08120125CITY OF CUPERTINO
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COl�f`CRTOR�INFORMATION
BUILDING DIVISION PERNIIT
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BUILDING ADDRESS:
PERMIT NO.
10740 ORLINE CT
AFFORDABLE WATFR HEATERS
08120125
OWNER'S NAME:
FERMR ISSUE DATE
PHO :
SA CONTIIOLNO.
ARCHITE /ENGINEER:
BUILDING PERMIT INFO
RMV RPLC WTR HEATER 50 GALS
BLDG ELECT PLumi{ MECH
O O O O
LICENSED CONTRACTOR'S DECLARATION
Job Description
p .
1 hereby affirm that 1 an licensed under
dm s of CMdc, 9 (mmmcncing
Pi
and
Division]of Ne Buri^«. and Profeuiou Caae.W mylicens is
NSectionand
iof
II. come and aB y (q 2�3G4Y
License CI Lie. M
Daw Comrscwr '401Pi.iA-
ARCNITECrS DECI.A A�'�—
I understand my plans shill be usud at, public records
Licensed Pmfess(anal
OWNER -BUILDER DECLARATION
I bcrtby aRam that I am exempt from Ih Conuactofs License law far the
following reason. (Smuan 7W 1.5, Business and Professwu Cade: Any city ar county
which ma,a cs a pmmit in conswcs alter. improve, demolish, or mpalr my suuctune
prim w its issuance, also m luims the applicant forsuch permit to file a signed suwmmt
Sq. Ft. Floor Area
Valuation
Net he is licensed pursuant to the pmvisiom of the Convector's License Law (Chapter 9
(eommeuing wish Section 7000) of Division 3 of the Business and Pro,"O tsCade)car
Nat h Is attemptNmerrom and the basis for the alleged exemption. Any violation of
APN Number
- Occupancy Type
Sedan 703" by any applicant fm a permit subjects she applicant w a civil penalty of
trot mart Nan five hundred dollars (SSW).
pmperry,mmY wpleyc= wagesasake( 1.
❑ Luowoert,
Required Inspections
Budrcss
canteredW.Buamse,
will do ad an
ands:
an Owner of
he Comtsnots License LawdA(mule(Sex.M in
Cade: The Comrscwrs
and Professions; Code: Law does not apply
and f ut
progeny who builds or i and who
property
hf.
d tat suIhrean,
We
own employers, provided that such imps son for We. If.
are eat intendedof m
mid wait leemE
however. the Wilding or improvvvmt ts old within arc yeti of c the
prove far purpose of
builder will have Ne WNcn of poving that h did not Wild or improve fm puryose of
ole.).
1, as owner of the property, am =elusively contracting with licensed contractors to
construct Ne project (Sec. 7044. Business and Professions Code:) The Caownor's II-
cesse Law does not apply In an owner Of property who Wilds or improves thereon, and,
who contracts for such projects wits a convacur(s) licensed pu saam in the Contrxtors
Liana Law.
❑lam=emptunderSee ,B&PCfm Nismaun
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby a0inn under penalty of perjury one of Ne following decla ndonc
❑1hamaMwnlmunWnaCmr..Mof Co=niwself-imumfm Wod sCompcn-
satio t, as provided far by Secfon 37M of Ih Mbar Cade. for Ne performance Of Ne
,
wart for which this Introit is issued.
1 have and will maintain Wmser's Campeuatian Insurance, u required by Section
MV of the Labor Cade. for Ne perrormaneeofthe work for which Nis permit is issued.IFF
'
WerkarsCam�pewdangWu�nce camfor aM policy, number are:
Camr. l7_2 i ylk policy No.:-ZO6 2,rW A03
CERTIFICATE OF EXEMFIION FROM WORKERS
COMPENSATION INSURANCE
(Thu scedon meal nathecomplmM ifft permit Is farces hundred dollars (SIM)
or less)
1 certify that in the perfarmoce of Ne work far which this )cads is issued, I shall not
employ any persan in any manner an az w become mbj=I w the WorknY Compensation
Laws; of California. Date
Applicant
NOTICE TO APPLICANT: If, Aer making Nu Cenlricae of Escmptian, you should
become subjen to the Workers Compensation pa vis;om of Ne Labor Code, you am
' faMwhis comply with such provision or Nu permit shall h damned tenanted.
i
CONSTRUCTION LENDINGAGENCY
1 W tsu Mete u cnntruc. agency far de perfunnanm of
r whaRtm
30 7, ON.
' Ne wort for which Nu petmil'u issued (Sm. ](g'1, Civ. Cd
s
'
Lcntlara Nama
lenders Ada.
1 cmdfy that 1 hove and this application and sow that Ne above information Is
' cmrm 1 agnea w comply w;th all city and county oNinan¢v and state Ian relating m
building construction, and hereby auteodrz reprumom ives of this city in enter upon Ne
.haw -out= aOM property for inspecam. t urparal
(We) agree to save, indemnify and keep harmless the City of Cupenino against
liabilities, judgments. .0 and cxpcnw which may in any way acne again, mid City
r in <ensequmm of the gnnung of Nu T11"
U
APPLICANT UNDERSTAN AND WIL MPLY WITH ALL NON -POINT
Issued by: Date f
SOURCE REGULAI
Re - roofs
Type of Roof
SiSignatureof AppliwnVC or Dam
Signature2
HAZARDOUS MATERIALS DISCLOSURE
pantor fnWilding occupantswm i
m buardmaterial
VIIINcCu
az OcOnM by Ih Cupertino Municipal Code. CTapmand 9.11, cad dm H=IN and Safely
Code. Seedon u5]1(A?
Y=
All roofs shall be inspected prior to any roofing material being installed.
❑
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding Occupant tau mquipmcnt or devices which
emit hezardnu; air canuaiminu as defined by Ne Bay Area Air Quality Managemem
all new materials for inspection.
DimicR
E] Y. ❑jo
neg3.d25us under Clupwr6.95 Gilding
Ih& neat Lha h,S=
cad 75534.1 "iflh
7.5M5.s crnaM Nuicup Wilding
Hntcou Safety Cade, Scedanhat
it i1SSTl
to Ne
= not cumcndy hese � mn.1 that it is niC mills
gmmmcnts whicnm t'de mel pri us aCmtireaw ora
ac or OC ���f
Signature of Applicant Date
All roof coverings to be Class'%}" or better
Data
owner or authmnol agent
4 ITEMS OF 12
CITY OF CUPERTINO
PERMIT RECEIPT
• Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 35922056.00
DATE ISSUED.......: 12/19/2008
RECEIPT #.........: BS000006863
REFERENCE ID # ...: 08120125
SITE ADDRESS .....: 10740 ORLINE CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER ............: WADE HUANG
ADDRESS ............ 10740 ORLINE CT
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4351
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
----------
1,700.00
----------
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
VOICE ID DESCRIPTION
VOICE
ID
DESCRIPTION
------------------------------
518 WATER HEATER
--------
------
-----------
0
D.
CI OF
CUPEkTINO
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
Og12o1�-'
APN#5 -S
Date:
/Z Ad
Building Address:
)O7Lf0 021�w�
Owner's Name:
Phone #: y0 39.?e
Contractor:
Phone #: (a(o f - zs q , ),15
pFFo�onei�, wAa�� 4.�d.�
Fax #:
Cupertino Business License #:
Contractor State License #:
�?)36�
Contact:
Phone #: (o
SCo }-k
Fax #: (o6( -2,r(- 5:M-6
Building Permit Info:
OBIdg Elect
Plumlafr Mech.Es....
Residential
Commercial ❑
Job Description:
3-0 60
WA' -o �
Strappedi❑ On PlatfonTVU Bonded New Location ❑ Replacement
Valuation (cost of project): ! 706 06
Project Size: Express ❑ StandarcK
I 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:
LJ
Revised 6/16/08
A
C rV OF
CUPERTINO
CITY 'OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
1PCWHEATR
Commercial Water
HeaterNent
B
PCWHEATR
1BSEISMICOM
Seismic Commercial
B
1PRWHEATR
Residential Water
HeaterNent
B
PRWHEATR
1BSEISMICRE
Seismic Residential
B
1PPERMITFEE
Plumbing Permit
P
1 TRAVDOC
Travel &
Documentation
B
1BUSLIC
Business License
B
0
0