08120043 CITY OF CUPERTINO >
BUILDIN+DIVISION PERMIT „Cc,O BACTOWINF MAT'ION
BUILDING ADDRFSS: PERMIT NO.
1026 CRANBERRY DR HOME DEPOT 081 2Q043
OWNER'S NAME: PERMT ISSUE DATE
NE: A CONTROL NO.
(425) 636-7054
ARCHTfECf GiNEER: BUILDING PERMIT INFO
_ BLDG ELECT PLUMB MECH
w00 LICENSED CONTRACTOR'S DECLARATION IObDesCrl IIOn
U 1 Wm ?red by a Nat 1 am licensed under provisions of Chapter 9(commencing P
with Section 7001))of Division 3 of the Business and Prercssiuus Cade,end my license is
^�nudi in full faux and effem. REMOVE/REPLACE GAS WATER HEATER
j J Z Licenn clan Lic.g
�Fp Dau Comae,
M
pp 7W ARCHITECTS DECLARATION
W u 1 undersunJ my
Plans small W used ns public records
n
g G G Livened Prefeasional
5 OWNER-BUILDER DECLARATION
1 bcmby affirm that l am exempt from the Conuemm's License law for the
i 0o
O following mon.(Section 7031.5.Business and Prefessians Code:Any city or county
e m0 Pi which mquiro a Permit to eme ruct,Jur,improve,demolish,or.Pair any atructara
uZi prior to its issuance.Jso requires the applicant for such permit to file a signed statement
s< that he is licensed pursuant lO Oe Provisions of the Cammcurs Lice=Law(Charter 9 Sq.F[.Floor Area Valuation
YFG (commencing with Seeded 7000)of Division 3 or the,Business and Ismicsiom Cost)or 449
y`<� Nat Im u exempt thercrrom and me basis for the Jlcgcd exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil peruRy,of APN Number Occupancy T
rot mom than five hundred dollars(SM 36204054 . 00 P y Y�
❑I.u owacr of ted prvpmy.car my ttoploycn with vagi u Ne'vsote eompemtion,
anddo theworlr,and me iimctme u rod Contravenes Lice scar aw do Tante(Sec.70/4,.1 of
and erty whi W Codedm m vasemon.Littre Law data cam apply u m awacr car Required Inspections
property who battidemimpovuch imps and who doesuchwork himulred Oorsam his
Own employers,provided that such improvements o2 not es,oft.molftted for mn I.
however,the building or improvement I,sold within ane year of completion,me owntt-
sam.). wiB love the burden of proving Nal W did rod Wild a improv for purpose of
um.).
O L as awed of the property.am esdusivdY contracting wild licensed concert a
construct me prejac7(See 70".Business and Pafessiao Code)The Comsacwh Li-
cuss law does sot appy to an owner of prolany who builds or improves thement,and.
who conrracu for such projects with a cantrectar(s)Waned pursuant u theContnuoh
LI¢nm Law.
O lmoeacmptundar a .B&PCfarmismsmn
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 bereby tlEsm under penslty of perjury one of the fallowing de tanstiau:
I have and will maintain a Confit of Conentto elf--inumm feworkefscompes,
cation,as provided for by Section 37M of the Isbm Code.for the Performance of Use
work for which this permit is issued
O 1 have and will maintain Worked Compensation Insursoce,as required by Section
37x0 of me Labor Code.for ted Performance Orme work for which One permit's issued.
My Workee,Compensation Insurance artier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rImsectim aced mtbe completed if the permit is for.hundred doll.(SIM)
or lass.)
I,miry met N the pttt..of the wart the which this permit is based,l shall tet
,.Ploy anypermn in any mamerse as u become subject to the Warbmn'Comptttsation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccnincae of Exemption.you should
become subject m the Workers Compensation previsions of the Ishor Co h%you mom
.JO forthwith comply with such provisions or this Permit shadl W deemed mvoked.
Z CONSTRUCTION LENDING AGENCY
[-m 1herby affil.that mem U.mnstrctirm lenling.gem fm ted pttfoenan¢of
tx the work for which this permit is issued(Sec.URI.Civ,C.)
W� Q L.cnders Name
v7 z Lenders Address
U 0 1 certify that I have mad this application andstate the ted above infomut an 1.
ly F
comes.I agree to comply with JI city and county ordinances and sum laws totaling in
0 U building construction,and hembg mmorine repreenutives of this city to cnw upon tha
[u above-mentioned property for inspection purposes
0. (Wc)agree to save,indemnify and keep hatmless ted City of Cupertino agsinsl
H to liabilities,judgmcnu.casts and"peres which may in any wy..against said City
U Z in consequence of de porting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signuum of AppliaDau
HAZARDOUS MATERIALSDISCLOSURE Type of Roof
Will me apCupertmfMuni bpalCgoccupantnomorand hualthad Safety u Cock.
Sec on V5 Cupertino Municipal Code.Chapter 9.11,and ted Health and Safety
Calc,Section 25532(x)7 All roofs shall be inspected nor to an roofing material being installed.
❑r" ON. P P Y 8 B
Will the applicant or future Wilding occupant use equipment or dcvices which If a roof is installed without first obtaining an inspection,I agree to remove
roll hxrsrdoa it coomninumts as defined by ted Bay Arca Air Quality Mm.gemem all new materials for inspection.
District?
OYns ON.
Ihavemadme Wu mmaterialsmquimmcnuunder Chapur6.95ofine Califor.
niceHealed&Safey Cade.Secdam255115.25533mJ25534.1understandm ifine Wilding
doe not currently have a mnmt.mat it u my responsibility m notify de occupant of the
requirements which moat W met prior in issuance of a Cartificau of Occupancy. Signature of Applicant Date
Owner or autharnrd agent Dam
All roof coverings to be Class'%?."or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36204054 . 00
DATE ISSUED. . . . . . . : 12/04/2008
RECEIPT # . . . . . . . . . : BS000006753
REFERENCE ID # . . . : 08120043
SITE ADDRESS . . . . . : 1026 CRANBERRY DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHUANG GEORGE I AND IRENE I
ADDRESS . . . . . . . . . . : 1026 CRANBERRY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4926
RECEIVED FROM . . . . : JEFF JORDAN
CONTRACTOR . . . . . . . : FRANK BLAKE LIC # 30610
COMPANY . . . . . . . . . . : HOME DEPOT
ADDRESS . . . . . . . . . . : 12601 132ND AVE NE
CITY/STATE/ZIP . . . : KIRKLAND, WA 98034
TELEPHONE . . . . . . . . : (425) 636-7054
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ----- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 449. 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 VISA
---------------
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
•
Community Development
10300 Torre Avenue
Cupertino
CA 95014
�'"
Telephone(408)777-3228
F Fax(408)777-3333
IOCUPEkTINO
Duilding Department
JOB ADDRESS: 1026 CRANBERRY DR PERMIT# D 8 I A DOq
OWNER'S NAME: CHUANG,GEORGE PHONE # (408)446-3401
GENERAL CONTRACTOR:HOME DEPOT FAX# 425-814-9516
I am not using any subcontractors:_ 6�-,z. 11/4/08
Signature Date
PIease check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Pencing
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
OOwner/Contractor Signature Date
000000
Permit No:OR I Zo0q 3
(office use only)
. City Of Cupertino Building Permit Application
E-Mail: Building-Permits(a)cupertino.org (Address is case sensitive).
Jobslte Address: 1026 CRANBERRY DR Date: 11/4/08
Assessor's Parcel Number: 3L2 Dq D54 00
Owners Name: CHUANG,GEORGE Phone No: (408)446-3401
Project Valuation: 449.00
Building Permit Info: Bldg Elect Plumb x Mech
Job Description
Remove/Replace Gas Water Heater
Contractor Information
Company Name: HOME DEPOT Phone No:
• Contact Name: Carol Randall Fax No: 800-454-8955
Address: 12601 132ND AVE NE E-mail: carolr@fastwaterheater.com
City, State & zip code: KIRKLAND, WA 98@34
State Contractor's Lic. No: 602331 Expiration Date: 9/30/10
Worker's Comp No: 1928756 Expiration Date: 3/1/09
Carrier. AMERICAN HOME ASSURA
City of Cupertino Business License No: I-))pptked
Credit Card Information
Credit Card No: Expiration Date: 11/10
Name on Card: Jeff Jordan
Visa ® MasterCard ❑ American Express ❑
• The Building permit application and a completed & signed
contractorlsubcontractor form need to be submitted with each permit.