08080170 (2) CITY OF CUPERTINO "�']a!+^� �(�}�� + " 9`3/'x`
BUILDING DIVISION PERMIT ,�CoL� ACTIOW1t,�� T �/„N��.'
BUILDING ADDRESS: PERMIT NO.
' 7142 DRAKE CT AFFORDABLE WATER HEATERS & 08080170
NER'S NAME: PERMIT ISSUE DAIS
CAR[., TUBS 24707 RATLROAD AVE 08/22/2008
PNONE: SANITARY NO. CONTROL NO.
(661) 259-7131
ARCHTIECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT FLUME MECH
tall. LICENSED CONTRACTOR'S DECLARATION Job Description
an 1 hereby street that 1 am licensed under provisions of Chapter 9 reammmeing
who Section 7(W)of Division 3 of the Business and professions;C`M,and my liccw is REPLACE 50 GAL. WATER HEATER
„ in full forte and err J T
pqz LkewClasa "`C 3(w Lx.« UT
o F o Dvu C /n f. C.mncur A
tJa .CHTrECTS DECLARATION
-a I understand my plans shall W used as public records
s`
o to I;dewd Prokssiansl
OWNER-BUILDER DECLARATON
1 Wrehy vRrm the I em exempt from the Contractor's License Law far mft
y
L p O following mean.(Saul to
e4 skrss and w,dem li Code:Any dry as county
5$
which itsho•permit recmtheppiicimprosudemolish,care a sig any structure
priormiu iensedpto requires m lWvisions of for such permit Ek,sigaWsuumem
E€$< thuhaucn wJpmwan7ow)orDivision 3 the Comment's an ccwlaw(CMplor9 Sq.Ft.Floor Area Valuation
(commencing with Section 700a)nf Divisi.n3mftW Business and professions Code)or $1300
— ded he is csempt therefrom and the bust for the alleged wmpdom Any violation of
Section 1031.5 by any•poli=,for a permit objects the applicant to a civil pcnahy of Number Occupancy
not mom than eve hundred dollars(s )k 316 3 2 015 . Pane Y Type
I,uewser of tae propeny,ormy wployua with wgn uth'v sok comprwdan,
will do thework.and the structure is notinxnded oraReted ferule(Sec.] ,Boomers
and Prof...Cada:The Com.xmrs I..law don not apply in sm owner of Required Inspections
property,who builds or impraw thereon.and who does such work himself or through his
awn employees,provided that such improvcmens m not imeMW oroffemd forsak.IL
however.the Wilding or improvement is old within one you of completion,the owner-
Wilder will have the burden of proving that he did not build or improve for purpose of
sak.).
❑1.as awnm of the property,uo euluuvcly...enacting with Bawd condxtors m
consunn the project(Sec.7W4,Businw and professions Cade:)The Conaactmes V.
caw law don not apply m an owner of property who Wilds or improves themes,and,
who eantrous for such projects with a eonmrxlm(s)licensed pursuant to the Centrume's
Lkcw law.
40 lameaemptunderSee ,B&PCfarthi3rm on
yr Dau
WORKERS COMPENSATION DECLARATION
1 hereby affirm under isalty o(p dur,one of the following de,larulons:
1 have and wHl munhoin a Cntifiau of Cowm w self-insure fm Wmkds Compri
asuon,u provided for by Section 3700 of de Mbar Code.for the performance of de
work for which this permit is issued.
❑1 have and will returns.Worker”Campasadon I..as refound by Sodium
37W of the labor Code,for ft perform,mx ofthe work for which this permit is issued.
My Work Who and Policy�numJb 7
Carrier. /G. heti Policy
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W compleud if the permit is fora.,hundred dollars($100)
or k ao)
I certify that in the performance of the work for which this permit is bound.l shall not
employ any p,com in any etaorcr se as in become object to the Warken'Compemsulon
Laws of California Dau
Applicant
NOTICE TO APPLICANT.If.after making this Certificate of Exmption.you should
become objem in the Worker"Comp,wu.n provisions of the UW,Cade.you rev
.J O faMwith comply with such provisions or this pcquiuMll bo ro
deemed oked.
z C CONSTRUCTION LENDING AGENCY
i I herby affirm Nat them isoconsuvcunn lending.,.or far due performance of
Cli > be work for which etas permit is tasted(Sec.3091,Civ.C.)
0 Undoes Name
z Lender's Address
U Q 1 cenify that 1 have read this application and show that the above btromm stun u
,,, ^ coneet.I agree to comply with all city and county oNinann cand sum laws relating u
C) `SJ' Wilding construction.and hereby othmin represecand s of this city in cour upon the
"4above-mentioned property for Bup etion purposes.
(We)ague to eves indemnify and hcep harmless n the City of Cu ams,s gainst
y liemurequenc. fth,c mmmg eapensawhich may in uYw',Y+.cmc against cid City
C)z A APPLICANT
of Ne granting of this D WA p �'
�••n APPLICANT UNDERSTAND D W COMPLY WITH ALLJON-POINT Issued by: Date- .-22
SOUR RE
/��/�'/
/ N Re-roofs
Smgnuute of AppliwHAZARDO Dun
HAZARDOUS t to I MATERIALS DISCLosuREe Type of Roof
WIII the applicant or forum Wildl g aecupot sax or handle hawdons maxrist
Rood by tie Cupertino Muni" Code.CWp cr 9.13,and dk Health and Safety
e.Suction.25532(,)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya No
If a roof is installed without first obtainingan inspection,I agree to remove
Will ms applicant in future Dui "2 attupant vo'quip
imcnt or deviate which P ire
,D;trict? ns alr donumimanho Rnsd by the Hay Axa Air Quality Management all new materials for inspection.
❑Yrs ON.
I have,reW the baezod.materials mrsimments under Chapter 6.95.ftheCalifor-
nie Tical"Safety Cook,Secuan 25505,25533 and 25534.1 enticement that if the Wilding
dna not cumnndy have a uanx mu it is my rea,mon ibility m mofy the o¢upam of an
xyuimmc hkmm� fume wiueanxar,cemireama c Signature of Applicant Date
2z
Owner�thonacd agent Dow All roof coverings to be Class'W'or better
-,, CITY OF CUPERTINO .
;CCS WATER HEATER
CUP `
CITY PERMIT APPLICATION FORM
VU `O/ 70
APN # Date:
313 2 CSIs: 00 $ ZZ D
Building Address:
1clI 42 0ray,-P- CO tbv� -
Owner's Name: Phone #:
►/
Ta ,
Contractor: Phone #: b't- 1S9 - 7130
iWordahle Dela+2rl
Fax (,/al -�Srj - 9556
Cupertino Business License #: Contractor State License #:
a b81SD 6A73V
Contact: Phone #: (,G 1 - .Aq. o 5a-D
• $cofifi Li� tle-Fieldl
Fax #: l�bl -3Sq- 956
Building Permit Info:
Bld ❑ Elect Plumb Mech
Residential Ef Commercial ❑
Job Description:
ftaa-&- 5[J
[�,
Strapped On Platform ❑ Bonded New Location ❑ Replacement
Valuation: t�Q�
Green Building Check must be completed and attached to this application. _
• Green Building Points achieved:
CITY OF,CUPERTINO
WATER HEATER
n OF
CUPEciI�TIN0 PERMIT APPLICATION FORM
Quantity Fee ID ]Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
Heater/Vent
BSEISMICOM Seismic Commercial B
IPRWHEATR Residential Water B PRWHEATR
Heater/Vent
I BSEISMICRE Seismic Residential B
PPERMITFEE Plumbing Permit P
TRAVDOC Travel & B
Documentation
BUSLIC Business License B
Community Development
10300 Torre Avenue
1S&aly, Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*CUPERTINO
Building Department
JOB ADDRESS: PERMIT # G O
V2- 1b-z U-� C„� �o�
OWNER'S NAME: (C,y 7y6 S PHONE # — `7g
GENERAL CONTRACTOR: &Cwp4p FAX #
I am not using any subcontractors: 2
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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
2 Z�vS
Owner/Contractor Signature Date
• CITY OF CUPERTINO
4 ITEMS OF 24 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31632015 . 00
DATE ISSUED. . . . . . . : 08/22/2008
RECEIPT # . . . . . . . . . : BS000005866
REFERENCE ID # . . . : 08080170
SITE ADDRESS . . . . . : 19742 DRAKE CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CARL TUBS
ADDRESS . . . . . . . . . . : 19742 DRAKE CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2432
RECEIVED FROM . . . . : EDDIE 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
---------- -- ------ ---------- ---------- -- -- ----------
113SEISMICR VALUATION 1, 300 . 00 0 . 50 0 . 00 0 . 50 0 . 00
I.PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
.1 PRWHEATR UNITS 1 . 00 24 .48 0 . 00 24 . 48 0 . 00
IT RAVDOC 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
•