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06120064 (2) G11')IrOr,CUPERTINO�,�; !.':.le 'CONTIVACT �_::Iss TY or VISION .-.;-:.a ORMATION 11.B UILDING DIV] :4PERMIT ERMIT NO. AFFORDABLE WATER HEATERS 120064 _06 2f692 FAIRWOODq� OWNER'S NAME: PERMIT ISSUE DAM MELODY OU 24707 SAN FERN ANDO RD 12/14/2006 E: SANITARY NO. CONTROL NO, (661).259-7131 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH liX, I C= 0, LICENSED CONTRACTOR'S DECLARATION :ws Job Description I Iretelay affirm list I am licensed under provision of Chapter 9(commencing with Section 7M))of Division Sof the Business and Professions Cod,and my license is infull force and effect 2 REPLACE ,WATER HEATER te coup, /I -ARCHITECTS DECLAR TON I understand my plans shall he used ras public records :.0 u.t; Licensed Ponficerefined i 0 OWNER-BUILDER DECLARATION i a I hereby affirm that I am exempt from the Contractor's License Law for tire :00 following moon,(section 703 1.5,business and Professions Code:Any city or county which requires a Permit to construct,shall,improve,dcroolish,or repair any accurcure $850 2 Ill Prior in its issuance.also requires line applicant for such permit to File a signed V'ii t� that he is liccread purnican,to pill Provildmul Of the Connector's License Law(clualne,9 Sq.Ft. Floor Area Valuation Z�Q (commencing with Section 7")of Division 3 or the Business and Professions Code)or Nat the is exempt ft.f..and On,basis for the alleged exemption.Any violation, Section 7031.5 by any applicant for a permit subjccn the applicant to.civil Kinithy of r. Occupancy Type not moreffican fin hundred dollars(S50y. tlo arks snot nkndedo on inns and Proposal..Clardin:-The Conrumselth's Luaciss,Lw.docr.1 apply balmonomenid- Required-Inspections.- �Ig_T7 -, i inckanywh6 builds dr uniiisinvis thirleop,and who does such work himseff or though his! )::'A . ,q r7 Own coupdoyceal provided calkstrich improvements are no,intruded OF ciffiied for sale TE1, I however,the building or uppronment is sold withinince yeti ufcomphnion,the owner-I U 1 buibjWwill hiivc�llhta burden oll chailm did-ORI bliidWirbIrl fur P7_rPC;F6r-------- 04.as owncroddleproperly.am exclusively contracting with licensed conscious to i ....... ---------- -------- clumarld,One project(Sec.704,1.Business and Professions Cade:)The Conrail Li. ecom Law delear nota pply to an owner of property who builds or improves dremor.and who contracts for such projects with a contranctor(s)ficennad pursuant in dre Contractors _7 0 flin exempt under Sec NO. B&PC for this reason Owner. Date P0flI`EC1JFNQWORKER'S COMPENSATION DECLARATION- I hereby affirm under penalty of Perjury one of the folio wing declinations. ,_I)o i Eli-f 11-1j,du M Fc.i: T.� ------- au�di sidicup,as provided for by Section 37M Of th,Labor Clxuc�for. Ne performane,of,dindll work forwhich this perapi is 5,2 b1i;1ve AJ'�lill'outiollon Worker!Compensation Insurance,all miimul by Section issued, M Wmkr1sC.up,m.�nI dP Ii b, My rare Cruntic"Ir 5 - _CERTIFICATE OF EXEMPI70N FROM WORKERS'-- h[� cusm'Pn:L.u'acnld COMPENSATION INSURANCE UWNFIlR;:L(:.A;iAl]ON I crus well..need not in,comph eled if the Planes forcom hundred dollars(SIM) j,A > r A,1.1v clmrt, a"no tu­l"ro, "a"le��r dil,work I �` " I iiiiii,6 hlf ,which Ill,,pe,noft[a lssxuxd� K, in an - g6iter sour beconiii�Ulijcci 14 the W6,klh,C.m66]psaihxm- 10 Po c� 14 "a i. ali "r I., Sq:Fi. Flo-i-A c NOTICE TO APPLICANT If a0cr makingN C nE of of Fac pt on you shrill - "'____----I—-- tiiciniIe ilubjl&Ili thnFWOft'&'3'Coo� ' ojjti b pru�iii&1'62`lhe Lal oi Code�56uuhiis, n_,L I,- ------- Ohuhhwilb comply,veldbiu,,N'roosioul thiss period,shall la,accrued revoked. -,,Il­CONMUC1 RON LENDING AGENCY,g,70, r--- —-- rill herohY aRrm that Nem sato iwcu Icndmg agency fn the forma c.ej. T I r, t 4p frr, o Irti oil S -- dac'.w9c),17 co%,?,hich this perolsit is wduacd.(Scc.3097.Civ.C.),u k I L&.dcr's,NuurF,. _ Si 4 z Lender's.Add. C) II l !'lc,of ccmfy W.11 ban nExcl un...ficiabroand sure Nit the jdu,Ie jpfuoi,jficp is 7 c6oicel.I-,me to comply with all lily and county milrespec,and 111,law,il to U buil4ing construction.and hereby loolhouirc representatives of this city to color coup plot Rap Z i.c.psxrporbc,,.fdm,.drilroffluispil;= _ch may any wa Iccm,against said City ------ .... APPLICA D AND 3yILL COM ITH ALL-NON POIN ssued by: Date I 'RE'�L� Re-roofs i pnerm......cm, Date 1 I 11coct, atom HAZARDOUS MATERIALS DISCLOSURE ii,u Type of Roof UZ, Will ductippliclullorf or..buildipt'cF-Psutsuo­-�hnpdlc,ni vPrdlm­nam as defined by the Uillutfu6'Mimicioal C de.Chapter 9A 2� oil the Safety lrent�11.1 I Tt,-!, �, O�l CorkWidtli 25532(ir c ,,�n..........d7 elm, im All roofs shall be inspected prior to any roofing material being installed. If a roof is without first obtaining an inspection,I agree to remove j,,xuvdch installed anagenicia all new materials for inspection. 0, ......JI fN 'Id I lonce us, 1,'Sar the Calif.r.! A building' Jots up, I, the C men w Y. n`harardou Signature of Applicant Date Ownercir ', ate an 71, " All,roof coverings-[obeClass-"B"or better I. Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 S�UPEf�TINO Building De artment JOB ADDRESS:2cq z' �( S PERMIT OLo i z( — tD OWNER'S NAME: PHONE #Wo f _ ,3 GENERAL CONTRACTOR FAX # I am not using any subcontractors: 4— lZ����C 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 2 of 7 PERMIT RECEIPT OPERATOR: amyw COPY # 3 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35913110 . 00 DATE ISSUED. . . . . . . : 12/14/2006 RECEIPT 4 . . . . . . . . . : 37051 REFERENCE ID # . . . : 06120064 SITE ADDRESS . . . . . : 20927 FAIRWOODS CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MELODY OU 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 EE 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 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • CITY OF CUPERTINO WATER HEATER • CUPERTINO PERMIT APPLICATION FORM APN# � n � I� — I I D Date: vl lU Building Address: c? ,) cm r w oods Olt- Owner's Name: Phone#: mbtAL0u ok 59 - 3oc� Contractor: Phone: (rte 1 License#: Xfordo6le worer anti -113 1 (007 3!°8 Contact: Phone: (Pbl labCupertino Business License#: CoV LlIrleF;eld s a5av a (0crSo _ Building Permit Info: Bldg ❑ Elect ❑ Plumb (� Mech ❑ Job Description: c.Ce_ SD anon WATer N2AT2r (Same � oCaran _ Gari ,� Residential Commercial ❑ Cost of Project: WS 1 t. • Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Re lacement ❑ -.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