06060115 (2) CITY OF CUPERTINO
BUILDINGINVISION PERNHTNFO =IpN
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BUILDINGADD EAS: AF ABLE WAT9R HEATERS PE1tM1TN0'06060115
10904 NORTHVIEW S
OWNER'S NAME: PERMIT ISSUE DATE
VACCARO GEORGE V 24707 SAN FERNANDO RD 06/14/2006
NE: SANITARY NO. CONTROL NO.
(661) 259-7131
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 (� O
appLICENSED CONTRACTOR'S DECLARATION 30b De On
u� 1 hereby affirm Wt I ern limmued under provisions of Chapter 9(ammencing
with Section 70M)of Division 3 of Ne Business tib Profession.Code,and my license is ��
n Inmumnaandarc L g 7�LSS REPLACE WATER HEATER 40
j Z Licamc Cl ! CoA N W
=p Dam f ComriCmr
aU171 ARCHITECTS DECLARATION
1 understand my plus shall he used As public records I1 1;15
k G] Licensed Professional 1006
OWNER-BUILDER DECLARATION y -
'�<9 I hemhy eRnn that I R-BUILDER
R from D BmRTIONContractor's License Law for the
lWy`/llVgf
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
I9 E which requires a permit to connruset,alter.improve,demolish.or mostly any strucmm 12 0 0
�.aon prior be its lbfWna.alW legalres lheapplleat,for such Permit to file angred structure
< then het,licensed pursuanttoMae provisions ofme,Conuecmr'slJausLaw(Chapmr9 Sq.Ft. Floor Area -on
E (commencing with Section 70(10)of Division 3 of the Business and Pmfemlam Code)or
that he I.exempt therefrom and the buns for Me alleged exemption.Any vlalatiun of
Section 7031-5 by any Applicant for a permit subjects the applicant to a civil penalty of Occupancy Type
Am mom tun fmw hundred dellus(5500).
❑1,As owner of W property,or my employees with wages As thek sok compewtion,
will do the work,and the,tructum is net Intended or offered fanale(Sm.70".Business Required Inspections
lifess
d Professions Code The Commetm',License Law does rem et apply an owner of q p
properly who build,or improves thereon,andwhodoes,ech work him elforthrough his
oweemplayees,prodded that such Improvement,am not!men arorcnred for rale IL
however,me building or improwmant issold within one year ofcnmpledon.the owner.
builder will haw me burden of proving that he did not build or Improve for purpose of
sale.). .
❑1,As owner of to property,Ann exeluiwly Contracting with licensed romuamn to
Construct the project(See,70".Business and Professions Code:)Tie Contractors Li.
come Law does not apply to an owner of properly who builds or improws menton,lid,
who comme,for such projects with a cor nctor(U licensed pursuant to the Comncmr,
License 4w.
❑lamessmptunder See .B&PCfm Nis wan
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hemby affirm under penally of perjury ads of the following declaratia¢
1 have And will maintain A Certificate ofComcm to self-Insum for Worker,Compcn-
udan,As provided for by Section 3700 of dm Labor Code.for Me performance of the
work for which this permit is mooed.
❑1 haw and will maintain Wahcrs Compemation Wunnm,As required by Sedan
3700 of to Lab"Coda.for die performance afthe work for which this permit is issued. '
My worker,Comport danylnsunme carrier and PAlldy7r �b
Cartier:2— 1^^II 1L.•�� Palmy Na:Til D
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TMs sxdon red ant b;completed If the permit is fm ane hundred dollars($100)
Or lea)
I ani[that in the performance of the work for which this permit is Issued,I shall not
employ anypermn in any manners,u to hamo subject to the Warkeri Compensadon
Laws of Califarolu Data
Applicant
NOTICE TO APPLICANT:IL after making this Cenifiore of Exemption,you should
become subject in the Workers Compensation provisions of me Labor Cade,you mot
.J O forthwith comply with such provisions or this permit shall be deemed revoked.
,z.,y CONSTRUCTION LENDING AGENCY
t-s l hereby Affirmthen Nem lA a constriction lending agency for me perfarmaom of
rG> the work for whim this perms t,issad(Sec.307,Civ.C.)
yW Q Lender's Name
2 Lenders Add.
U0 I curry that I haw read this application lid Stam then me show Information Is
f7. F cermet.I agree to Comply with all city and county atdinances and some law miming m
0U building Construction,and hereby mmhodm mpresemmivm of this city mo enter upon the ,
r a alcw-memiuned property for inspection pm cont.
(We)agree to saw,indemnify and keep harmless me City of Cupertino against
rap Iiabilitimjudgments.emu and expenses which may in any Coy Acme against said City
(„) m comequem,of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH A NON POINT Issued by: Date
SOURC NS. /,, / J
;atilt/ G »/ �4 Re-roofs
Signature orApplicarrUCommucior Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
VAR the applicant or future building oaupest,mre or handle hazudom mameisi
As defined by the Cupertino Municipal Code.Chapter 9.13.And the Healer and Safety
Caere,section 33532(.)? �.,f All roofs shall be inspected prior to any roofing material being installed.
❑Yea Q-4.
Will Ute applicant of fortune building occupant tic equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvaydno air canuminsnu u de d by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Yes u
I hew mad the hasardousma trials requbamemsmwkrChapmr6.95ofOm Csiifar-
nbHcalm&SafetyCade,S.d.MSM,25533snd25534.Iunder aWifinebilding
does nal cumin ly haws 4,n thou It is my msponslbility m notify the occupant of tae
tequimmcnts her bcB4fpdarmluuuaOra ccniOcamgromu Signature of Applicant Date
owner ar anthoria Aged i Dam All roof coverings to be Class "B"or better
T CITY OF CUPERTINO
am 3 of 5 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31636058 . 00
DATE ISSUED. . . . . . . : 06/14/2006
RECEIPT # . . . . . . . . . : 34855
REFERENCE ID # . . . : 06060115
SITE ADDRESS . . . . . : 10904 NORTHVIEW SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : VACCARO GEORGE V
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : AFFORDABLE WAT 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
4kEE 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
08/15/2008 10: 45 FAX 408 777 3333 CITY CUPERTINO IQlooa/eus
Community I evelopment
10300 T-xre Avenue
Cuper inc i CA 95014
• Telephone(401)777-3228
0 ' Fox(404)777-3333
CUPERTINO
1 ;uilding De artmer .t
'1 111"" --1"%0U 0
OWNER'S NAME: PHONE# Y'
GIIVERAL CONTRACTOR ZI FAX# COC
�I / s�
am not using any subcontractors:
�4
Signature Cate
Please check applicable subcontracts r_9 and complete the f0ll2win tnformati- In:
SUBCON'TRACT'OR BUSINESS NAME BUST ESS LICENSE #
Cabinets &Millwork
CementFiniShing _
Electrical
Excavation
Fencing -
Flooring: Carpeting -
• Linoleum/Wood
Glass/ Glazing
Heating
Insulation _
Landscaping
LAthing
Masa
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic'Tank
Sheet Metal
Sheet Rock
Tile
. Owner/Contractor Sign tune Date
S'd ££££LLL80bT :01 0S8S T£9 029 H3H N31UM 378UaN0JdH:W06d dTb:90 9002-9T-Nnf
CITY OF CUPERTINO =00 115
WATER HEATER
CUPEI�TINO PERMIT APPLICATION FORM
APN# M. r�J u ''nom Date:
Building Address: �ll�(J
p goof A/o, k v �
Owner's Name: Phone#:
V A CC A 2U yo — L/l/6 5E 6 a
Contractor: Phone: License#:
ForDAquw lo(,/- 2s5_ -71 ('OZ 7 3 6 y
Contact: 1 Phone: Cupertino Business License#:
.5c.o+4" Li'1""� � �e.�( rlal /ob f'1-t7� 05,,-U Z Lpso
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech ❑
Job Description:
t c� 40 Cyn1 4..- l0c44,�
Residential Commercial ❑
Cost of Project: vX0
Strapped On Platform /Bonded El
New Location ❑ Replacement
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
•