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07010115�cc0 m =ZW a<c, �z a ACL LLL[_ 00 EEC 0z Z O CITE' OF CUPERTINO BUiLDir;G DIVISION PERMIT IN QR TT€TN: . BUILDING ADDRESS: PERMIT NO. OWNER'S NAME: U A HAIG SHALVARJIAN 124707 EAN FERNANDO RD 01/19/2007 ,ONE: SANITARY NO. CONTROL NO. (661)259-7131 ARCHITECT/ENGINEER: BUILDING PERMIT 1NFo BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing P with Section 7000) of Division 3 of the Business and Professions Code, and my license is REPLACE WATER HEATER in full force and effect.4�2>� a.71' JJ License Class Lic.ii Date I�Contractor ARCHITECTS DECLARATI 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed to the of the Contractor's License Law (Chapter 9 Sq. Ft. Floor AreaValuation pursuant provisions 1000 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $1000 that he is exempt therefrom and the basis for the alleged exemption. Any violation of 32613 0 5 6 Number OCCU Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars (s500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of Q property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Carrier. Th t ��+1(1 h PolicyNo.: B o�L CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation _ Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATI S. Com" C) - 0Re-roofs Signature of Appli t/ omractor Date HAZARDOUS MATERIALS DISCLOSURE Type of R )of Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? C3 Yes u � All roofs : hall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which croft hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? y ❑Yes YIWu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & SafctyCodc, Sections 25505, 25533 and 25534.1 understand that if the building does not currentlyt a tenant, that it is my responsibility to notify the occupant of the requirements whicst be me to issuance of a certificate of Occupancy. Signature , 3f A icant Date Tri P.i All roof coverings to be Class "B" or better Owner or authatllzcd agent Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: -3 3b CUrT� (31 cc, PERMIT # OWNER'S NAME: PHONE # 4o&-- S - 3Flb GENERAL CONTRACTOR' FAX # I am not using any subcontractors: " —Z tC7- Signature Date Pl,o9CP r1 - g -r1- an»lirnhh. ,11hrnntrartnrg and comvIete the following information: Owner/ Contractor Signature Date SUBCONTRACTOR BUSIl'sf ESS 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 3 ITEMS OF 3 CITY OF CUPERTINO PERMIP RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 32613056.00 DATE ISSUED.......: 01/19/2007 RECEIPT #.........: BS000000263 REFERENCE ID # ...: 07010115 SITE ADDRESS .....: 22335 CARTA BLANCA ST SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OPERATOR: amyw COPY # : 1 OWNER ............: HAIG SHALVARJIAN ADDRESS .......... CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1008 RECEIVED FROM ....: RECEIPT INTERFACE CONTRACTOR .......: LEONCE ROUX LIC # 26850 COMPANY ..........: AFFORDABLE WATER HEATERS & ADDRESS ..........: 24707 SAN FERNANDO RD CITY/STATE/ZIP ...: NERHALL, 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 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 84.02 --------------- 84.02 VOICE ID DESCRIPTION -------- ---------------------------- 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING REFERENCE NUMBER -------------------- MC VOICE ID DESCRIPTION -------- ---------------------------- 506 GAS TEST CITY OF CUPERTINO CITY OF CUPERTINO WATER, HEATER PERMIT APPLICATION FORM Building Address: I)-� V3 ) CG'•r fico Owner's Name: 1P c, Contractor: A��►,�rlGbl0- u?yi Contact: �Lp-rl Li JT 1 e -f E Building Permit Info: Rids ❑ Job Description: VGA U, r-\ Phone: �� t �ecr2rs aS`` -1'3 Phone: Elect ❑ Residential Commercial El Cost of Project: Strapped ❑ On Platform ❑ Bonded New Location ❑ Replacement Er Qty. if Plumb LTJ Fee t iu111yilab i .+ Energy Business License 00010 tl�j