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08110032 CITY OF CUPERTINO 7777 < BUILD.NG DIVInION PERMIT ,CURACTO•RINP,�4�tMATIaN BUILDING ADDRESS: PERMITNO. 10325 BONNY DR WATER HEATERS OWNER'S NAME: PERMIT MUE DATE NE: A A CONTROL NO. (800) 83.5-5946 ARCHRECOFNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 uoo LICENSED CONTRACTOR'S DECLARATION Job Description 1 homey alliin Nat 1 sm licensd under provisions of Chapter 9(mm1nnulamg p with Scotion 1")of Division 3 of the Buenev and Professions Cade.and my license is ? ,a imfull rameandeffea 37f�S73 REPLC WATER HEATER IN GARAGE ,,va Z Ixsvn[tau t- 36 Lie.« 7n�Conuacmr ARCHITECTS DECIA t4A31U kn U 1 undersand my plans shall Its wind as public records �� ¢cnse Ld Professional OWNER-BUIIDE0.DECLARATION 1 herehy air,.that 1 am exempt(mm the Canuaeors License Law for the O o following mason.(Section 7(n I.S.Business and Profecsiuv Code:Any city at county t m which mqW.•permit to construct alter,imPmve.demolLsh,ser repair any met— act to its issuance,also rout the applicant for such permit to file a signed sutemem pp xx C that he is licensed pursuant to the Provisions of the Comrmmr's Liamvc law(Chapter 9 Sq.Ft.Floor Area Valuation yF$ (commencing with Section 7()()0)of Division 3 of the Business and Professions Cde)or 9(30 y — that he u esempt therefrom and tiro basis for the alleged exemption.Any violation of Section 7031.5 by any appllunt for a permit aubiccu the applicant to a civil penalty of APN Number Occupancy Type out mate than five hundred dollars(M). 35913007 . 00 ❑ ownerof the proptny,mmy employeswithwagas uthe'vmle campensaden, anddoteweb,andthe e: :ovum isnots Livens serow d(m rolepply Dab Bodeen and Professions Cede:The Comrmmra nd who Law dao mit apply lf m sone.of Required Inspections Own property who buildaad mprow thmconmd who dee,vec ounce himsel red for ughWe his Own cmpleyes,provided that such imProvemmffiu are not inandd oroRerd far sale.B. however.Ne building ser improvement Is sold within one Kar ore fee the Wilder,wilt wilthave the bwdrn of proving that ha did not build or Improve far purpose of sale-). ❑1.as comer of the Property am eaclusively stomaching with licensed mnwnors m co uumn tK project(Sec.70aa,Business ad pretenders,Cade:)The Corsuaemrs Li- cove law doe em apply he an owner of property who Wilds or improves thereon.and. who contracts for such poejacu with aconuxmRs)licensed pauum to 1W Contraction L ceve taw. M Iamesemptunder5ee .B&PCfmthis. Owner Das WORKERS COMPENSATION DECLARATION k1 hereby air under porosity of perjury one of flue following declaruions h:,s ad wid to ruin•Cerdficem of Covert m self-insureforWorkersCompeer- don.as provided for by Scott..3700 of the labor Code.for test,perfmon.of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as required by Seninn 3700.1'Ne Latma Cock,far Ne perfomanen ordm work for which his pcmot is issued My /Work�e-rsC�onoppeensauon lem.ce carrier and Policy number am: Cartier.CA Cartr,C PolicyNo.: ys03 ly9 CER FICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (hisseelon need not W completed if the permit Is fortune hundred dollars($100) or lois) I certify that in the performance of then wink for which this permit is issued.l shall not. - employ any person Warty manrcrw as m become subject m 1W Wmkeri Component. Laws of California.Date Applicant - NOTICE TO APPLICANT:IL after making this CenificaN of Esemption,you should become subject to Ne Waher's Compensation previsions of the labor Cade,you most O forthwith comply with such provisions or Nu permit shall he doomed rev.kcd. 'Z` CONSTRUCTION LENDING AGENCY [-, Ihereby affirm that Nem is a cmuvuctum lending agency for the perfumance of CC > the work for which Nis perch h issued(sec.3097.Civ.C.) W Q Landers Name jz lander,Add. U O 1 mdfy that I have red this application aul sum Nat Nee above info urns,is W F carsnt.I agree m comply with all city and county Ordinances and sea laws missing an 0 U building construction.and hereby auNaria mpm,enudsv o(Nis city to now upon the r W above-medomd progeny for ivpedcn purposes. G (Wee)agree to ave,indemnify and keep handiness dm handlCity of Cupertino against Hr/) liabilities,jdgmena.cosss mdeapaxswa which may Nasty wyamue agairestwel City U z in consequume of the grade{of this permit. ^ AP ICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date L CE REGULATIOr Sr oe Q , d�y-:� ��- -a Re-roofs d Signuurc of ApplicanYConua saw Dam HAZARDOUS MA AIS DISCLOSURE Type of Roof Will he applivnt or future Wilding occupant stem or handle herudoas material as defined by the Cupenine Municipal Code.Chapter 9.11 and the Health and Safety Code.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yns Will the applicant d1fomwildirl,occupant use equipment ser device which If a roof is installed without first obtaining an inspection,I agree to remove it h®afdnv air conumive nu as defied by Ne Bay Area Air Quality Management all new materials for inspection. me'? ❑Yv y I have-11 aAous mamdaIs requiromenu under&.Iucrfi.95 of Nee Califor. .is Health&SafetyC ,Secsiov 23505,25533 and 7.5534.l understand Nu iflM Wilding docs n 'wren. ,have a mnme Nu k is my responsibility to of,the occupant of the req nu whichm t kmetpriorminumccofa CeNBcamof Occupmry. Signature Of Applicant Date 11-117-a All roof coverings to be Class'RW'or better Owner or auth.n. .seem Dom M CITY OF CUPERTINO � 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35913007 . 00 DATE ISSUED. . . . . . . : 11/07/2008 RECEIPT # . . . . . . . . . : BS000006573 REFERENCE ID # . . . : 08110032 SITE ADDRESS . . . . . : 10325 BONNY DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JOANIE SHELL - ADDRESS . . . . . . . . . . : 10325 BONNY DR CITY/STATE/ZIP . . . . : CUPERTINO CA, 95014-2905 RECEIVED FROM . . . . : EDWARD A GREGORY CONTRACTOR . . . . . . . : MCGEE, PAT LIC # 18986 COMPANY . . . . . . . . . . : WATER HEATERS ONLY ADDRESS . . . . . . . . . . : 970 E MAIN ST CITY/STATE/ZIP . . . : GRASS VALLEY, CA 95945 TELEPHONE . . . . . . . . : (800) 835-5946 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 990 . 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 Community Development �c 10300 Torre Avenue i [ v Cupertino CA 95014 'y Telephone(408)777-3228 CITY OF Fax(408)777-3333 46UPEI�TINO Building Department JOB ADDRESS: PERMIT # 3Zs- �o�H -� . 0e/("oa3 -1- OWNER'S NAME: Soo e. S Aeal I PHONE # //p _ 777-9.316 GENERAL CONTRACTOR: t FAX # I am not using any subcontractors. 11- 7— 0 P Signature Date Please check applicable subcontractors and complete the following information: 60 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 <l Plumbing e r y < s n Roofing Septic Tank Sheet Metal Sheet Rock Tile 11771 Owner/Contr r e Date If gip,' CITY OF CUPERTINO C� � r f WATER HEATER • OF CUPEkTINO PERMIT APPLICATION FORM APN # Date: 59/ 3 �� • `� �' //- 7- 0- Building Address: //�o .3Z Owner's Name: Phone #: D-0gn " e �� el` Yoh - 5 Contractor: Phone #:Wq Fax #: -'S-30-7 Cupertino Business License #: Contractor State License #: 3�Ys�3 Contact: Phone #: s-/a W G6z/ /t sQe Fax #: Building Permit Info: Bldg Elect . Plumb Mech [ — Residential Commercial ❑ i Job Description: e P 4gce Strapped On Platform Bonded New Location ❑ Replacement Valuation (cost of project): .� Project Size: Express ©—Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points achieved: Revised 6/16/08 CITY OF CUPERTINO ?. WATER HEATERCITY OF . CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1PCWHEATR Commercial Water . B PCWHEATR HeaterNent 1BSEISMICOM. Seismic Commercial B IPRWHEATR Residential Water B PRWHEATR HeaterNent IBSEISMICRE Seismic Residential B 1PPERMITFEE Plumbing Permit P 1TRAVDOC Travel & B Documentation 1BUSLIC Business License B