08070109 CITY OF CUPERTINO .t/r
BUILDING DIVISION PERMIT l.O4401F
PERMTT NO.
Bull.gly�c4A8D�fE5 .TEVENS CREEK BLVD AFFORDABLE WATER HEATERS & 08070109
OWNER'S NAME: PERMIT ISSUE DATE
11111. rUrl'AI: ],IOU 24707 RAILROAD AVE 07/16/2008
NF SANITARY NO. CONTROL NO,
ARCHITECT/ENGINBER: BUILDING PERMIT INFO'
RPLC 50 GAL GAS WTR HTR 'BLDG ELECT PLumB MEcx
300 LICENSED CONTRACTOR'S DECLARATION O O O O
v� I hereby aRm that 1 an licenlicensed!vunder provisions of Duper 9(commencing Job Description
== with Section 7lllm3)afDivisionSof Ne Business and Professions Code.and my licensee
'=e in full force and cRgD..;� Ih.• L273L b
=p Dbtc 'v. 1 ... Corrector My eate ff
77W ARCHr1EC1-S DECLARATION
� U I ukcrsund my plans"I bo used ss Public word
led
y o 3 Licensad Professional
OWNER-BUILDER DECLARATION
1 hemhy al0m that 1 am exempt from the Contractors License Law for Us,Do following mason.(Section 7011.5,Bushes and Professions Code:Any city or only
$ which nequirad a permit m emutruc4 alar,improve,demelu i.or repair any suuctum
prior to its lYuaMn.also requires theappllcanl forsuch pCrmilto file&signed abutment
€o that he iso«na<dpu.twthe proAsiaroarthacammemrrU..Law(aaper9 Sq.FC Floor Area Valuation
$ (commencing with Section 7000)of Division 3 ofthe Business and Professions Code)or
— that he is exempt thacftom std ON,bass for the alleged adempdon My Nolatlm of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil Penalty of APN Number Occu ane
rot come than five hundred dollars($50B. P Y Type
I,u owrcr of Us,property.m my wplayead with wage u Nov sole comRnvUon,
will do the .it,and the stmctum is con intended straitened for axle(Sec.Mal,Busircv
and Professions Code:The Comacurs License Law dead rot apply to an owner of Required Inspections
property who Wild orimpmves thereon.and who doe:such wmichimselrorthmagh his
own employm,pmHded that such improvements are not intended bordered foreale If.
smewr.the building or imprower ent is said within atm year of m spletion.Ne manner,
builder will ave Ue burden of provtng that k did but Wild or improve for purism:of
sale.).
❑I.as Ovcon of the property,beat ex l.drelY contracting with licensed conuenees in
construct the project(Sec.7000.Business and Profersions Cede:)The Con :cue's U.
caress,Law does not apply to an owner of property who Wilda or improv Hewn.and
who mnu.ets for such pmjcm with a eontrxtorts)licensed pas em,to the Comeacbm.
License Law.
❑Iamexempnundm5ee. .B@PCfothurcason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby air=under pmWty of Perjury oro of the following dalbeulomc
I have and will maintain a Cenificau of Consent to salt-imum fee WorkeraCamper.
union.as provided for by Secure 370&of the Labor Coda for the penfarma c of use
wort fee which this permit is inued.
❑1 have and will maintain Worker.Corn,momon I...as required by Section '
3700 of Nc labor Code,for the pedismanarftha work fa which this pc.I,is Wood '
My Workear'.Compensation War.arricr and Policy number art:
cauria, r 4"k_ Policy No.: Z-O&-2 SR 7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not k completed if the permit is from hundred dollars(SIM)
or 4ss)
I certify bass in the performance of the work for which this permit is Wood.1 a sul not
amploy any person in any mzmmr se as to become subject to the Workers'Comprmatimt
Laws of CaltI m s.Dato
Applicant
NOTICE TO APPLICANT:If,after making this CceiOcau of Exemption,you should
hecome subject to the Workers Con,cre ad as provisions d the Law Code you most
.J O foMwith comply with such provisions or Nu permit shall W decmod mwked.
z CONSTRUCTION LENDING AGENCY
[-rte Ibomb,aM.dust ft.I.&covuetinn lending agency for the performance of
ori > the work for which Ibis pemit Is issued(Sea 3097,Civ.C.)
ul 0 Undoes Name
OaL z enders Address
V CI.., correct.1 comfy Nat 1 hate need this application and sus tha the&Ww information is
Itn Vcorrect. emptyI.gw to empty with all City and county ordinances and same lava relining Is
.C) Wilding construction.and hereby andmrfre opubsmudws of this city to anter upon Us,
shove.menuened property for inspection pusyasaa
F y (We)agree to saw,indemnify and kap harmless the City of Cupertino g.hut
rA llnbilities.judgments.cem and I.M.which may in any wryaame against said City
m eortscquurce of Ne un{of Nis permit.
ti SOURICA U TIOST
NS.NDS AND WLLL COMPLY WITH ALL NON-POINT Issued by: Date th
7/��
Signature o(Applicart/Contracror Data
Re-roofs
HAZARDOUS {
Wilding
MATERIALS DISCLOSURE Type of Roof
WIII Us,a Cupar t or(Muni Wilding e.Geplaore m handle Halload material
ss dcfimd by IM Cupertino Municipal Cod.Chapter 9.12,and to Health and Safety
Coln,Section 255324)? All roofs shall be inspected prior to any roofing material being installed.
�Yad -
If a roof is installed without first obtainingan inspection,I agree to remove
Will de applicant m future_erWilding occupant use equipment car Mann which Pe g
it hvsrdoad air mnuminsnts ss deli pta Bay Am Air Quality Management all new materials for inspection.
District?
❑Ya u
1 haw mad the hauNnw maetiabmquinemer sunderCapler6.95 ofthe Califon
ria HcalNh SafetyCude,Snots 5(15,25533 and 25534.I undersand thaifte Wilding
Jou ml curmnUY ave 4 tin Wt has m rcapendbility be notify de occupant of de
negniremntswitich metpn uaaeofacenfeaeof Signature of Applicant Date
c
'711 `e All roof coverings to be Class'n"or better
Owner car auNaveda em pas'
CITY OF CUPERTINO
4 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32650073 . 00
DATE ISSUED. . . . . . . : 07/16/2008
RECEIPT # . . . . . . . . . : BS000005480
REFERENCE ID # . . . : 08070109
SITE ADDRESS . . . . . : 22407 STEVENS CREEK BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : FUTAI LIOU
ADDRESS . . . . . . . . . . : 22407 STEVENS CREEK BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : EDDIE D 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
---- ----------- ------- ---------- ---------- ---------- ----------
I.BSEISMICR VALUATION 1, 400 .00 0 . 50 0 . 00 0 . 50 0 . 00
I.PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1PRWHEATR UNITS 1 . 00 24 . 48 0 . 00 24 .48 0 . 00
1TRAVDOC 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
-- -------------- -------- -------- ----------------------
518 WATER HEATER
•
CITY OF CUPERTINO .
070/0?
WATER NEATER
CITY OF
• CUPERTINO PERMIT APPLICATION FORM
APN # (o U O O Date: -7/// 16 FI
Building Address:
aa90-7 S+eUErNs CreQk
Owner's Name: Phone #:
FU -hrA ; Luti Llo� - -7 -7 -7 - 9 -7d-j
Contractor: Phone #: (,(ol- .15-1 - 7 1 3 1
ffFof-dable- WCAW Ne_Afe-r5"
Fax #: robl - d.Sy - 95"56
Cupertino Business License #: Contractor State License #:
,2 6 Bb W-7 36,f
Contact: Phone #: (,6 - x.59- o 5-X a
Scott LittleFielcl
• Building Permit Info: Fax #:
Bld ❑ Elect ❑- Plumb Nd Mech
Residential Nf Commercial ❑
Job Description:
R-�►°lGck �C �c.t� on �aS Wgker Neu-{ er
Strapped Nf On Platform ❑ Bonded N� New Location ❑ Replacement
Valuation:
I x-10 I) -
Green Building Check must be completed and attached to this application.
• Green Building Points achieved: (/
Community Development
f; 10300 Torre Avenue
j. Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4§UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
,�3 q o 7 gte qtn S ( frzeK (31 V/� so? Ol O
OWNER'S NAME: 'L i u u PHONE # y0 g- 7 7 7 - 9 74-
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: -7 (,
Signature Date
Please check applicable 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