08120078CITY OF CUPERTINO
3'- W;3' -tom m"
BUILDING DIVISION PERMIT
INTO IO
BUILDING ADDRESS:
PERMIT NO.
10798
BETTER
OWNER'S NAME:
PERMyr ISSUE DATE
:
A CONTROL N0.
(408)250-6672
ARCNI'fELT/FIv'GINEER:
BUILDING PERMIT INTO
BL00 F.IFIT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
IOU Description
booby affirm that 1 metli¢vd under provision of Chapter 9 (commencing
oeu soul Prolms u Code. and my ncume is
with Section 7M) of Division 3 of the Budm
n=mrce and mfr 2$ /(�
'
REPLC 75 GAL WATER HEATER IN GARAGE
Clef Lac. 11
Dam C.mncorffm
ARCHfIECrS DECIA A ON
1 mulem and my pas shall W used as public rccoMa
Licensed pmfcumnal
OWNER -BUILDER DECLARATION
1 kmby affirm that 1 am exempt from to Contractors License Law for to
following reason. (Section 7031.5, and. and Profusions Cade: Any city or counry
which mquhms a permit to construct. cher• improve, dcmmWt, or repair any svuemre
prior to its issuamm, also requires de applicant forsuch permit to tile.,igned sutemem
Ft. Floor Area
Valuation
thY he if licensed pursuant to the pmvlLmn of the Contractor's Uccom Law (C pmf9
Sq.
(commencing with Section 7000) of Division 3 of ilc Business and Professions Code) or
51200
dist he is comom therefrom and the basis for the alleged esrmptiom Any violation of
APN Number
Type
Occupancyro
Section 7031.5 by any applicant for a permit subjects the applicant to a rnll penalty of
t mare dud live hundred dollus (5500).
342 rJ7006.00
Ol,uowneroftapropeny.omympla)eeswMWageudehs.tec.m don,
Required Inspections
To mato(Bac.W-Buti
wi➢w Nswok, andteeswcsumhtelmendrdeLaw
of
and Rofetuons Code Ta C.nuacors I.ie•a law docs rot apply o an owner of
co
p(operly Wllo bYllda IX Impro4ea dlereon. Nd Wlrmd0e3aYL11 WorklYmfelf0r IhrWg➢IIY
employxtpmHded Natoehimpmwnwmamno imumdedmoRered far sale. B,
the building issold yeas ofImproe for pose
Wilderhowever. aim of proving of purpose of
Wilder will luso time bmdrn of proHng Nat a did rot build or improve far purpore of
did
tele.).
❑ I. as owner of the property am uclmivcly contracting with licensed mntracmn o
mmftroct Ne projm (See. 7061. Business and Pretensions code:) The Conmcors U.
cense law does not apply to an owner of property who Wilds of improves Merton. real,
.
who contracts roar such projects with. eoewcor(U licensed pursuant to the Condactors
Liceue Law.
[3I un exempt under Sec . B A P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I amby affirm under penalty of perjury oro of the following docluatiord,
hawend will maintain a Cmdbote of Content to self -Wort for Werk sCompen.
on. u provided for by Section 37M a de Labor Code. for the Performance of the
wart for which this permit is issued.
0 1 have and will maintain Wolters Compensation Insurance, as required by Section
3700.(Ne labor Godc.for the performanceol Ne wort(.which this permit is issued.
'
My Workere..Compemw.. Inwnme curter and Policy numbs art: /
/Do yl✓7
/
Omer. f"12if &Ml P� Poll, No: 1IV9 V
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Oris socd.n reed relaconpleted Irma Permit isroree, hundred dollars ($100)
or lm)
1 certify des, in the perforce. or the work for which this funds is issued. I shall net
employ any person in any e m ac, so as to became subject to the WmI en' Compensation
Laws of California Dau
Applicant
NOnCE TO APPLICANT: IL aro, making this Certificate of Escenption. you should
become subject m Ne Workers Compensation pervisiorta of due lab. Cade you muss
forthwith comply with such provisions or Nu Permit shall W decend rooked.
I
CONSrRUCnON LENDING AGENCY
I Wroby affirm that Nem is a construction buts t agency for the performance of
' the work for which dus Permit is issued (Sec. 3097. Cie C.)
lender's Name
,
Lender's Address
i 1 certify that 1 haw rew this application and sum that to show information is
' comm- I agree to empty wish all city and county .Nin mmut and sum laws relating he
building construction, and hereby authorim rep escn mins, of this city to emu upon the
above -mono ed Property for inspection Purpose
(We) agree to saw. indemnify and keep harmless the City of Cupcnine agaimt
j liabilitien.jndgmcnu.cons ata expemu which may In any wayamocagarnst aid City
in e.mequence of Ne granting of this pmmiL
' APPLICANT UNDER AN ND WILL COMPLY WITH ALL NON-P01NNjtkRe
: Date a `�
S EGULATION� /
/ �/�
/I
Sigmatism of ApplicauWCmammor Date
A ARDOUS MATERIALS DISCLOSURE
Roof
Will the applicant or future Wtlding occupant some or handle ha'rallous material
as defined by de Cupertino Municipal Code. Chapter 9.12• and the Health and Safety
Code. Section 25532(.)7
All roofs shall be inspected prior to any roofing material being installed.
Yu e
If a roof is installed without first obtaining an inspection, I agree to remove
Will the.pgdi.t o our Wilding occupant caw equipment ce devices which
havardou it conuminams as defined by the Bay Arta Air Quality Managcmcm
all new materials for inspection.
cl7
Oyu u
I have mad the hvaNaumateriaismqutremcnsuwer ChaPtu 6.95 ofNe Califo-
nis Fuel" Safety C.M. Seeuom25505, 25533 aud25534.I umtenand use ifue Wilding
does not cuneoly have a recont,jult it is my responsibility as notify de occupant of the
regmre tsWlanmmta rmiss racemtihmteef0c.n
Signature of Applicant Date
Z 17All
roof coverings to be Class'W' or better
Dam
Owner or auuoved agent
• 4 ITEMS OF 4
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 34257006.00
DATE ISSUED.......: 12/08/2008
RECEIPT #.........: BS000006783
REFERENCE ID # ...: 08120078
SITE ADDRESS .....: 10798 JUNPER CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: JENNY CHENG
ADDRESS ..........: 10798 JUNPER CT
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: FRANS CARTWRIGHT
CONTRACTOR .......: FRANS CARTWRIGHT LIC # 26514
COMPANY ..........: BETTER WATER HEATERS
ADDRESS ..........: 351 FALCATO DR
CITY/STATE/ZIP ...: MILIPITAS, CA 95035
TELEPHONE ........: (408)250-6672
• FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
IBSEISMICR
VALUATION
1,200.00
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
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
106.56
---------------
106.56
VOICE ID DESCRIPTION
-------- ----------------------------
518 WATER HEATER
•
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
CITY OF
OUPERTINO
Cl
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
PERMIT #ON DO7U
OWNER'S NAME: -14-- ,'VY 6(7 Y 6s
PHONE # u y z-5'0 - ?-'&-
GENERAL CONTRACTOR: 1.3g7rM, w470t- m
FAX # v 55.;L - 9 �-
I am not using any subcontractors: / z o u
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
/2, a� 0
Date
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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature
/2, a� 0
Date
CIN OF
•CUPERTINO
L
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
APN # 2Ir F
Date:
A
Building Address:
/ v 9 y ti n/r!' — Ccn,-i.� Gr,P n •vo C4- g j',, c/
Owner's Name:
Phone #:
JbVNt( CftoV6�
1050 z10 -He l
Contractor:
Phone #: .
117 -
Cupertino Business License #:
Contractor State License #:
S7,iU -3G
Contact:
Phone #: yof' 2,50,(,6- 7 L
�Yt/�✓ S Ga-r-��2f �i
Fax #: 0 5$7 —kq9 7 -
Building Permit Info:
Bldg Elect 21_�
Plumb] Mech M_
Residential
Commercial ❑
Job Description: 12,lpt4-z4� .'7 5 614v
W" G��an'►LIAI
Strapped ❑ On Platform ❑ Bonded
New Location ❑ Replacement
Valuation (cost of project): 1200,
r
Project Size: Express Q�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.
—6—
Green Building Points achieved:
Revised 6/16/08
41'TYOF
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
I
1PPERMITFEE
Plumbing Permit
P
i
1TRAVDOC
Travel &
Documentation
B
1 BUSLIC
Business License
B
E
0