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06050009 (2) CITY OF CUPERTINO daCONTRAC OoRINFORMATp - BUILDING mvlslory PERMIT - BUIIDINGADORESS: LE WATER HEATERS PEaMrrNo.0605O0O9 10218 COLD HARBOR AV W NER'S NAME: PERMIT ISSUE UE DA BAKENHUS AUGUST F AND VELIA M247O7 SAN FERNANDO RD 05/01/2006 ONE: SANITARY NO. CONTROL NO. (661) 259-7131 ARCHITECTPNGINEFFR: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 goo LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm mat 1 am licensed under provision;of Chapter 9(Commencing .j with Section 7")of Division 3 dw Business ami Pfafearion Code,and my license is + REPLACE 40 GALLON WATER HEATER (SAME LOCATION) � krellfaweandCri jy�2 License CW T- r po Dam S ' •Db CSDECL t w ARCHITECTS Ds psbIk T N I 77U 1 undcreund my phm ehdl as mud u public rods .It; Licensed Perfectionist OWNER-BUILDER DECLARATION 't iI bemby affirm that I am Exempt[man the Convenors License LAW for dm �rrtyy��,__,,irk�fjf\\FI D O fallowing sawn.(Section 703 1.5,Business and PrEessiow Code:My City or=only 1r—O G 'vs,. .tiGy., $M Which requires a permit re cennuuct,Wet.someone,demulhh,of repair any strommou NN CC CC If 7,s l Ya..SSST��i $800 prior khis iuuewe.dwmquiresthcapplicantfarwchpermitmnmasigwdmtemcnt Ft Valuation ee < Nat he h licensed pursuant to me provisions of Ne Convaclue,lJewc Law(Chapter 9 Sq• (f e� (commencing with Section 7MO)of Division J of dal Business and P=fessians Claim)w r •e'� 2036 e thin he h marpt ftentam and the bash fur did alleged caption.Any violadon of a QCCU Section 7071.5 by say applicant for a permit subjects site applicant m a civil penalty of Occupancy EYP raw mom than fl.hundred dollen(5500). araC e ❑I,as Owner ofdk propeny.w my employees wide wages as deo wk Compensation. will do dee work and Else atructum is not khmkEt or offered fanak(See.7044•Business IJ r°r. spun,'"m - and Profession Cade Tse Canuanors Liana law doe not apply m an owner of -�RequlredlInspecuons property who bulli+or hmpeoms meman,and wha dace such work hires el f w through his awmemplaytet,provided Nn Inch improvements art not Inended woRered ferule If. however.the building or improvement useld within ON you ofcompmtiw.the aw er- builder will haw dee Writes of proving that he did nm build w Improve for Purpose of calej. ❑1,as owner of the property am exclusively communist wide licensed contractors in cwutntct the pmkct(Sec.7044.Business and PosieWwu Cade:)The C=awbr's Li. team law does net pply to an owner of pmpeny,who Wilda ar interests;thereon.and, who carnets for such projects with a Contricur(s)licensed pursuant m me Convacmra Lkewa law. ❑Ism ExemPtunder See .BkPCfurdehmaaasO - nv —DECLARATION WORKER'S COMPENSATION I hereby+Rine motor penalty of perjury Was of ern following ded"Its": ❑IhamaenmllmdnulneCaNOmmof Conunteulf-InsumfwWnrkeraComPen- sadon,as provided Per by Section 7700 of de Law Code,for de pattern ce of tie walk for which this permit is Issued. ❑1 More and will maintain Workers Compensation Insurance,as required by Section 3701 Labor Cade,for the perfarmance of the work formich this permit is..west r,me,. s-�C-(om�pemNlon InIn.rnUwe arrive and NI:numbeWORKERS' , limier. f f` 1 A O sen Paliry Na.: CERTIFICATECOMPENSATION SATIONI NFROM ORKER COMPENSATION INSURANCE v mais section wed notbecampkted ifthe Permit is forams hundred dollen(Sip) w lea) I certify mot in the pwfoneawe of dal work for which this permit Is blued.I+hell not employ=y person in any menwrso as an become subject in the Workers'Compensation Laws of Ceilamh.Dam Appliant NOTICE TO APPLICAND If.after making this Certificate of Esemptkm,you should wEome subject m dm Worker's Compenadon provisions of me Label Code.You mum Q O roMwith comply with such provisbas or this permit dealt W decreed nwkad. z C2CONSTRUCTION LENDING AGENCY (•" I hereby anion dal then is a comswcdnn lending agency for to pufwm of tri > me work fer which thts permit Is Issued(Sec.7097.Ch.Q 6Wi Q Lenders Name z lemies Adders U Q I coolly that h Mw mad this application and sum mat the show information Is {a.H Cones I agree to comply with all City and county ordinenees and sues laws mlNng to 0 Wilding comauetion,and herebyautWriae representatives ofmiscity to enter upon the tl7 shout-mcmimod Property for RUPenian Puryows LL (We)agree to save,indemnify and keep haneless me City of Cupertino adakeL cn Itabilities,judgmemu,cam aualum of the .nd expenses which may In my nay a=ma against aid City G U APPLin ICANT UNDEf 1h R Nos rant NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIO 1-tib Re-roofs Signuureof Appliean amncmr Own Atarfu USMATERIALSDISCLOSURE Type Of Roof Wilby the lantno uni Municipal gaceupwteorew auntie bauNoematedd as dcOwd by tial CupeNCo MunMpl ode.Chapter 9.13.and de Nuhn end Safety sue.Section 2557x47 All roofs shall be inspected prior to any roofing material being installed. ❑Yes a Will me applicant or future building occupant use cetupmut or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit huaNnur air comuminamu as d nod by the Bay Ama Air Quality Management all new materials for inspection. Disv n7 DYes o I have mad me W.M.amied.lsmquiremenu underclupter05 of me Califor• nu Halm 6 SdctyCom,Safi 303.33377 and 27574.Iwdemand maifine Wilding Lines wt currently haw a mean t It h my msponsihility to notify de occupant of the requirements which met be nerlivior 4 issuema of.ceNnam of omuparwy, gnature of Applicant Date 1-0 b All roof coverings to be Class"B"or better Owner or mmarisd a n 'Dam" CITY OF CUPERTINO 1 of 6 PERMIT RECEIPT OPERATOR: Buem COPY # 3 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 36909038.00 DATE •ISSUED. . . . . . . 05/01/2006 RECEIPT #. . . . . . . . . : 34203 REFERENCE ID # . . . : 06050009 SITE ADDRESS . . . . . : 10218 COLD HARBOR AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BAKENHUS AUGUST F AND VELIA M ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3327 RECEIVED FROM . . . . : AFFORDABLE WATER HTR 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 • Community Development F 10300 Torre Avenue 1 ' ,✓' Cupertino CA 95014 Telephone(408) 777-3228 Cl Of Fax(408) 777-3333 OUPEkTINO Building Department JOB?� �SS: PERMIT # OSOG>� OWNER'S NAME: PHONE # dcS9- GENERAL CONTRACTO • FAX # I am not using any subcontractors: r 1 -61e 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/ ontractor Signature Date CITY OF CUPERTINO Wo5occq WATER HEATER • CUPERTINO PERMIT APPLICATION FORM APN# Date: Building Address: 0'ZY L' o1(� HUCbor ()vk - Owner's Name: Phone#: +A uST 0kVCr kUs L10k45-1 " 114 Ay Contractor: Phone: tC(¢1 License#: AWnt-&W- oze mTP rs sksl -113 1 loa-7 31� Contact: Phone: (obi Cupertino Business License#: colF Li lT I P-ROA e gSo Building Permit Info: Bldg ❑ Elect ® — Plumb Mech ( � Job Description: RePICAU `r.a colon WATer HmTer (ScAme JoCaT-nh Residential Commercial ❑ Cost of Project: WDu Strapped On Platform Bonded ET New Location ❑ Re Iacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING •