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07090165 7-77777777777777 CITY OF CUPERTINO BUILDING DIVISION PERMIT >jCRTR�`�CTC�lR INITTON. PERMIT NO. "'I"l L IN�AM"ItTAUFFER LN BETTER WATER HEATERS 07090165 L PERMIT ISSUE DATE OWNER'S NAME: WILLIAM LO 351 FALCATO DR 09/24/2007 SANITARY NO. CONTROL NO. .)NE: BUILDING PERMIT INFO ARCHITEC IENGINEER: REPLACE 75 GAL W/H IN HOUSE, BLDG ELECT PLUMB MECH 10&z LICENSED CONTRACTOR'S DECLARATION Job Description W C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z u� with Section 7000)of Division 3 of the Business and Professions Code,and my licetrc is t a a in full force and effe L C—3(e j n z License ClassLic•S iF m Dam Contractor LU ARCHrCECCS DECLA A 1 N i a< 1 understand my plans shall be used as public records tUJ U.y Licensed Professional aOWNER-BUILDER DECLARATION iWIn > 1 hereby affirm that 1 am exempt from the Contractor's License Law for the jm O following reason.(Section 7031.5,Business and Professions Code:Any city or county <m ff which requires a permit to construct,alter,improve,demolish,or repair any structure z r prior to its issuance,also requires the applicant for such permit to file a signed statement .Ft.Floor Area Valuation _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q 2 $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any viola"of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Num beT Occupancy Type not more than five hundred dollars($500). ❑I,as owner of the property,or my employees with wages as thea sole compensation. will do the work,and the structure is not intended or offered for sale(Sec.7044,Bus:ttcss Required Inspections and Professions Code:The Contractor's License Law does 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 sate.ff, 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 Contractors Li- cense Law does not apply to an owner of property who builds or improves therein and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑lam exempt under See. B&P C for this team 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 WorkeesComperi- 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: O Cartier. /;/U:cL-"/ct Policy No.: AVe*V/OO � I CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(S 100) or less.) I certify that in the performance of the work for which this permit is issued.I shall riot employ any person in any manner sin 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. z"" CONSTRUCTION LENDING AGENCY Fr.�-. I hereby affirm that there is a construction lending agency for the performance of ,7.> the work for which this permit is issued(Sec.3097,Civ.C.) W Q L.endcr s Name Lender's Address U 0 I certify that I have read this application and state that the above information is ► corect.I agree to comply with all city and county ordinances and state laws relating to Jbuilding construction,and hereby authorise representatives of this city to enter upon the (3a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against f p" " liabilities,judgments,costs and exPC1ses which may to any way accrue against said City U Z in consequence of the granting of permit. Date ( �» 1— APPLICANT UNDERSTA D ALU—COMPLY WITH ALL NON-POINT Issued by: S REGULATION /J Re-roofs t nature of Applicant/Contractor Date T Of F.00f HAZARDOUS MATERIALS DISCLOSURE Type 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(x)? All roofs shall be inspected prior to any roofing material being installed. C3 Yes No , 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? �� ❑Yes lY"' I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth&Safety Code,Sections 25505 25533 and 25534.1 understand that if the building does not currently have a tenant tt my responsibility to notify the occupant of die requ' nts which must be m9frior to issri 4 Certificate of(acytp�lt --Signature of Applicant Date All roof coverings to be Class"B"or better Owner or authorized agent Dat 070 -� CITY OF ("UPERTINO '-!M TING PERMIT APPLICATION FORM APN � I ( w 0 O�—� �( Date: � 1p�(' t : Buildinu, Address: ' Owner's Name: Phone Con tr ctor: License : WmTn— Contact: Cupertino Business License Building-, Permit Inlo: Bldg, ❑ Elect --------- Plumb Mech �-- Job Description: Residential 9 Commercial ❑ Cost of Project:g Strapped On Platform fT Bonded New Location EL Replacement Qty. if, Applicale Fee ID Fee Description Fee Group BPWHEATER `Vater Heater ' Vent BUILDING / PPERMITFEE I'lumbinL, Permit Issuance PLUMBING BEN ERGY "nergy BUILDING BUSLIC 3usiness License BUILDING CITY OF CUPERTINO 3 ITEMS OF 6 PERMIP RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 36509050.00 DATE ISSUED. . . . . . . : 09/24/2007 RECEIPT #. . . . . . . . . : BSD00002745 REFERENCE ID # . . . : 07D90165 SITE ADDRESS . . . . . : 11229 STAUFFER LN SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . WI.'=AM LO ADDRESS . . . . . . . . . . : 11.229 STAUFFER LN CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014 RECEIVED FROM . . . . : FRWS CARTWRIGHT CONTRACTOR . . . . . . . : FRkNS CARTWRIGHT LIC # 26514 COMPANY . . . . . . . . . . : BETTER WATER HEATERS ADDRESS . . . . . . . . . . : 351 FALCATO DR CITY/STATE/ZIP . . . : MI:JIPITAS, CA 95035 TELEPHONE . . . . . . . . : (408)250-6672 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 40.79 0. 00 40.79 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 86 .44 0. 00 86.44 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 172 . 88 VISA --------------- TOTAL RECEIPT 172 . 88 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING e ,,F Community Development 10300 Torre Avenue { Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: tZ,47 A/r N-v PHONE # a --(e"(; 7-2- GENERAL GENERAL CONTRACTOR: FAX # �- I am not using any subcontractors: �-- S:gnature 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 t�1� 1- �"- Amlv-s 5 7 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date