08100192 CITY OF CUPERTINO �+Y��g,gT�+ �..>? a!rr ♦ fit:
BUILDING DIVISION Pyvy�MI r���Vi\�1��tTRt�� onTiOy
BUILDING ADDRESS: PERMIT NO.
10048 DOVE OAK CT AFFORDABLE
OWNER'S NAME: PERMO ISSUE DATE
p CONTROL NO.
661) 259-7131
ARCHTIECOENGINEER: BUILDING PERMIT MF-0
-^ BLDG ELER PLUMB MECH
uao - LICENSED CONTRACTORS DECLARATION Job Description
g u 1 hereby allium Nal l am fiicnued under previsions of Chapter 9(commercial
with Secilfatioon70 of Division J of Me Buunw and Pofesians Code.and my Ike== REPLC 50 GAL WATR I-IEATR
25= uewmnes Lc.g �0.17'�bSC
Dens Cur, aQ w Q
g ARCNyECrSomrseDECLARATION
W V 1 underatzml my plass still W mud as public mwrds
s
G w License)Professional
3 OWNER-BUILDER DECLARATION
i hemby affirm Net 1 am exempt free the Contractors License Law for Use
Zoo KO fallowing mason.(Section 7031.5.Business Bad professions Code:Any city or county
e u. which tarpons Permit N consumer,alb.Improve,demmlLW.M Rpan my sUYCart
prior to is issuance.also requires Ne applicant for such permit N file a signed suumut
p < that hcislicensed pursuant tothcpmn
visioafNeContractor'aLianmlaw(Chip=9 Sq.Ft.Floor Area Valuation
y�g (Commercial,with Soden 7")of DlvtsiOnJof the Business and Prefruiaus Code)w
_ drat he s exempt temreLom and the basis fm Ne alleged enempti m,Any vialauw Of $1600
Section 9031.5 by Boy applicant for a permit subjects the applicant to a civil penalty of APN Number O
ret mom Nan five hundred dollars(M). Occupancy Y�'Pe
❑ 34232088 . 00
will do Me work.and Me stmcture is act manned mnrtamd fawn,(San.7044,Business
n
and Profeons Cade:The ContaoNra License Law dams not apply to an awns of Required Inspections
property who builds car imposes Nucor,and who dam such oat himrelf ee through his
own employ.,provided that Bush improvements art nm imeddeed aMered fatale It.
however.Me building or improvement is mid within one year of completion,Ne owner-
builda Mn have the burden of preving Nat the did Mm build or improve for yaryose of
old
I.a awrcr of the property,am exclusively contracting with licensed commissions N
mntoct Me majeu(Sec.911/4.Business and Profession Code:)The Contractors U.
cense Law don not apply to an owner of property who builds or imposes daemon.and
who contracts for such prejeeu with a contractor(s)licensed pursuant m the Comaetora
License Law.
0 I am ammpL under See .B&P C for this mase.
0. Dau
WORKER'S COMPENSATION DECLARATION
I hereby aRum under puWty Of Battery arc or the following daluatwue
k1 have Bed will maintain a Cmiftnu of Consent m self-insure for Workers Compere
Mr,u ad
fa by Section 3900 of the Labe Code.fa rhe perform.of rh
for which Nis Permit is issued.
❑I have and will maintain Workers Compensation Insurance,as meshed by Snow
3900 MNe Libor Cade.fa the pcRorm.afthe work for which this permits hued. '
My Wo BCompemkalItiw,bout.nuiu wd Poliry num4rare:
C...... Iyi'h Policy No.: Z— d
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thsseetion reed not becOmplemul If the pewit is forme hundred dollars($100)
or kss)
1 cuufv Net in the performance of Me work for which this Permit is Issued,l shall era
employ anypeton in any manrcr an u Be become subject to Ne Workers'Compensation
Laws of Califamia.Due
A,11cm,
NOTICE TO APPLICANT:If,aMr making this Cenifimste of Exemption,you should
become subject so the Worker's Compensation provisions of cite Labor Cade,yen most
Ofunbwith comply with such povidans as pmail l Be Mariana revekcd.
yCONSTRUCTION LENDING AGENCY
`
[•n 1W.byflrum than there iso connection kndingagercy for doe perform.al
Ci> the work fa which this permit Is Owned(Sec 3077,Civ.C.)
QLenders Name
Z) Z L<ndeesAdd=
U Q 1 atdfy that 1 haw read Nis application and sus that the above information is
IT.F correct.I agree N comply with all city aM canary ordinances and mute serer miming to
C U building construction.and hereby auNatim¢prnenuuvms of this city Be cnur upon the
W aM.e-mentiorcd property,for iospedon purposes
LL (We)agree to.ave,indemnify and l np harmless the City of Cupertino against
pt
liabilities.judgments.encs and expenses which may in any very eccNC against said City
U z A APPLICANT
U Ne granting of this D IL rI
^� APPLICAAT U$$DDEEIpSfANDS AND ILL COMPLY WITH ALL NON-POINT Issued by: Date V�L
SOURC CCULATIONS�
/a /25/6K Re-roofs
Signatusa'st ptinnUComaaosor Dam /
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ar future bJlding ampantnom rehandle harardaus materia
as defused by 0n Cupertino Municipal Code.Chapter 9.12 and the Heatto and Safety
Code.Sa<uon3553z(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yrs a
Will Ne applicant of forum building occupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove .
kkoth ha,&Ob us air contaminants s d rrcd by the Bay Area Air Quality Management all new materials for inspection.
u m?
❑Yrs No 6
I have read Ne hvardus materials requiremensunder Chapb5.95 ufthe Califon
ns HcaIN&Safety Cad%Sections 25505.25533 are25534.lu alsom rl thatif tis:building
does not cunedy have•humt.that u my msponsiNfiry Be notify the aaupa rt or the
require whi h m mueem.ofaCerd&aura( repsoy Signature of Applicant Date
��Owner or auNoris<d egenm Dau All roof coverings to be Class'W'or.better
'
CITY OF CUPERTINO
•4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 34232088. 00
DATE ISSUED. . . . . . . : 10/29/2008
RECEIPT # . . . . . . . . . : BS000006497
REFERENCE ID # . . . : 08100192
SITE ADDRESS . . . . . : 10048 DOVE OAK CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SHARRON FRENZEL
ADDRESS . . . . . . . . . . : 10048 DOVE OAK CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5608
RECEIVED FROM . . . . : EDDIE D NALLEY
CONTRACTOR . . . . . . . : LEONCE ROUX LIC # 26850
COMPANY . . . . . . . . . . : AFFORDABLE WATER HEATERS &
ADDRESS . . . . . . . . . . : 24707 RAILROAD AVE
CITY/STATE/ZIP . . . : SANTA CLARITA, CA 91321
TELEPHONE . . . . . . . . : (661) 259-7131
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 1, 600 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 .00 40 . 79 0 . 00 40 . 79 0 .00
1PRWHEATR UNITS 1. 00 24 . 48 0 . 00 24 . 48 0.00
1TRAVDOC FLAT RATE 1. 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 106 . 56 0 . 00 106 . 56 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ---- -------------
CREDIT CARD 106 . 56 MC
---------------
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---- ---------------------------- -------- ----------------------------
518 WATER HEATER
•
ob v o / ,7
CITY OF CUPERTINO
G�QS' WATER HEATER
CITY OF
�CUPERTINO PERMIT APPLICATION FORM
APN # !L Date:
&&302U ��
Building Address:
�Ooq CA
Owner's Name: Phone #:
Contractor: Phone #:
� orpAAl� 1 C-k, kvJ—,r
Fax #: &0- 05y - 15T6
Cupertino Business License #: Contractor State License #:
(�Z7 3��
Contact: Phone #: L G 1 --2-5j-717/
Fax #: (,Gl- Z�f-9Y5L
Building Permit Info:
Bld ❑ Elect Er Plumb El� Mech'r'
Residential Commercial ❑
Job Description:
Sd Ga W
Strapped On Platform Bonded New Location ❑ Replacement 0"
Valuation (cost of project): r (,oU
Project Size: Express Ea'-,Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to
Othe application or if applicable, include in plan set & the sheet index.
Green Building Points achieved: -
Revised 6/16/08
CITY OF CUPERTINO
WATER HEATER
CM OF
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BSEISMICOM Seismic Commercial B
0 1PRWHEATR Residential Water B PRWHEATR
HeaterNent
/ 1BSEISMICRE Seismic Residential B
r 1PPERMITFEE Plumbing Permit P
I •
I TRAVDOC Travel & B
Documentation
1BUSLIC Business License B