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05120077 CITY OF CUPERTINO "*+ ,m arr ^�• `"5 `� '" '' a'7 BUILDING DIVISION PERMIT ,GONTRAGIT,0WINFORMATION BUILDING ADDRESS: AFFORDABLE WATER HEATERS PERMIT"0.05120077 568 WATERFORD DR OWNER'S NAME: PERMIT ISSUE DATE GORDON JOHN A AND DOROTHY T 24707 SAN FE 12/14/2005 )NE: - SANITARY NO, CONTROL NO. (661) 259-7131 ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH l� 0 XO' LICENSED I amCONTRACTOR DECLARATION Job Description u❑ Iion7 afftrm Nall 3limned under provisionsofChapter9(commencing P ZW with Smtion]IXq)af Division 3nfthe Business and Professions Code,and mylicense is in full roma and. REPLACE 40 GALLON WATER HEATER (SAME LOCATION) 5icense �Z LClass Lk.N n F w Dale Contracar - „s ARCHITECTS DE LLA re 1 ds � -a I undersand my plans shall he used az public rcenNs the JyV s o Licensed Pnsfessionel IVA S a Oat I am exempt from m the Con ION ZOO I naso .(Sure(Section n I am eaempt from the Conlnaoh e:Any c law for KpO whichfolloire ma0oa.anntt7031.5,Business slidove,dprofessions h.or Any city or county It v m which rtyuiru a permit rel conslmn,alter,improve,demolish,or repair any stmctum /y/r 18400 prior to its issuance.also mallei Ne applicant for such permit to file a signed statement ESG that he is licensed pursuant to the provisions of the Contractor's U..Law(Chapter 9 Sq.Ft.Floor Area /a zoos Valuation z l-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or �(r� o Q thm he is eaempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty ofJAW P C GcU ane T not oan five hundred dollars(5500). flt1B P Y YPe mm N ❑1.as owner of the property,or my employees with wages as their sole compensation. will do the work,and the awares is mot intended aanend for sale(See.7066,Business and Professions Cad.:The Coronaries License law don Out apply to an owner of Required Inspections property who builds or improves theme ,and whodossuch work himselfor dontgh his own employees,provided thnsuch improvements are not intended aroReseO for vie.If. hmwew,,the building or improvement is sold within as year of oompledon,the owner builder will have the burden of Proving that he did not build or improve for purpose of sad'.). ❑1,as Owner of the pmpeny,am eaclusively contracting with licensed convectors to construct the project(Sec.7W.Business and Professions Code:)The Contracmr's Li- mose Taw does not apply an an owner of yrofco,who builds or improv themon.and who contracts for such projects with a condacmr(s)liamsed pursuant in the Contractors Lim.law. 1 am eaempt under Sec. .B&P C for Nis myon Owner Dale WORKER'S COMPENSATION DECLARATION 1 hereby affirm under family of perjury am of the following decluadons: 1 have and will maintain a Certificate of Continuo self-insum for Workers Compo. 737W on,v provided for by Section 3700 of the labor Code.for Ne performance of the rk for which this permit is issued. I have and will maialain Workers Compensation Insurance,as required by Section of thea abor Cade.for the performance of the work for which this permit is issued. My mcrrk )' Q -'es«lsa carrier cyN 7%'�� 2G ,5 i CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Olds.,in.need nor W completed Ride Permit is foronc hundred dollars(SIM) or less) 1 certify that in the performance of thc work for which this Permit is issued,I shall not employ any pawn in any mannersn as a become subject to the Workers Compensation Laws of California Data Applicant NOTICE TO APPLICANT:If.after making this Cenificam of Exemption,you should honoree subject in the Workers Compensation provisions of the labor Code,you muss .J d forthwith comply with such provisions or this Permit be demandrtvaked. z y CONSTRUCTION LENDING AGENCY C4 5: 1 toomy affirm don then is a..on.lcnding ag.ney for the Performance of C4 the work fur which this Permit is issued(See.3097,Co.C.) 0.Q Lenders Namc Z lender's Address V 0 1 certify that l have read this application and salt that the above information is 13. F COUCCL l agree to comply with all city and county ordinances and sure laws relating to O V building const!action,and hereby authome repicuntaiv of this city to enter upon the ' �N.1 almvetmcntiumedats. mus urty f niaspection.purpoWhich ms. H 6r (We)agree to save,indemnify and keep harmless the City of Cufcnino against Z incommius. dgmenhe goading ofPensesmit. may in any way accrue against aid City Uz in convguencc of she granting of this permit. ^' APPLICANT UNQERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SO G CATIONS. ' 2(/ i 116 Signature ol'Appranucanu0etorData Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building omupanr mom or handle hvallous meatal a defiaed by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safely C ode, D en zss33(.n All roofs shall be inspected prior to an roofing material beim ❑Yns L9'Faa P P � Y S g installed. Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hmardnas air mnuminar(sac lmrd by the Bay Ara Air Quality Management all new materials for inspection. (// (]Yes btu I have mad the harardoes materials requirements under Chapter 6.95 ofthe Califor- m.Health&Safclygode.Se dnd355os.15533mdM3a.lund mrsm i(thc Nilding dma nal C nix ave 0 1,NB(1113 my(eipnn{Ihlllly nmd(y dl.aKYPam of the gory .naw met ries ssa mmorace mates am wry. Signature of Applicant Date 7 ren xIv %ZI�Y�o3' Owner atauthorind agent D,te All roof coverings to be Class 'B"or better Community Development 10300 Torre Avenue R s © S J / Cupertino CA 95014 —7 �— b Telephone(408)777-3228 CITY OF (� � Fax(408)777-3333 Sc 2 UPEPTINO �, 1- 0 C> 7'L-1 Building Department JOB ADDRESS: PERMIT 0001/ lei) 17(Lf12 � o � 7 OWNER'S NAME: u.;,,, ,,i k- PHONE # GENERAL CONTRACTOR: p r n l{, FAX # (o I am not using any subcontractors: )ZI aT Signature Date Please check applicable subcontractors and complete the following information: 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 Til Owner/Contractor Signature Date 11/23/2005 09:45 66122599556 AFFORDABLE WATER HET PAGE 01/01 CITY OF CUPERTINO �5i a oo-j 4- WATER HEATER CUPEI�TINO PERMIT APPLICATION FORM APN# Date: 310 - Building Address: rISUg WaTer�6� Os Owner's Name: Phone#: oV,r Cao(-dote ok- g9lo- I e Contractor: Phone: (cO l License#: ab e Loore_L 4m7trs 4TI .713 ) l02-"7 3� Contact: Phone: lob( Cupertino Business Licensc#: Cov Li IT 1 ek l i d5 b a d V o'l 1v R,5-0 Building Permit Info: Bldg ❑ Elect CJ Plumb f� Mech L' Job Description: gePIGCe � o.�lon WA�eT 6�@aTQr ($Ame 18CgT��n Residential Ef Commercial D Cost of Project: q00 Strapped El on Platform LJ Bonded ❑ . New Location ❑ Replace ment Qty. if Applicable Fee ID Fee Description Fee Group BP v HF-AT.ER Water Heater I Vent BUILDING PPERN91TEE Plumbing Permit Issuance PLUMBING / BENERGXEner BUUIDING BUSLIC Business License BUILDING