The URL can be used to link to this page

06060113 CITY OF CUPERTINO •Y sham >c> '` `"`'" ` BUILDIN'6 DIVISION PERMIT CONTRACTaR IN ORMATIO,N - BUILDING ADDRESS: AFFURVABLE WATER HEATERS 6 PERMITNO.06060113 22165 VIA CAMINO CT OWNER'S NAME: PERMIT LSSUE DATE gilk FULLER LYNN M 24707 SAN FERNANDO RD 06/14/2006 IFINE: SANITARY NO. CONTROL N0. (661) 259-7131 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 uQa LICENSED CONRACTOWS DECLARATION e t.m C 1 horror affirm than I am licensed under provisions of charter 9 fcommemina lob Description ?Zz with Section 7")of Division 3 oftheBusiness and Professions Code,and my lismic is n. LimnlscaccaMeff 3� Llc.x G273� f , REPLACE W T1 OGAL F q Dam Conlncwr ,s 7W ARCHITECTS DECLARATION 3�wA`s wV 1 undersmnd my plans shall be used az public recorN got', Licemcd Professipnal JUNZg 3OWNER-BUILDER DECLARATION I 1 hereby strum Nat I am exempt from the Contractor's License Law for the p o following reason.(Sutton 7031.5,Busimss and Profession Cade:Any city or county ��11 s1 E which requires a permit to construct.almr,imprew,demolish,or repair any nrueune 19 k Fy 7' $1200 prior m its issuance.area requiv thcapplicant for such permit to file a signed statement 0�/y �f,+� Valuation < Nat he is Iiecmcd pursuant the provisions of the Connector's license law(Chapter 9 Sq.APHO Ca'Jf N N sYT V!_ y�S (commencing with Sutton 7000)of Division 3 of the Business and Professions Cade)or _ Nat he u exempt therefrom and the basis far the alleged axempdon.Any violation of Section 7031.5 by any applicant for a permit subjects the a irdicam m a civil penalty Of r Occupancy Type not mom Nada five hundred dollar,(5500). ❑I.azowner a(Ne property,car my moployees with wagesu Ness salt eompemadon, willao Oework.andthesmnumisnotimmndedoroRemdforsak(Sec.7W.Bu must and Pmfess(om code:The Conuacmrs License Law ane set apply m an owner or Required Inspections ownertywho lt.provided Out improvements mesotimen elor ffereddough nu own ve,.O.truiprovided Nat such improvements are oat ear of d amRered themlmc.r- builder Ne ave the or ran of p oent u hath within ane year of mmove fora.the ownu- builder will have Ne Eurden of pressing that he did not build or improve for purpose of akJ. ❑1.as owner of the property.am exclusively Contracting with licensed conmamrs to CmtsI=the project(Sec.7U1d.Business and Profetiam Cade:)Th Centimeter.Li- cense law does not apply to an owner or propcny who Mild,or improv thereon,and, who contracts for such projects with a conuacsor(s)Bemused pursuant an dm Contnmor's License law. , ❑Iamuemptunder See .B&PCOr Nureason Owner Date WORKER'S COMPENSATION DECLARATION I hereby a?rm nder penalty of perjury ase of the following dularatiom: I ham and will mdnuain a CcniBmte of Consent to self-insurefor WarkeYSComilm. =I..az provided for by Sutton 3700 of the labor Code,for the performance of the wants for which this permit is issued. 1 haw and will maintain Wor%ce,Compemadd.Inti ..as roquined by Sccdan 3700 of Inc Labor Code,far Ne peRormantt of the work,for which Nis permit is issued. My Warkefs7.er �In,mance canner mad policy number 7 �7U Cartier. PON FROM CERTIFICATECOOF EXEMPTIONPROM WORKERS' COMPENSATION INSURANCE (TIOsectim need not becompleed if the permit is furnace hundred dollars($100) or less.) 1 certify On,in the performance of Ne work en which Nis permit is issued.I shall not employ any person in any m=mrw u th become subject to tK Workers'Comperamon Laws bf C.Iiforma.Dam Applicant NOTICE TO APPLICANT:If.after making this CcniRam of Esemption,you should become subject an the,Worker's Compensation provisions of the labor Code,you most Oforthwith comply with such provisions or this permit shall be domed muted. z CONSTRUCTION LENDING AGENCY [-+4 I hereby affirm Nat there u a convection lendir,it mey for 0e pe formance of Cu 7 the work for which this permit is issued(Sec.3097,Civ.C.) (t.7 Lenders Name Lcndu's Add. ' U Q I certify that,I have read this application arta mute Nat an,above information is I2,H correct.I agree to comply with all city and ecumy ordinances and.me laws relating to 0 Wilding convection.and hereby authorve mpmsenatives of Nis city to cmcr upon the G above-mcrdionccrus. ,lyCost fond expenses xp Non purposes. (We)agree to save.Indemnify and kcep harmless the City of Cupenino agmmt F" h Iia cooducxjudLmcnhecoming of this powhich may in anyway scree against said City U,x m cooegnemo of the granting of this perosis. ^ APPLICANT1yp ER NDS AND WIL C PLY TH ALLrN-PO Issued by: Date soypcEtt fig[ k ' lv '5 Re-roofs Signer off AApppticam/Conmutor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occuphatAore Or handle haraAous material u defined by she Cupertino Municipal Code.Chapter 9.11.and Ne Health and Safely Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Ip""" 41 Will rte, Brent or comm building atm ant u, If a roof is installed without first obtainingan inspection,I agree to remove applicant L P equlpmmtotlManagc aCm emit luiarduos air contsminanm u deft ed by the Bay Arta Air Qudiry Management all new materials for inspection. Disuiu? C]YC' u I haw real Ne hessaduus maentils mquimmcrosunder,Chapter 6.95 of Oce Califon nice Health&Safety Cade,Sections 25505.25533 and 25534.1 undersand Nat inhe Wilding dos not currendy have m it u my mpomiM1ilitY m novfy Ne ucupant of Ne requiremcntsw ohm t priorroi,muameaafacenireateafoe [q�<r//' Signature of Applicant Date 0wner 0r au " Gy All roof coverings to be Class "B"or better thorir agent � D te' g CITY OF CUPERTINO �m 1 of 5 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32646011 . 00 DATE ISSUED. . . . . . . : 06/14/2006 RECEIPT 4 . . . . . . . . . : 34855 REFERENCE ID # . . . : 06060113 SITE ADDRESS . . . . . : 22165 VIA CAMINO CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : FULLER LYNN M ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : AFFORDABLE WAT HEAT CONTRACTOR . . . . . . . : LEONCE ROUX LIC # 26850 COMPANY . . . . . . . . . . : AFFORDABLE WATER HEATERS & ADDRESS . . . . . . . . . . : 24707 SAN FERNANDO RD CITY/STATE/ZIP . . . : NEWHALL, CA 91321 TELEPHONE . . . . . . . . : (661) 259-7131 �EE 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 VOICE ID DESCRIPTION ------ 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • 06/15/2006 10'44 FAX 408 777 3333 U11Y UUFLKI1NU SQjVVC/UVB Community Development j 10300 7 orra Ave= Cnpdtin>CA 95014 Telephone(4C 8)777-3228 OUPEkTINO Fax(4(8)777-3333 r 1 1�1 1 fluilding De artmer .t JOB ADDRESS: �� Yia (20Vy �0Ci'= PERMIT#0ZU00X�Q, OWNER'S NAME: i\ PHONE #i12i —p GENERAL CONTRA R: FAX# OT X35 am not Using any subcontractors: Signature / p�� Please check-applicable subcontracts 7I and complete the followinginformatic r SUBCbNTRACTOR BUSINESS NAME BUSIN ESS LICENSE # Cabinets&Millwork Cement Finishing Electrical Excavation - Fencing Flooring; Carpeting Linoleum/ Wood Glass/ Glazing - Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Pa • Plastering Plumb' - Roofing tic Tank Sheet Metal Sheet Rock Tile • J// Owner/Contractor Signae re Date 2'd ££££11.L80bT :01 0SBS T£9 0S9 d3H a3iW 3-18d0210ddd:W0aj d0b:90 9002-91-N(1f CITY OF CUPERTINO 0(�O�01 i3 WATER HEATER •CUPERTINO PERMIT APPLICATION FORM APN # '�� Gt� ly�o� Building Address: rvc� C 2Z f �� Vii CV1 Owner's Name: Pho l#_y / _ O 6 7cr Contractor: Phone: Li ense#: rDlol6 , as - 4 �� G��— ZSS� 7 r3 �j 2 7 3(- `6 Contact: Phone: Cupert�0 Buswess License#: �S5— OSzU GG L! Building Permit Info: Bldg ❑ Elect ❑ Plumb NJ Mech ❑ Job Descriptiop � I u 4✓ S6 Residential Commercial ❑ Cost of Project:4jL ��M Strapped Ll On Platform LIJ Bonded ❑ New Location ❑ Re lacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY Ener BUILDING BUSLIC Business License BUILDING •