06040078 (2) CITY OF CUPERTINO '
BUILDING DIVI4fON PERMIT UICONTRACTOR INF(?RMr1.TION.
�.•rzn'iSPWe' S'rY,° '•,
pulLDl1G ADDRESS: WATER HEATERS ONLY PERMITNo.06040078
7952 FOLKESTONE DR
OWNER'S NAME: PERMITISUEDATE
GILL DOYLE 970 E. MAIN ST, SUITE 200 04 /14/2006
NE: SANITARY NO. CONTROL NO.
(800) 835-5946
ARCHITECT/FNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l� Q
LICENSED CONIRACTORSDECLARATION Job Description
f1 Mreby affirm that 1 Me Ilceued under pmvWou of Chapter 9(commencing
I h Section 7M)of DIA km 3 of dm Business aha Proleui AS Code,aha my license is
in full from and affect. WATER HEATER REPLACEMENT
?E= License Class L"c.0
e p Date COMOSSOM
ARCHITECTS DECLARATION undimmedFINALE'®
ft 7W7W1 undimmed my plans shall 4 records used u public recordsJ1146
y G� Lkeemmd Pmfcesmad
OWNER-BUILDER DECLARATION
I hereby Wine that I am ucmpt from the COmsmtoh License Law far We APR fV 2006
OO following moon.(Sadao 7101.3.Business and Professions Cade:My dry or county
$
6! which requiem;a parmit m coutrucl sber.improve,demullN,fir m*my Waetum $450
Z�s prior to its issuance.also requires the applicant for such permit o Ole a Signed stsmmem
�a
that he is licensed pursuant to We pmvislou of We Conuacmr'a Liaasc Law(Cliaplm9 Sq.Ft. Floor Area a
$ (commencing with Section 7000)of Division 3 of de Business and Professiom Code)or
the ha u.0t edm b
refsom and aso exe
far the alleged mpdm.My vialNon of
SeNon 7031.5 by any appllunt for a permit Subjects We aPPlmmt m•civil Penalty of T u IJ O&Lipe
not mom than nw,hundred dollars(5500).
❑1,as owner of the pmpm y.m my employed wish wages u their sole eompenasdon,
will do the work and the museum is no.intended a offered for sW(Sec.7044,Business Required Inspections
and Pmfeselona Cade The con summers Licen law does ret apply W an Owner of 9 P
W apeny who builds ar im pm.d daemon.and who dee m eh work himadr fir woagh his
awn employees,provided that such improwments sm not Marshall antlered far Sale If.
however,the building m improvement Amid within me year of completion,the owmr-
Witt er will haw the burdan of proving tint rte did an,build m improve far purpose of
mm.).
❑1,as an=of the property,am uncleanly contracting with liamed cunummta to
eamome,at project(Sec.7044.Beane,and Profesdau Cade:)The Cmummra Ll-
cause Law does sot apply at an Musa of property who built,or improves themon.ad.
who contracts for such projects with a mnuamorls)licensed pamam to doe Contrmnara
Lkeve Law.
Qlam exemp,u mer sec. .B&PC far this mason
Ownar ZCG Data Y ry
ORKE 1 COh ENSA7101 DECLARATION
1 hereby alum tenter penalty of Perjury am of este fallowing deciss id— -
I Its.e add will munuin aCmdfiests of Camcnt W self.inwm fa WarkeraCOcnpen-
Sudon,an provided ror by Section 3700 of the Labor Cade,fa the perfmnatma of the
work for which this pcmit is inad
❑1 Mw and will maintain Workers Compensation lastrance.d required by Section
37M often Inbar Code,for the performance of We work for which this permit is hued
My Worker,Canpeuation Insurance artier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
I
(Thu auction need not be completed If the permit IS foram hundred dollen($100)
or leu)
I unify that in We performance of the work for which this permit Is issued.1"I ret
Laws
mymmn abbe embjatm the Works 'Com ammo
Laws of California.Dam
Applicant —
NOTICE TO APPLICANT.If,after making this Cardfluam of Emit yin ahauW
he erste mbjm to the Workers Compensation provisions of We labor Code.yin moa ,
0 O forthwith comply with such provisions a this permit shall be,domed MwkN.
Z= CONSTRUCTION LENDING AGENCY
[^i 1 hereby alliin that dere is.ematrmdnn keding.gcay far We performance of
C(. the work for which'Wu permit is Annual(Sec.3097.Civ.C.)
L0 Lender's Name
n z homes Addmss
UR1 notify that I haw read this application and sum that We Shaw information Is
H cortmn.l as=m comply wish all city and comity andinar a s aW sum Awa relaung m
�U Wilding canswction,and hereby suthatim represenutiws of this city to enter upon Ile
W above-mcntiuned property for iupeNon Purpmes.
(We)agme to an.indemnify and keep harmless We,City of Cupertino 2001
raA liabilities.Judgments,nom and expend which may In my way accrue agaiutsmul City
U'j, in cmmequence fir the Seaming of this permit. /
r..a APPLICANT UNDE ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date / (-0(-
SOURCE REGULATIONS "I
EG iLATI `I (y//;-"0 6 Re-roofs �2 Signore or pdcmVCmuactor
HAZARDOUS MATERIALS DISCLOSURE Data Type of Roof
Will de appWtsnt or future building oanpmt mrt Or handle hnudom Material
as;defined by the Cupertino Municipal Cade.Chapter 9.12,and the Health and Safety -
Com-Section 23532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes PN.
Will We applicant or future building Occupant um equipment of devise which If a roof is installed without first obtaining an inspection,I agree to remove
cmlt hmardous air contaminants u dented by the Bay Ama Air Quality Management all new materials for inspection.
District?
❑Yes j$N.
I haw mad the huanlam m.,"riW requimmenummr Chapmrd95 afthe Califm-
niaHeslW&Safety Com.Sectiou25505.25533at 25534.IeWcsaandmalfue hilding
dad ret cwmntly new.mune dot it b my mspemulf liay m maty the Mccupant of As
requirements Ica Ohm Iprior mlsser.Ofacerdikse a Signature of Applicant Date
y tom'' All roof coverings to be Class"B"or better
Owner on arimd agent Dam'
Community Development
10300 Torre Avenue
_� 1 ✓ Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPERTINO
Building Department
JOB ADDRESS: 7aj�'Z /Slke,r6ll e. /Jr , PERMIT#
OWNER'S NAME: 6;11 i0o /L PHONE #
GENERAL CONTRACTOR Wale r 1�e a> err 'fin/ T e FAX #
I am not using any subcontractors: 41L ! iy 24",6
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
Wm 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36211004 . 00
DATE ISSUED. . . . . . . : 04/14/2006
RECEIPT # • • . . . . . . . : 34002
REFERENCE ID # . . . : 06040078
SITE ADDRESS . . . . . : 7952 FOLKESTONE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GILL DOYLE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4959
RECEIVED FROM . . . . : GILL DOYLE
CONTRACTOR . . . . . . . : MCGEE, PAT LIC # 18986
COMPANY . . . . . . . . . . : WATER HEATERS ONLY
ADDRESS . . . . . . . . . . : 970 E. MAIN ST, SUITE 200
CITY/STATE/ZIP . . . : GRASS VALLEY, CA 95945
TELEPHONE . . . . . . . . : (800) 835-5946
•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
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 84 . 02 DISCOVER
TOTAL RECEIPT 84 . 02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
CITY OF CUPERTINO ow 04001v
WATER HEATER
• CUPEI� TINO, PERMIT APPLICATION FORM
APN# �� /fin r I IDate:
Building Address: !/,'/ qSZ 1b/keslnne or ,
Owner's Name: % Phone#: y g) 9q 6 -7618
Contractor: . Phone: l- $rry-g 3 S.S j tL License#:
UVaari l a�err Only 2.7a, 3-7KS"7 3
Contact: Phone: Cupertino Business License#:
ill l e (Yv-,?)5'96 -79`78 l�`14to
Building Permit Info: w y der y, Q o f¢
Bldg ❑ Elect 13 Plumb ® Mech [
Job Description:
Residential a Commercial ❑
Cost of Project: e f S p
Strapped On Platform Bonded
• New Location ❑ Re lacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERN=E Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING
•