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06070122 (2) CITY OF CUPERTINO :$• '*7�s' c + +� "S§ BUILDING DIVISION PERMIT ''CoL\"1'�4v� .Q�I'i•`O O'` -.v� BUILDING ADDRESS: v AFFORDABLE WATER HEATERS F"n"'NO'06070122 0294 MINER PT, OWNER'S NAME: PERMIT ISSUE DATE LOGAN RAM 24707 SAN EERNANDO RD lip NE: SANITARY N0. CONTROL NO. (661) 259-7131 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BD PLUMB t� 0 loo LICENSED CONTRACTORS DECLARATION Job Description u 1 berebr affirm th.t L w lianeed anile.providoes nrQuPmr 9(canmenemg P wlN Snetian 70flU)of Distimlaf the Budrwv aM Na(cseau Code.and mylkene is Bi InmBraeeandelf C sed f2 Z73roY REPLACE 50 GAL WATER HEATER SAME LOCATION r n z Lkenw less F Da¢ Cm DELL Go✓nh A72 W +� ARCHITECTS DECLARATION i I undcntand my plata shall be used as public records s Mtad� Licensed Professional :y Oat I am exempt from DECLARATION :0 I hereby a(Em that 11. exempt from Ne Casiamh License law for mc :p o following meson.permit i 7831.3,Business and ve.de au Code:Any city car county :3V which requirea n permit w curl the alms.impor each deermit t fi mpoig try uroewrt .41 10 0 Q Iiy prior wis Muanec.dw mquima lbs appikantfor such permiawfile aligned uammant that he is licensed possum,to the provisions ofthe Convector's Ucanw Law(Chapter 9 Sq.Ft.Floor Area /�'Gg(!alnation a (commencing with Section 7008)of Division 3 of the Business and Profosimts Code)or Nat he I,exempt thadmm assumption.and the basis for the alleged assumption.My violation of v�en a• Sermon 1031.1 by any appllam Io a permit subjects the applicant to a civil Penalty oflllQi�der /C, Occupancyr 1 not more than five hundred dollen(5500). 1,as ownerof Ne popaty, mmwtinleycexoroffc ex rs their W.Be near - andPrMil�NewonsCde,The wmuwammicans: au,clans, um(SOc.70 N,maner of s 04 j and property who code The Canuecaon.and who Law dao two apply to rt avner of Required I /nS .(jrj+ Own enywhabulproaimproveach thereon meaeuchwded aroelforNwugh his p� e howee to rr ilding or INat vemimprovement,Ismidinam earn edoaeemd for Owner. v /11.5, bailee,the Wedirgoimproamantiawt Ice did amYearN improve tion. the awe> builder will love the buNan of proving Nit he did rot MW a improve far purpose of �� aam.l. - R{R{R{t � E�ff�� ❑1,u owner of the Property,ora exclusively eanmacdng with licensed wnuacwra a (Mljp—� comic as dm pmjm(Sea.7044.owner a and PinProperty who buins,lds Cade:)Tpro Cs theme. nd roue law does Out apply a is aver or propmy ilea Mrd p or Improves um Ilmrton.and. who comments Lam fm tucA projects wide amnux7oNa)uwtned pawm w the Gntmoh Lkeamanu �9 inn ❑Ism exempt undo See .BaPClo dcta moan Owner Dam WORKER'S COMPENSATIONtar,on DECLARATION 1 hereby alarm under penalty of petJury one of the following dwlatatlona: ll I have and will maintain a Catificam of Consent to self-insum for Works is Camper. rt. cation,u provided For by Section 3700 of the Tabor Code,fa me performance of dm woh for which this permit is issued. Q I have tad will maintain Worker's Gmpcnudoa Insurance,u required by Section 3700.f the labs Code,for the perrarmmme of the wart fowhich this permit m Mod. My Wortrta Co ems.i9Qwra hvcc awia and Policy number am: Grtkr. �¢✓(•'Y`` Policy No.: b-z—�7B5R O� CERTIFICATE OF EXEMPr10N FROM WORKERS' COMPENSATION INSURANCE (This sectlan need Out becompletad if the Permit Is!sone hun lmutdollan($108 nr leu.) I certify that in the performance of the work for which this permit is Mated.I shall mat employ any perwn in try meaner an u an become subject to Ne Worans Compeuation Laws of Califomm.Dam Application NOTICE TO APPLICANT:If.after mddnp this Ce tificam of Ecamption.you should become subject to the Worker's Compensation provisions of the labor Code,you moat .J z forthwith comply with each pmrisiau or this permit Mall be domed revoked. Z M CONSTRUCTION LENDING AGENCY M(~ Iherehyrtfirm dot Nertuaed(Sec.30 len ding agemy for Ne performance of 94 the woh fa which des Permit h MOcd(Sec.309'1,Civ.CJ GQ lane.Name Z)z Lender's Mdreu U0 I certify that I have read this application and rum that the above information is IL.f~' correct.l agree to comply with It city and county ordinances and sum laws relating to 0V building construction,end hereby wNarim repreuntativer of this city to cnmr upon the U ahovc-menduncd property for iupccdon purposes. (!•^•i (We)agree to ave,indemnify and keep humkss Ne City or Cupertino spiut rr rrA liabilities.judgments,costs and expenms which may In try way amuse agdut and Clay V z in consequence of the granting of this remit. "•r APPLICANT U��1111DDDDjjy��STAAppNOS AND ILL C MPLY WITH ALU.NON-POINT Issued by: Date / SOURCE$ECUtdQI (G�s �y '7�Data Re-roofs Signuurt pp caHAZARDO Osie HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will and applicant or( ni Wilding Occupant saw orhautdau mawsid u defined by Um Cupertino Municipal Cam.Ch .4 the 9.13.tad Ne HNN and SafetyCade,section 3553:(.)7 All roofs shall be inspected prior to any roofing material being installed. [:]Ya wls41 Will the applicant o future building Occupant use equipment car devices which If a roof is installed without first obtaining an inspection,I agree to remove emir hauNo to air contaminants u nth by the Bay Arc.Air Quality Management all new materials for inspection. District? C]Yu Nu I have read Nc huaNwsmeeridsrtquiremctu underCMpmr6.95 ofthe Gli(or- nuhealthaSafety Code.Sccd=33505,35533md35534.1un&na n Neifthe Wilding does tart cumndyc3h[yd��aa.�t�ant.Nan n u my rmvo ihi' w notify the occupant of" regdremcytyth� met priarw Ma ( cmrwam of OC Signature of Applicant Date / ' 4/ 7 All roof coverings to be Class"B"or better Owner or uthariaed agent Dam Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408) 777-3333 �JPERTINO Building De artment JOB ADDRESS: PERM # v29 WN, -7 Z) ( Z � OWNER'S NAME: 7r3/ GENERAL CONTRACTOR: FAX# OV I am not using any subcontractors: 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 S1a 6 Owner/Contractor Signature Date CITY OF CUPERTINO �m 2 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31646023 . 00 DATE ISSUED. . . . . . . : 07/19/2006 RECEIPT # . . . . . . . . . : 35309 REFERENCE ID # . . . 06070122 SITE ADDRESS . . . . . : 10294 MINER PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LOGAN RAM ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : AFFORDABLE H2O HEAT CONTRACTOR . . . . . . . : LEONCE ROUX LIC # 26850 COMPANY . . . . . . . . . . : AFFORDABLE WATER HEATERS & ADDRESS . . . . . . . . . . : 24707 SAN FERNANDO RD CITY/STATE/ZIP . . . : NEWHALL, CA 91321 TELEPHONE . . . . . . . . : (661) 259-7131 4REE 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 168 . 04 MASTERCARD TOTAL RECEIPT 168 . 04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • CITY OF CUPERTINO oc�10 � 22- WATER HEATER • CUPEkTINO PERMIT APPLICATION FORM APN# 31 1p� `4 -' � Date: / 6)(6 Building J (5 Building Address: K, c Owner's Name: Phone#: L nJ b —,Sc-6 - D11 Contract r: Phone: Li ense#: Igf:r-aYOa (,1-ewwavl,t s btp/—a5 — `713) Contact: Phone: Cu ertino Business License#: Seo+k L, }}( � ��r1 61or - z _ o�zc 0,756 Building Permit Info: r Bldg ❑ Elect Plumb 14 Mech Job Description: c Iax . Residential [V Commercial ❑ Cost of Project: Strapped V On Platform Bonded New Location ❑ Replacement 21 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 •