08060177 (2) CITY OF CUPERTINO .s+ x'ti�wmv,as xut4s �'� ` }
BUILDING DIVISION PERNIITCONTRACTC1T.t.INP'Oit1V1ATIO.N
', .
PERMIT NO.
BUR.91bt'9T �:IIERYL DR AFFORDABLE WATER HEATERS & 08060177
OWNER'S NAME: FEE MIT 155UE DATE
JOHN LUO 24707 RAILROAD AVE 06/24/2008
IrNE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINFO
REPLC 40 GAL GAS W/HEATER, BLDG ELECT Plume MECH
3 o i; LICENSED CONTRACTOR'S DECLARATION O O O O
Job Description
1 hereby affioo that 1 sm uxned ander provisions of chapter 9(mmme ting
ai with Section 7000)of Division 3 of the Business and Protmiians CJq[pa,andmylkoricia
o, in den forte ane cr ! 27' 6r/
�_ license CI s� IJc.
CS1ECr
ARCHITECTS DEC ATION
'W' 1 undersand my pies uWl he used as public records
goy Licensed Imessionil
g 5 OWNER-BUILDER DECLARATION
4 i XI lemby aRrm h
that 1 am cmpt from the Contractors License Law for the
O 0 following mason.(Secure 8131.5,Buuess and Rofcssiom Code:Any city or county
$ which operasa permit to cmwnes,alter.improve,demolish,nr repo,any CO.
_i< pricr to its issuance.].requites tic applicant for such permit so rile a signed sem cracm
that he is licensed purmant to da provisions of use Coareemrr License Law(Chapter 9 Sq.Ft. Floor Area Valuation
1- (commencing with Serum 7000)of Division 3 or the Business and PrefesiOns Code)or
that W is exempt themfmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by my applicant for a permit subjects the applicant 10 a civil penalty of APN Number Oceu ane T e
not more than five hundred dollars ISM P Y yP
0 Lu owner notion property or my employes with wages as theirmic compensation,
anddo the work and the he Core rd mtNLnded oraw dos Out apply IOa4,B neer of
and Ro W bis carie:The Contracmh Imam law doh not appy lf an owner Required Inspections
new cro wW buiprovidmpratsadaimprove wW dmasechw tied oro lfarNmszk his
awn cmploym,provided tprr such improvements in nos intended mplmon.for sale U.
baleen.Ne Wilding or improvement is halt within one year or completion,Ne owe of
builder will haw the burden of proving that he did Out build or improve(or purpose of -
saleJ.
0 1,u Owner of the property,am exclusively contracting with licensed crmusesora to
contract the project(Sec.7044.Rosman,and Professions code:)The Caatraexra W.
came Law des ma apply m an owner of property when Wilds or improws daemon.and
who contracts for such projects with a contactor(s)licensed pursuant to One Contractors
Licertz law.
0 lamexemptunmer See ,B&PCfmthismawn
onwer Dam
WORKERS COMPENSATION DECLARATION
1 hereby aRrm under penalty of perjury ane of the fallowing declarations:
1 haw and will maintain a Certificate ofConeent to sdf-inyre for Workces Compen-
swan.as provided for by Seem.3700 of the Labor Code,fm the perfmmance of the
wort far which Nis permit is issued.
0 I haw said will maintain Wagers Compensation lamsna,as twinned by Section
3700 of One Labor Conn,for the performance of the wort for which this permit is issued '
My Worke'r7s Compen/s�at�im 4tsutance hrtier and Poli m art ^
Canis. 2c:-,-Pt Paliry No.: O �^
CERTIFICATE OF EXEMPTION mom WORKERS'
COMPENSATION INSURANCE
rlbts scabs need Out W completed Uthe permit is ram a hundred dnuan(SIaO)
or bass)
1 cenify that in In perfarmame of the work for which this permit It issued 1 shut mt
mnploy any'person in any manner x so x become subject so the Workers'Communed.
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.afar making this Cenincaa of Exemption,you.Mould
become subject to Ne Worker's Compensation previsions of On,labor Codc,you most
O forthwith comply with inch provisions or Npermit
Nu shall W dcmW rewind.
Z`" CONSTRUCTION LENDING AGENCY
(-+ I hereby aRam that them is conswctinn lending agency fm the performarcc of
E
.moi
the wort der which this permit I,issued(sec.3197,Civ,C.)
Landers Name
7 z Lender,Address
U 0 1 mtify Nn 1 have mad his application and stem lam Ne mew informNnn is -
tL P cearaT.1 agme b comply with all city and county Ordinances and sun laws relating to
0 V Wilding construction,and hereby mNoria representatives of this city to enter up"the
Fshove-mem oncd pmxny for inspection purposes y (We)agree to an,indemnify keep ley the City of Cupertino agent
r(ZI liabilides.pigments.costs and ex w ' many xray ammagunt end City
in consequence of the granOn is
^ APPLICANT UN S tLL COMP WI L'Npggfffiii-POINT Issued by: Date —' Z
SOURCE I
l///'L Re-roofs
Signuurto ppliandContracror
Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding eccupmt store or handle haurmus material
an,defined by the Copertbo Municipal Code.Chapter 9.13.and the Health and Safety
Came,Section 25532(a)t All roofs shall be inspected nor to an roofing material being
❑Yrs P P Y g g installed.
Will the applicant or hurt building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
! ha�nns air cantyninnu as by one Bay Area Air Quality ManagContra all new materials for inspection.
DYh Nu
I have mad the harardues mascriats oupA.mcnuunder Chapter&95 ofthe Caiirar. -
niaHcaith&Safely Code,Section 25505.25533 dZ5534.I understand thatlf Ne Wilding
does not currently have•maul ponsibility to mury don occupant of me
requirements whielt m t pis an Cabo of Occupancy.
Signature of Applicant Date
Ow %{
ner ar.uthori si'grni Date roof coverings to be Class' ."or better
CITY OF CUPERTINO
• 4 ITEMS OF 20 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 35915041 . 00
DATE ISSUED. . . . . . . : 06/24/2008
RECEIPT # . . . . . . . . . : BS000005201
REFERENCE ID # . . . : 08060177 '
SITE ADDRESS . . . . . : 20683 CHERYL DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JOHN LUO
ADDRESS . . . . . . . . . . : 20683 CHERYL DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2909
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
--------- --------- ---------- ---------- ---------- -----=---- ----------
1BSEISMICR VALUATION 1, 600 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1PPERMITFE 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 OJ lU 6 v r 77. .
WATER HEATER
OF
CUPEflTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
abeg3 Ctieryl
Owner's Name: Phone #:
J o4.r Luo yo&- 85-q- �a7b
Contractor: Phone #: 661- 16-1 - 7131
Affordable WckW NeAferS
Fax #: Wof - asy - 9SS6
Cupertino Business License #: Contractor State License #:
�691S0 6 -73i 9'
Contact: Phone #: (, ( - jS9- o 5d-o
Scot-t Lifi- leFielcl
Fax #: fabl -�S�'- 9SS6
• Building Permit Info:
Bldg ❑ Elect ❑ Plumb Nf Mech ❑
Residential Nf Commercial ❑
Job Description:
R-0-vo Ic cF- Lfo gC-(IdPNqq., UJ//*
Strapped �] On Platform ❑ Bonded New Location ❑ Replacement
Valuation:
i l�uu
Green Building Check must be completed and attached to this application.
• Green Building Points achieved: ��
Community Development
Cupertino CA 95014
Telepbone(408)777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
ByRding Department
JOB ADDRESS: PERMIT #
906S3 C ,er 1 0dO6'0 (1-?
OWNER'S NAME: 0 h v\ L u O I PHONE # /DS-- be,-Pa-1(a
GENERAL CONTRACTOR: /�,,tf9 r- k/ ,(d FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 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