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06060117 (2) 7.NER'SNAME: PERTINO :r DIVISION PERMIT � C�NTRA.CTORnINFORMATIONSA DR S: AFFORDABLE WATER HEATERS PERMRN0.06060117 ANTA TERE PERMIT ISSUE OATSARD WINTHER 24707 SAN FERNANDO RD 06/14/2006 NE: SANITARY NO. CONTROL NO. (661) 259-7131 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG EIEC( PLUMB MECH I� � t� Q nOo LICENSED CONTRACTOR'S DECLARATION lob Description m 1 hemby affirm that 1 am licensed under provisions of Chapter 9(commencing P Zo with Secuon7M0)of Div on3ofdie Badrwasand Professions Code,andmylicc=is n<n in fun To—and � e to-?,-7 REPLACE WATER HEATER 40 GAL �? License Cl s Lm c~� Dow 1,91100C Contrxter 4fjj1ICbvlpAb%z, ARCHITECT'S DECLARATION Ste i I understand my pians shall M used As public records JyU ;aN Limned Pmfcssitnel g OWNER-BUILDER DECLARATION .�a C I hrthy aSec that 1 1. exempt from the ContratefeWonsar3 :A n c ty o for the ❑O following mazon. Patin t ]IDIS,Business and Pmfasku Code:Any city structure County $ which coquina n permit re coda,oke improve,forst demolish,or repair any strument ], _i y that the its icnance,also requires to he the applicant fo Contrch actor's to signed statement m< (Commencing cinaedpursanuo00)ofDivision3 fsheBuxmrsndpraessorsCaptar9 Sq.Ft. Floor Area Valuation i�O (Com eI.catwith Section 7000)of b.ison3rf the Business and Professionslaton of y�� Net he u exempt therefrom and the bazar for Ne alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit suhjeca the applicanuo a civil pemlty Of r U U Occupancy Type by,more dun five handled dollar($500). ❑Lo towner of 0a pmperty,ter myotimmudedwiN Bled uNe(See 7044.Business will dothcwork.and the structure s Me.License La ertA outsell.a.1Apply he An Owner of Required Inspections and property wh ole Code The Contrxmrs Liaise Law docs not apply lf r through uwrcr is q P Own easy who Wilds provid mpmwsdemonand who Am n sxh w tied oroclfor orWe his awn a however. t e building Nat vele improvements are not intended mafiered for sale.r- RNALE however.Ne building a improvement u sold within one year of completion,the owncr- builder will have the burden of proving that he did nos build or improve for puryme of .IC.I. Z2 �OU6 ❑I,as owner of the pmpeny,am exclusively conuaning with liaised mnu m w convect the pro clot(Sec.7014.Business and Profession Cade:)Tk Conoacars Li- ceasLaw dtnotApply to An ownerofpomPary who Whits r,Improves Chm., who contracts for such projects vine,onm(s)licpurmans us ran y's BULDW El Lkcne Law. Iamexempturr Selo ,B&PCfmthismuon Owner Data WORKER'S COMPENSATION DECLARATION I hereby allirm under pcalty,of perjury urc of the following declarations: 1 hsw and will maintain a cer ifialcof Camcnt to self-imam fm WortehCmnpcn- sm.n,u provided for by Section 37M of dta Labor Code,for the performance of the work for which Cis permit is issued. ❑1 haw and will maintain Workers Compenutitn Inmance.u required by Section 3700 of dm Labor Cook,for the pufofmana of the whet for which this permit u issued My Wo,kcrs Compensation Tzfm Cartier nPolicy number Are.—, re: $"' Cartir. Z'E Polity NnZb b-, �70 1 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Minsecoom need not be completed if the permit is Were hundred doflm(SIM) or less) I ecrtify,that in the performance of the work for which Cis permit is issued I shall not employ any person in any manner an As m become subject to the Worked Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after meting Cu Certificate of Eacmptian.you asomw become subject to the Workers Compensation provisions of the Labor Codc,you most .J z forthwith comply with such prtvisiom of this permit hall be deemed mwked. z O CONSTRUCTION LENDING AGENCY f+4 1hrebya(Tam that drcre iso Conusx4on lcndin for Cc rfunnnccof gag rcy p 6ai > zwork for which Cu permit u issued(Sec.3099,Civ,C.) Le Lenders Namc z Tendert Aaarexx C)Q 1 ret ify that I haw fad this application and stain that the above information is Fcome'.1 agree to comply with all city and county ordinamm and state laws relating to O V building Construction,and hereby authorim representatives of this city to enter upon Ce al Cog,utnrd IS Costopuny for inxpc ma purpmcs. H 6Wi (WC)agree to saw,indemnify And keep harmless lac City of Cupertino againt fq liabiliun,Judgmcna cosy an pcnct which may in any wayaccme,gainLand City Uz in crnsequnmeo g Cit permit. APPLIC S NO WILL(AMPLY WITH ALL NO//N-POINT Issued by: Date SOU RE A Re-roofs HAZARDO Signmurt of ApplicaDow HAZARDOUS MATERIAupa O15CLOSURE Type of Roof Will the applicant or forum building e.Chapter 9.1 m handle Health and M defined by the Cupertino Municipal Code.Chapter 9J2,and the Health end Safety Cmk.Scerion 2M32(a)7 pyr All roofs shall be inspected prior to any roofing material being installed. o Yu If a roof is installed without first obtaining an inspection,I Will Cc applicant or forum building Occupant tax equipment or dcvica which g agree to remove P mttncm Nasus air conaminana u/dc6ncd by the Bay Arca Air Quality Management all new materials for inspection. 01. 'Nu 0 1 have real the haraNswsmaterials requirements umlcr Chaptar 6.95 of the Califon nu Halth&SafetyCode.Sections Ti 15,25533 am125534.1 undersand the tithe Wilding does nm curantIY haw a L Cat it 4 my responsibility M ratify the occupant of the reyeinemen. en metpdar ssnmatfaCerti0aCOfOceuponcy. Signature of Applicant Date � �� ow err o�,e ,gent D,te All roof coverings to be Class"B"or better CITY OF CUPERTINO �m 5 of 5 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35617026 . 00 DATE ISSUED. . . . . . . : 06/14/2006 RECEIPT 4 . . . . . . . . . : 34855 REFERENCE ID # . . . : 06060117 SITE ADDRESS . . . . . : 11130 SANTA TERESA DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LEONARD WINTHER 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 WEE 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 420 . 10 MASTERCARD TOTAL RECEIPT 420 . 10 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • 06%15/20u6 10 45 FAX 406 ((( JB4:i uli7 uurtnilnu wjvv4/VVO Community Developmanc 10300 7 mm Avemic Cupettto)CA 95014 Telephow(4(8)777-3228 0 V4 Fax(4(8)777-3333 CUPEI�TINO I Wilding D e artmer .t JOB ADDRESS: 4 I I� t�� „ � # Q OWNER'S NAME: Lem1T PHONE # ;L GENERAL CONTRACTOR N, FAX# • �am not using any Subcontractors:- ` z Signature /�L-ate- Please atePlease check applicable subcontracb es and complete the-followin infannati au SUBCONTRACTOR BUSINESS NAME BUSU [ESS LICENSE # Cabinets do Millwork Cement Finishing Electrical Excavation Fencing Flooring:Carpeting Linoleum/ Wood • Glass/ Glazing - Heating Insulation Landscaping Lathing Masonry O<namental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal y Sheet Rock Tile / • Owner/ContractorSigru titre Date t"d ££££1.2_L80t>T :Ol 0S8S T£9 0S9 C3H J31UM 308COJOddt1:WOJ3 CTB:90 9002-9T-Nnf 06/12/2006 07:13 66122599556 AFFORDABLE WATER HET PAGE 02/02 0"0111 CITY OF CUPERTINO • 1oF WATER HEATER CUPEkTINO PERMIT APPLICATION FORM t� Building Address: 1 i l 30 �a�r.T0. I�-reSti p�• Owner's Name: Phone#: L.e-o yte- ;X57-7 - O8'i 1 Contractor. Phone: Ue t License#: c,ba UARJS asr (0003b Contact: Phone: (cb{ Cupertino Business License#: cov Liv eField 5 oiau a+��So Building Permit Info: Bift ❑ Elect ❑ Plumb Mech ❑ Job Description: RePIqC� L(0 aeon WATer i.{egTer (S4M- 10e-a h Residential F6 Commercial ❑ Cost of Project � 0190 • strapped W on Platform Bonded New Location C1Re !.cement Qty. if ApDlicable Fee ID Fee Description Fee Group BPWHF.A'1 ER Water Heater/Vent BUULDING PPERIvIIIk Plumbing Permit issuance PLUMBING BENERGY Ener BUILDING BUSLIC Business License BUILDING