06120065 (2) �� - AIIJ I:am f IP: .. t IFr ar.-•a , 'a4ol nm.•r'.1 - - _ _ _
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CITY OI'CUPER7IN0 1 t) s#:(dk1( shX sz°ic' ri a-In z3h� q "x c'i 7` c ;ac.rel N'Ing IU alalicd
BUILDINt'DIVISIONJ PERMIT. �CO1�1T.,�t.�4.C� R7•NX`'�>RMt�' rQN r' 1 I
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eynnmcnopRFss •4,r .,..p*.,,_ .� �tpa,•'<xt1't• h'amr:•"",i AFFORDABliB l`WP:TER•' HEATERS IPERMIT NO. 06120065
I �1Or320: O ��
PERMIT LSUE DATE ,
"nn:pHARRY't LTU�,I.r_a 3 -I f U �tl.Pwl�� 24707 SAN FE 006
--'-' - -' --- --------" SANITARY NO. `- --"CONTROUNO:-----
r 'u IValh 'c M C'Ia. \ t T , . I ri rlll"IC•• 1C
htoto
ARCHITECTIENGINEER 'I
BLDG ELECT PLUMB MECH
lin;,' {� 'i.•l �•' ♦.." f.f' ��' 11. IM1'.Yd.l.':1 ,. , _ L J' lJ ..1� Q .
100 Description
LICENSED CONTRACTOR'S DECLARATION Job Dtion
%do❑ 1 hereby affirm that l am liaued under provisions of Chapter 9(commencing P
:iW with Section 70W)of Division 3 ofthe Business and Professions Code.and my lic.nu is
>>„ imm�mrcean rets �� 3G� REPLACE WATER HEATER
s t2 z bar- ss Lia N
;s,o Da Contracier 6 a ----
1R -CTS DECLARATION
i¢ 1 undersand my plans shall he used as public records - -
)wu
O y Licensed Professional
g OWNER-BUILDER DECLARATION
S 1 hereby affirm that I am exempt from the Contractors License Law for the
:M c following return,(Section 7031.5,Business and Professions Code:Any city ser county
5 m which require a Permit to commuct,ahs,improve.demobh,or repair any interum $1000
Prior it)its ivando.also requires be applicant for such Permit o file a signed suumenl
that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq.Ft. Floor Area r Valuation
r�o (commencing with Section 1000)of Division 3 of the Business and Professions Code)or -
Net he is exempt thehfrom and the huts for the aleged exemption.Any violation of
Section 1031.5 by any applicant for a permit subjects the applicant to a civil penally of -
.1 mom Nan five hundred dollars{5500). � i• O Occupancy Type
❑ propcny,or my employee with wagesaz Neirsole compensaJDn, '
will do the work,and Neandmbe is no,inhaded oiliffinondforsale(5 e.70,11,1,B iness
and..Qrofaes mos Code-The Co Incw'ta License V Cocs'not apply m amowimrof T - Regwred Inspections-
P ho bo ids orimPrmcsthercon,radvahodoessuchwark hlmulfo N gh hal P IC S' f s ; O r Lt H .fit'.R,
awnem to cis L '�- ` >✓e.; - HYit'� 1''?''p(�+al
p y pronEcO Naswih lm rovementsare naununded ara(fercd forsale.lf! '
howeve iheb Idmg or improvementea told within arse year of iompleuan Neo ne tY {- ( i I��t3t °4W I'j fel f �L; �k
I budde�,w I leave the buNc of p `ng Nat M1e d d [bit Id erre ovc for " ~ 1 - - - -�- I LIil1C I:!.
P.,. Purpose or. v , -ll..l
❑1,as tweet oLNe properly,,B exclusively confessions with licensed conuachss w.______- - ------- ----' -----'---
eoain al the project(Sec.]Oda,Business and ny who bei Codd)untrews',66id., id ! PF.!t:I:1'IS"ilf,
I whel6ati dossnouchplr ints with raf,propiny who licensed
t improve Ne¢ractor '
I whence Lacsk fetsuch projects wiNaconoacur(s)licensed puisudat in Ne Contractors' j
Lic
I ❑lame emPt wade See - "• � B&PCf thsrtazrn I s py j�l, ,r tilt i L
.Owner, _ .._\ DIC - ....-..: ' ...
1 •6:.11li 9hn-WORKERS COMPENSATION DECLARATION
Thereby aRrm under penalty of perJury enc of the follow gdedarallons I ��\I h. C. .' Il rr•�I
L _1
r•„,� Iharc and w111 maintain aCcrtifiahof Conumlo ulM1irlwmfor Workcts Compcn-1 ---'—
` - i ton;uprodcdlor,by Sectmn37Wof;be Labor Cade'far.thepeR ofthc zCI,1)i1Pn
I' we kfo tech Nu permluslssucd h.:. •s JPz''u m0.,1 yl u
r? ❑II ti c an0
Will maimain Workers Compeosauon Insurance,u req d by cited -
�- :l7w thalobar Code.per the performance of Ne work fur which this pe.it is issued: '
My Worke�rs�Com�pen�mti�an�lnwren¢<irticr and Policy umber ass/--- r'�
Polity Nob 7b I Q
... . ._ .-.CERTIFICATEOFEXEMPpONFROMWORKERSI-
'y J wen.il Pefc.:,:n,.:: COMPENSATION INSURANCE
OWI”ER-61111.fiMI,1!C..Ag Alit
da I(jhis umipn necO nos A.cwnpichdiflbe rertnitis foranNmndrcd tlnllan(EIWY
;Cpl or msa,);c; n.(I cumr M31',Buc-v;,:':1 Laicuvio..,Cp:e:Any coy,r cooary
1 Laws of Cabfonna!Dale mannersnazld lissome sub eel to the Workers
peelan
-' -' - --" -'-"-
1 eenifv th t iAc pert mare ce of Ne o+k for nth ch N s p u s lou d I shall
, I Sq.Ft. Vaha.
�i 'Appbca t r a r\ u - u.ln tt0.1
a 5^I NOTICE TO APPLICANT If aft r m king Nis Ccn R i'c of Exempl'on you ihduld -
IbaomesuhjcahothWoFYch'Crmpcnsirianpro sens'ef Ne loud Coat you 'oxo �'• f•r Q: S.1?r i)';CUr),rt!^y LO -- �---
'foaliwiN eamplywuM17ueh prrvsnns nr Nis perm t shall be deemed rtvokcd.
Z �]1 a s n
' 1
----
1hemby.IlUmNaithcclsaconst ni Ilcndmg agcncy,lw the performe 'c f T
Y.9 Nc wtyk re huh thgp rm us 9su.d(Sd;J091C C),kn scfunhroynhi ! 'kll r 1 iq• - .
l7 Lcnddr'a Namc ^t` •� `
Lcndel's A.cxddmsa .. - - "1 s.'1)'l 1 ._ _
p u(L4f"1 eemfy dut0 hiM r6lid N s appllia n and'stalc Nut Nc"abovc Infom'atian rs -- _ t ,� --- ,, , '_ - -- ._. .
yH corteet.Iagree in comply with all city and county ordinances and state laws elating war
V.h dd gconswm on and hcubYa No.usp;icprescputfee {Nits ty,h Icopo JmeI
F[3 ibo a mentioned properly for nspection puous s. S d )R ra c ' -- '•!Il' _
6' I,.(Wp)agrca to save,indemnify ad keep badmu
le 'the City ofupc
Cn iso agernstl -
laalbticsludsmentsensuandexpcus,Which any,in-byyiay accom.,dust said Cetyl"
J z
APPLICANT,UNDERSTANDS AND L COMPLY-WITH ALL NON-POINT I$$Ued-,by n ' f` y Date -
SOURC L
{ ` // :ia 7�� 'Re-roofs_
9G'gr' ppheanJCent .tor Date <
I 1'n c y u!inl AZARDOUS MATERIALS DISCLOSURE cr:larans n. Type Of ROOF
I I --W 11 the ppbcam orf[redlddingar pants, c rhandieharmdous;ninn al, - --- - -- --- --�--- -- ..... . - _ ! '
uldcrinctl 6y din Cupen no Mui eji'd Clodc''Chold 911 and the Willi and Safetyl -"
Coik�Sccuon 25532(a)+.` -t ncL nae. „ncc 2 .a.cr.e'c .' •:,I 'le:'
t .! ❑tea ., ' All roofs shall be inspected prior to any rodfing material being installed.
"in,r.v.:rknr:r^^':,.:...'.n!"•:o•ant:,,a le.'.dr-:1•,sc.t:r':I If a roof is installed without first obtaining an inspection,I agree to remove
the.af.conil mf t rc bu'IJ n,erupt t tau cyuipm s or Jc fees whiehi g
ti ban coos ser cone it a u u ed_hy the Bay Arca Air-Quality Manage to all new materials for inspection.
_I Deo t?
- _"❑Yes ..
No .•Pnl -_ ___J
h fihavercdJ'Node Seeman
eeChaPhr6.95oftheCalifnl-
laHcalthdrSoflyCodsSecuou 525533arW255J41 undlharflhebu'Iding
I dpi not corcldly have ken us my rCSpO 0 of fy the rceupens of IAc1
11 rcy to nortwsivancc f {cam of Occup �y�a�'
tk a �� � Signature of Applicant _ Date
Ownerrr land igenl' `C 1� Date_ , ,,q . t T'll.rAll roof coverings to be Class"B or betted')
. .___—
Community Development
10300 Torre Avenue
Cupertino CA 95014
lfTelephone(408) 777-3228
CITY OF Fax(408)777-3333
*UPERTINO
Building Department
JOB ADDRESS: PERMIT #
3 2b O b-0 l- k)k cc
OWNER'S NAME: PHONE #(a '-ZS -
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: 40 l z7l f Z
Si 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 3 of 7 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35719027 . 00
DATE ISSUED. . . .. . . : 12/14/2006
RECEIPT 4 . . . . . . . . . : 37051
REFERENCE ID # • • . : 06120065
SITE ADDRESS . . . . . : 10320 ORANGE AVE
SUBDIVISION . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : HARRY LIU
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
•
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
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
CITY OF CUPERTINO or
WATER HEATER
• CUPEkIN0 PERMIT APPLICATION FORM DW-D �
APN# .�r nom, I/a�nn�I Date: ''1-�
Building Address:
ju3aD OSA.. A-,JR -
Owner's Name: Phone#:
c.<< , LObl�
Contractor: Phone: (ole l License#:
hrfDr&WWo,-reeere-rs a51 -313 1 ]pa-7 31��
Contact: Phone: (Pbf Cupertino Business License#:
coir L171 e.F�e i a
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ® Mech ❑
Job Description:
RePIGCe is anon WaTer Hcanr (SQme Javar'zn
Residential Commercial ❑
Cost of Project:
1O00
• Strapped On Platform 0 Bonded El
New Location ElReplacement
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
•