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07080094 CITY O,'CUPERTINO 7�.,� T BUILDING DIVISION PERMIT ��1 PERMIT NO. BUILDI"1 G D ESS: tS�t 0 UNITED PL AFFORDABLE WATER HEATERS & 07080094 PERMIT ISSUE DATE OWNER'S NAME: N. QUAY 24707 ;>AN FEE ANDO ED SANIT RY N CONTROL NO. (661) 259-7131 BUILDING PERMIT INFO ARCHITECT/ENGINEER: -BLDG ELECT PLUMB MECH o a a a z LICENSED CONTRACTOR'S DECLARATION Job Description i- -I hereby affirm that I am licensed under provisions of Chapter 9(commencing withSectidn7000)ofDivision3ofdtcBusincccandProFcssionsCodc,andmyliccnscis REPLACE 50 GALLON GAS WATER HEATER — SAME in full force and cffe W /' 2 7 .�� License Clas` C� Lic• LOCATION Date Contractor t9pljlt / �? f ARCHITECTS DECLARATION GARAGE 1 undefstand my plans shall he used as public records J ucelf d•Professional a OWNER-BUILDER DECLARATION 1 hcicby affirm that 1 am exempt from the Contractor's License Law for the C following reason.(Section 7031.5,Business and Professions Code:Any city or county U. which requires a permit to construct,alter,improve,demolish,or repair any structure _ y� prior to its issuance,also requires the applicant for such permit to Glc a signed statement Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $1100 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of A Number Occupancy Type not more than five hundred dollars($5(10). 3 2 6 5 3 019 .�V 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of 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 propose of sale.). 0 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. Q 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: tJ I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 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 Work n p Com eation surance carrier and Policy number ace: k7 Carrier. V i Policy No.:-7— CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be compacted if the permit is for one 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 provision or this permit shall be deemed revoked. 0 CONSTRUCTION LENDING AGENCY a I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(See.3097,Civ.C.) a Q Lender's Name Z Lender's Address 0 1 certify that I have read this application and state that the above information is �—' correct.1 agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the W ahovc-mentioned property for inspecuon purposes. (Wc)agree to save,indcmmify and keep harmless the City of Cupertino against jj liabilities,judgments,costs and expenses which may in any way accrue against said City may' Z in consequence of the g ting f this permit. Date r V� APPLICANT UN AND WILL COMPLY WIT AL NON-POINT Issued by: _ SOURCE S. O J Re-roofs Signature of Applicant/Cor tractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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)? ��tAll roofs shall be inspected prior to any roofing material being installed. CaN,� ❑Yes Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? Yes 1a I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Section 25 25533 and 25534.1 understand that if the building does not currently have a an a ' is m •'y to nodfy the occupant or the requircmcnsw ust et onto' u a niftcatcofOccupancy. Signature.ofApplicant Date Owner or a cd agent Date All roof coverings to be Class"B" or better a CITY OF CUPERTINO WATER HEATER OF CUPEkTINO PERMIT APPLICATION FORM C, 1� APN# 2 rC1 _ v Date:, / 7 J 2� S _I Building Address: Owner's Name: Phone#: hal a � ' zc— �l�9` Contractor: Phone: (,(e( License#: Gb e ale c., e-( a�"� -313 Contact: Phoi ie: (n b 1 Cupertino Business License#: coIF LiiTlef eta 5 • 05au L�150 Building Permit Info: Bldg ❑ Elect Plumb d Mech ' Job Description: Residential 1z Commercial [1 UjQrce_AT/(- - SW'�1►e 0Cc TI V r\ Cost of Project: I (" c t` Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERN=E Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING CITY OF CUPERTINO 3 ITEMS .OF 3 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 32653019 . 00 DATE ISSUED. . . . . . . : OE/09/2007 RECEIPT #. . . . . . . . . . BE000002331 REFERENCE ID # 07080094 SITE ADDRESS . . . . . : 1C100 UNITED PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CLPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . . N QUAY ADDRESS . . . . . . . . . . : 1C100 UNITED PL CITY/STATE/ZIP . . . : CLPERTINO, CA 95014-5712 RECEIVED FROM . . . . : EEDIE D NALLEY CONTRACTOR . . . . . . . : LEONCE ROUX LIC # 26850 COMPANY . . . . . . . . . . : AFFORDABLE WATER HEATERS & ADDRESS . . . . . . . . . . : 24707 SAN FERNANDO RD CITY/STATE/ZIP . . . : NEWHALL, CA 91321 TELEPHONE . . . . . . . . : (E61) 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 AMOUNT REFERENCE NUMBER '~ --------------- --------------- -------------------- .<: 'GREDIT CARD 84 . 02 . MC --------------- TOTAL RECEIPT 84 . 02 VOICE ID DESCRIPTION VOICE. ID DESCRIPTION ------ ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING boffir Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 0W OF Fax(408)777-3333 ''UPEI�TINO Building Department JOB ADDRESS: PERMIT# Cd0 V IV 4� l 0T70 d g `7 OWNER'S NAME: U Y Iq PHONE # L/p T GENERAL CONTRALTOAll--r-6f 0041.0— FAX # I am not using any subcontractors: - - ��Z, Si gnature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSI14ESS 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