06120066 (2) CITY OP
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BUILDING ADDRESS: AFFORDABLE WATERrHE ERSl-,&`ERMITNG,0 6,120066
_�rCAROL __DR---
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OWNERS PERMIT ISSUE DATE
XV , _C� I. - " I I .�.�11'i�?
I . .1 __ �li".r��: I I I - yO,'
JAMES BARNEY 24707 SAN FERNANDO Rb ---.3.2/14/2006
NE: SANITARY NO, CONTROL NO.
(661) 259-7131
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
lop LICENSED CONTRACTOR'S DECLARATION
:.r I thereby affirm that I am limmurd under provisions of Chapter 9(commencing Job Description
UZ With Section 7M))ofDovision 3 ofthe Business and Proftositun,a Code,and my license is
I i f flf and If _:�� -
C! Lie I 1f.-Y:z
Lima. Cl 23 " . REPLACE WATER HEATER
:0 (pV _C.Mouroul raAe,40
IT A -- ---- AAA Y1W
I understand my plans shall be used as public records
tau
u.t; Licensed Professional
0 OWNER-BUILDER DECLARATION
I hereby affirm fast I ton exempts don Contrarian's Lear.Low for the
0 C following moon.Section 7031.5,Business and Profestions Codc:Any city or county
which requires a Permit to erosional.alter.improve,demolish,or repair any Structure
$1100
priortu iUlssUane,&ISOmqoi=tkapp[iCantrorSuCh permit to file a signed sustemcm
that he is licensed pursuant to the provisions of the Contractor's Lictence Law(Chapter 9 Sq.Ft.•Floor Area Valuation
i (commencing with Scetion 7")of Division Sof the Business and Porfassions Code)or
4�E
that the is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects do,applicant to x 6,,fl p..by of Occupancy Type
mare th
has mare fiW hundred dollars($500).
bl.alowner cufthe property,.'
will do the workand the moneunc is..I Intended or offered for sale(Sec.70d4.Business
suld Praftestoorts Code:The Comewcuor,Licnianx act apply to an owner of Required Insp9ctions- --
prol,,erty ho builds'ariiinpro'vesNarcan'and who 6cessuchwo,kW sella dromailt his fI however -
Ji build luildc-r will ha��-ffi-e-bu-Me-n.-o-('p-mvin-g-ffia—I lie did n _ooro 7bnp;ovcfor Tu`rF,=--or,
0 1.isemmer.1 the mint,a.eacl.sivcdy muto,ling with licensed commenom to'
coromme,theRecycel(Sec.704,1,Business and professions Code:)The,Contractor's U-1 I e',17 7-.t'r C t.'*
room Law don not apply lose ewher otproparty who buildsonihopmoms llonon,and,
who contracts for such projects with a contractions)licensed pursuant to due Contractor's
Lonamee Law.-
0 1 in, a.,,on&,Sce. B&P C for this hom.,[ CONI pro,l"r,
owW'Iow. ,D.ux- L --------—-- --
IIIU;It 14WORKERS COMPENSATION DECLARATION
IT,!,V 1. I,7,
M.L6 I I
1 hereby affirm under Penalty of Perjury,one of the following cle,clasafione: I.... .
I hsoc and will maintain a cerninconarConsent W mlf�hnura for Worker's Conifer-
sadon:as,provided faulty Section 37M of,do,Lxtya�Code;for the performanen of the' s;
have end dll rinsinud,Workers Compensation Insurance,n required by Section'
37(10ofdac LaborCodkJortheNtformanecoftha a-ric-feir.-bilitthis peranuisiented.1
MyWorker'sCrumpenumdonlrandrand cariirrlard Policy humtheram- t
com :Iui 10
7 --.�Jclfl IFICATE OF11)(EMMON FROM WORKERS�-- ------
COMPENSATION 114SURANCE
V, !8P 31 uLX.i:R Drc,
and lmothermoplautdifthe Permit isfiroutchandral dollars
I(Flusseadmist ($10001
Illess.) 70.1 1. x,!I- i.-I,C •1,.A lil, c....1. 1
can, that in do, ,r......I don work far which this "ohoul' lsuc' I shall a."i
g.,I yraCY N'*r'son in an'Y'Moftrn' ,2 uT....t
er so as it) come so y,cl to�I�mk I cns#cr' I ,-t, 1-:...Ir
son
ti alifianda.Date to kj I(;j I
Kpitlicint' I
NCTICE.TO_APPLICANT'ff�ifterIernkint this Ceridic-irn'bbhfplor�'�uho'llh6kf, _J_
i�bjaci m so
z f."�nd,conn't"widt"Imitpi inorni or this permit shall the deemed ri,vr,kad.
Z2 -, I,I..) � .1"'.w.lcl.--1 1-1�r"lens. i
CON5T"ROCT1 ON LE3`ID ING AGENCY I S,c 7&,P.,.;rr-, I
I'ia6y`dru��Naf thit re is a_.&tontiona land I ni.,.reyjir,_0.P soce
Ch,C to;
�d> Vwoik fur:�,Inebibs ircrdh,is issued(sec.3
Laroices 997.
Ntc�oY
Laridie ado 1 7 1
,pll;,l,comfy
C on.ry read this application and'saiu,LaIidie hdIiinf&iiii&r
a.mccl.I agree 10 Comply With all city and county ordinances and stali laws miating Mi
J.
ho o-men oned property fooinaNcon.pdrlsxdsxxx�ti.m I;Ca-1c.) ,.c
11� Awc)are,W.,oc,indhorronlymd,keeplournlemilm City orcupcnino agamsEl
tzl resound axpcotmi winch in.,in anyway accrom Mains,mid Cityl
Z incoqunceofNegrintingo(Nisrxmit. -it ------
0� APPLICANT.UNDERSTA D_WILL COMPLYZITH ALL NON-POI Issued by:
SOURCE IO f S bate
10�-sgnawr ph Contmnor -- f G, roofs
L
Re-roofs
Lane
I au�:,HAZARDOUS MATERIALS DISCLOSU RE+11,r�u ,. ;I Type of Roof
�Will the Piditcoft.1 Lure building c.p.nL xWor.or handle hoocadmis nomfiall L_:-j
a deflated lh�'ft CoiWril"M" ' - d— "" � Holdi add Safety
s an unpal Cc c:Chapter 9 11.at
Code.SoEtion 25532(.)' ".a'.:--IN-:'uct.�
W;E],ai v'I "f, �.....I... y:: All roofs shall be inspected priorto any roofin
material being installed.
r r't 1 C P.
eillaii Im If a roof is installed without first obtaining an inspection,I agree to remove
I it] U'm it Ago'g,cupsont.tanacquipmem Z`o�l
rvha
r mcd by the Bay Area Ali Qxod,�yll.si6a
all new materials for inspection.
Disidet,
-ICINd fill' 5
he creel
haoaid
Ith&see' Ccehap Sectors 25515.25533 and 25534
at.Hen y tom'a...-ro, ad L" I I I not Its.Lard
goo menconeiral h .1 EI ' - ta�alifdlhc
Y. an. 1.hou c recupart 0
I require ssucolfictac of a
,j;nts linto
'177 1 Sig
nature of Applicant Date
or
a'.
-All roof coverings to be Class "B"or bctteriic,-.
ow as Onothorrinadagera
I,on-, I L
4
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
•CUPEI�TINO
Brun ildin De artment
JOB ADDRESb PERMIT #
115 �G�O� �u � C(oI am, ^r
OWNER'S NAME: PHONE # -ZS l= .
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
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
Tile
•
Owner/Contractor Signature Date
CITY OF CUPERTINO
em 4 of .7 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31623080 . 00
DATE ISSUED. . . . . . . : 12/14/2006
RECEIPT # • • . . . . . . . : 37051
REFERENCE ID # 06120066
SITE ADDRESS . . . . . : 10115 CAROL LEE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER JAMES BARNEY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : AFFORDABLE WATER HT
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 VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
CITY OF CUPERTINO I12, Qh(a
WATER HEATER
CITY OF
CUPEkTINO PERMIT APPLICATION FORM
APN# � ^ Date: I � Ol1 (/
„
Building Address: l
10115 C(Aro PQ— V7f
Owner's Name: Phone#:
SGc.aS f3GCne o&- 9 )3 -
Contractor: Phone: tela( License#:
hffirdcxb1p- Worer carers a" -713 ) (va-73L8
Contact: Phone: bbd Cupertino Business License#:
cOT Li�rleF�eta s a7av � �eS�
Building Permit Info:
Bldg ❑ Elect ❑ Q 01Plumb Mech ❑
Job Description: /S J
RePIGCe so a�lon Wgrer Nearer (5q me � oCar�an - Coarcl
Residential Commercial ❑
Cost of Project:
Ilou �
Strapped On Platform ❑ Bonded ❑
New Location ❑ Replacement
Qty. if
A licable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMTTFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING
•