISSUE DATE
IMER'S
GLASCOW, ARDAIN
PHONE:
SANITARY NO, CONTROL NO.
ARCHITECRENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
(� 0
LICENSED CONTRACTOR'S DECLARATION
Job D7yn[�O
1 thereby affirm that T am under provisions of Chapter ut (commencers
q
du Business aM Professiuus Code auto my license is
of MeBu
with Scorce
an effecDivisionlef
infull roreaana ertecL
REPLACE WATER HEATER
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Lio.P
i{/A/•y�7
DateClus
rwatal
Dam Can
ARCHITECTS DECLARATION ARATION
1 understand my plans shall be mud u public mends
JUN 0�a 1006
Licemed Professional
OWNER -BUILDER DECLARATION
91 A
1 Wmhy alRm Nor 11. exempt from the Conaracfcomon rs : Any a Law for the
fallowing mown. 7(m I.s, Business and ous Code: My oily Or county
eabort
e
w. demolish.
which requires a permit ro cnosw0. altar, improve. h, or repair any NurtureUILDIN
rj 0
h Permit
! also nt snhpemr's Lee aSigned
sl Tensed
Sq. Ft. Floor Area alU3tlon
aw(taument
K.heto
p....nitotet.Au.s of
of the Counselor's Pou^Law (s Code)
1 thommencing wit Pumuam ro NC of Division r Business arta vi Curie) tar
(commencing with
I
on. Any
Nat he u exempt therefrom and Ne peso for the alleged exemption. Any violation of
is exempt therefrom and the hems M al egad
3APNNg;FjjjTU Occupancy Type
Section 7031.5 by any applicant for a permit subjects Ne applicant m a civil penalty of
trot mom Nan lin hundred dolless (550().
❑ I. as owner of Ne ryapvty, Or my employees with wages as Nei I. exmpenvdan.
e
Required Inspections
will do Ne work, and the structure u nor inunded a, f,.d tonal. SOC. 7014, Business
and Professions Cade: 77u Communes Lieease Law does m1 apply to N coma of
9 P
property who buildsorimprosss Merton, and whodoessuch work himulf mthrough his
awn employees. provided Nal such improvements =out inuMed aroRcrcal fersau. If.
however, Ne building or improvement u mid within one year of completion, Ne correct.
builder will have due burden of proving that he did nal build err improve for purpose of
mm.).
❑ 1, as owner or rhe Property, am exclusively conumaing with litttued anuuwm Or
construct the project (Sec. 7044. Business and Profesdous Code:) The Committees Li.
cents Law does not apply m m owner of property who Wilds or improves Ncmon, and,
who concocts for such pojems with euaebrts) licensed pmahant to tW Canescroes
License Law.
❑ lam aernpt mule, Scc .B A P C for this maws
Dau ^ I 0
WORK PbNSATION DECLARATION
I thereby aflim order t err penjmy mu errtk following declarazionc
'
Ih:ve and will mainuinaCeni to.of Cousemm tall-imumfmWorkcbCompen-
sadm, as provided for by Section 37610 of the labor Cade, for Ns perfeame. of the
work for which thus purmit is iuucd.
❑ 1 have and will maintain Workers Compensation locon a e. u required by Smfon
3700 of Ne labor Coda, for Nc Performance of Ne worts for which this permit is issued.
My Workrls Campewdon Inst. artier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
'
COMPENSATION INSURANCE
mais section sued not W completed lithe permit is fmanc hundred dollam (SIOn)
r
or las)
1 certify Out in Me perFormanec of dm wart far w 'ch Nis Permit is issued. T shall out
employmypersaninany mann" casco brca jccttode WarkesecompcusNon
Laws ofC 'pool.. ^
Appli am
NOTICE TO APPLICANT: IL r maki 11 cm Marc of Exemption, you should
baome wbjecl b Nc Wohcr C pons�tion p isiou of Ne lahm Cole you muss
vitshallWdcemcdmoked.
r faMwiNeamplywith s-1 lions., is,
CONSTRUCTION com LENDINGAGENCY
lending agancy for dm Perfamanee of
1 herby aRrm dot Nim its con(Ses.
,Cm
work Nur which thus permit u issued (Sec. ]09T, Civ. C.)
3
Le
Lenders Name
-
hamlets Address
1 cattily Nat I have mad this application and sate that the shove infr madun Is
'
cameo 1 agree m comply with all city and county Odinances and state laws missing m
Wilding construction. and hereby ambOrim representatives of this city to enter upon the
move -mentioned property for inspection purposes
(We) agree to save, indemnify and kap harmless the City of Cupcninoagainst
j liabiliu".judgments. casts and espouses which may in any way amuse against rod City
In consequence of the gMling of ZL
" APPLICANT UNDERSTAND N ILL COMPLY WITH ALL NON -POINT
Issued by: Date U
SO RCE REGULATIONS.
Re -roofs
r7np'j- 9,S^I-
Signature of Applianl/Con Date
H D U ATERTALS DISCLOSURE
Type of Roof
Will Me applicant Tot ting occupant tore or banal. bauNous material
defined by du Cupenim not Code Chapter 9.12, and Ne Health and Safety
.section 255324)7
All roofs shall be inspected to any roofing material being installed.
El Y. ON.
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will Ne applicant or future Wilding =upant use equipment or dcvicns which
emit havarmux air contaminants as defined by NC Bay Asea Air Quality Management
all new materials for inspection.
D'Nier7
❑Ya 0 N
have read Ne Wnntnus mam6als mquimmcnu underCWpur6.95 of Ne Califor-
nia I d:5afny Codc.Savmts255os.255l1 and 25534.1 undcrnand NmiftW ddlding
'
umndy bac a temnL Nat it b my responsibility w trolly the asupmtt of the
whi[h mw{t W me( prior o lVuanec of a CenifKuse Of QNpancy.
Signature of Applicant Date
Q
All roof coverings to be Class "B" or better
r ammarime,gen,
Date
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: bethe
COPY # : 2
Sec: Twp: Rng: Sub: Elk: Lot:
APN ........: 37524003.00
DATE ISSUED.......: 05/01/2006
RECEIPT #.........: 34206
REFERENCE ID # ...: 06050017
SITE ADDRESS .....: 10424 STERLING BLVD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: GLASCOW, ARDAIN
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....:
REBUILDING TOGETHER
CONTRACTOR ........
LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP
....
,
TELEPHONE ........:
•
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
METHOD OF PAYMENT AMOUNT
_________________
NUMBER
------------
CHECK 84.02
-----___--_---___-
3043
TOTAL RECEIPT 84.02
VOICE ID DESCRIPTION
VOICE
ID
DESCRIPTION
502 FINAL PLUMBING ENERGY
-
506
GAS TEST
507 FINAL PLUMBING
•
P
CITY OF
�UPEkTINO
41
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax (408) 777-3333
Building Department
JOB ADDRES • nn PERMIT #
?6L2TLree)-c)0 1 041"')=Z;7
NAME: ED Ir i,/PHONE #
GENERAL CONTRACTOR ,�N t FAX #
I am not using any subcontractors: S-4-ok
Signature Date
Please check applicable subcontractors complete the following information:
Owner/ Contractor Signature
l -O b
Date
SUBCONTRACTOR
WUSINESS 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
l -O b
Date
•
n
LJ
a
(:I IV nl
CUPERTINO
CITY OF CUPERTINO
WATER HEA'T'ER
PERMIT APPLICATION FORM
APN #
Water Heater / Vent
BUILDING
Date:
75-2c -oo
-00
BEN ERGY
Ll -2 -3 -Ob
Building Address: (�
2 J ; FQ
-/ L �'�
9-5w/Q
of�CriJ
Owner's Nam :
Phone #:
2 r
N
Zs7— gp3 ,6
Contractor:
License #:
A,A
/u
Contact: U
Cupertino Business License #:
6
Building Permit Info:
Vq r.c aL )4 t'4 Y'sez
Bldg ❑ Elect
CJ
Plumb a Mech 0-1
Job De cription:
J
Residential
Commercial ❑
Cost of Project: A9,
9�
Strapped On Platform
I] Bonded
ET
New Location ❑ Replacement 9
Qty. if
Applicable Fee ID
Fee Descrintinn
Fpr r mnn
BPWHEATER
Water Heater / Vent
BUILDING
PPERMITFEE
PlumbingPermit Issuance
PLUMBING
BEN ERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING
Rebuilding
Together.
Silicon Valley
Village Rebuilders
Ditcch Conanunicalions
Network Appliance
Sobrato Foundation
Community Rebuilders
Adobe Systems, Inc.
Advantest America, Inc.
Calpine Foundation
Farrington Historical Foundation
Fry's Electronics
0x
City Rebuilders
Countrywide
Courlside Club, Decathlon Club
& Pacific Athletic Club
Draeger Construction
eBay Foundation
Ernst &Young
Sunnyvale Presbyterian Church
Honorary Board
Councilmember Nora Campos
City of San Jose, District 5
City of Cupertino
Building Department
April 28, 2006
RE: Application for Permit
Replacement of Gas Water Heater
Gentlemen:
Our non-profit organization is doing some repair work, primarily painting, at
the home of sisters, Ardath Glasgow & Linda Kraemer, who jointly own their
home at 10424 Sterling Blvd., in Cupertino. Both sisters are permanently
disabled. Their water heater has recently ceased functioning. We would like
to replace the water heater for them even though our budget was set for their
house some time ago and leaves little room for purchasing the appliance much
less for the permit fees. The sisters have called several possible resources
during the last 10 days to get the heater replaced but have had no success and
can't afford to pay for its replacement.
We request a waiver of fees for the issuance of the building department
permit. We also ask that the permit be signed by one of our representatives,
Pat or Johnny Dawson, in the absence of either of the two sisters.
The Cupertino City Council, at its April 4, 2006 meeting approved a grant for
$15,000 to support our activities in your city, but the paper work has not yet
been completed so our work in Cupertino goes on but has not yet been funded.
Thank you in advance for your kind consideration.
Congresswoman Zoe Lofgren
Slncerel ,
16" District, California
Tim Montgomery
CEO, Ditech Communications
Bever " y Jackson
John Neece
Executive Director
President, Catapult Strategies
Christopher Owen
President & CEO, Meriwesl Credit Union
Neil Struthers,
CEO, Santa Clara and San Benito Counties
But ding & Construction Trades
formerly Christmas in April * South Bay
P.O. Box 21996 San Jose, CA 95151 Phone (408) 578-9519 Fax (408) 578-9359
infoCurebuildingtogether-sv.org www.rebuildingtogether-sv.org
MAY 0 12006