The URL can be used to link to this page

07050246 CITY OF CUPERTINO tT h BUILDING DIVISION PERMIT � Q I � r. ... PERMIT NO. BUILgt)•I�pqD bANCY CT AFFORDA13LE WATER HEATERS & 07050246 G U b b PERMIT ISSUE DATE OWNER'S NAME: MARJORIE GILBERT 24707 SAN FERNANDO RD 05/24/2007 SANITARY NO. CONTROL NO. NE: (661) 25()-7131 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 1Wzo LICENSED CONTRACTOR'S DECLARATION Job Description j ulr I hereby affirm that I am licensed under provisions of Chapter 9(commencing z H) with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE 40 GAL GAS WATER HEATER/GARAGE h y in full force and effect/) b `�13b" ? Lire Class l.. Lk•g :Ftp Datc 7��—Contractor ARCHITECTS DECLARATION- i a< I understand my plans shall be used as public records )ur U.F' Licensed Professional w OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the :00 following reason.(Section 7031.5,Business and Professions Code:Any city or county .9 which requires a permit to construct,alter,improve,demolish,or repair any structure i a prior to its issuance,also requires the applicant for such permit to file a signed statement t' .Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 .hq $1500 t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 915 0 2 3 �Number Occupancy Type not more than five hundred dollars($500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sate.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's!- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: LJ I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers optpensati�on Insu Thee carrier and Policy nu(nLber are: G Carrier: � ')-X Policy No.: �L �b1 Q 9k)w CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z h"' CONSTRUCTION LENDING AGENCY (~-t rte.. I hereby affirm that there is a construction lending agency for the performance of p;> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name a z Lender's Address U O 1 certify that I have read this application and state that the above information is ► correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspccuon purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City /� S U Z in consequence of the granting of this permit Date ►- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGUIP+TIONS. 1 .A ca-e-t S Y Re-roofs �7J Signature Iicaru/Contractor Dare Type Of R Sof HAZARDOUS MATERIALS DISCLOSURE yp Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code, Section 25532(a)? All roofs:,hall be inspected prior to any roofing material being installed. ❑Yes ANo 1_ If a roof i:,installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which :mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m iterials for inspection. District? ❑Yes ftNu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- J nia Health&Safety Code,Sections 25505.25533 and 25534.I understand that if the building /1 H � V Lrcquirements not currentl have a tenant,that it is my responsibility to notify the occupant of the ��/ w hch must be me pror to issuance ora Certificate of Occupancy. Signatee Of Applicant Date All roof coverings to be Class"B"or better cr or thorizcd agent Date CITY OF CUPERTINO 3 ITEMS OF 12 PERMIZ RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot : APN 35915028 . 00 DATE ISSUED. . . . . . . : 05/24/2007 RECEIPT #. . . . . . . . . BSC00001455 REFERENCE ID # . . . : 07C50246 SITE ADDRESS . . . . . : 20E65 NANCY CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER MAFJORIE GILBERT ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : . , RECEIVED FROM . . . . : AFFORDABLE WATER CONTRACTOR LECNCE ROUX LIC # 26850 COMPANY AFFORDABLE WATER HEATERS & ADDRESS 24107 SAN FERNANDO RD CITY/STATE/ZIP . . . : NETHALL, CA 91321 TELEPHONE (6C1) 259-7131 FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34 . 86 0 . 00 34 . 86 0 . 00 BPWHEATER PER HEATER 1 . 00 10.79 0 .00 10 . 79 0 .00 PPERMITFEE FLAT RATE 1 . 00 38 .37 0 . 00 38 .37 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 84 . 02 0 .00 84 . 02 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF CUPERTINO WATER HEATER �16 CITY Of CUPERTINO PERMIT APPLICATION FORM APN# r Date: Building Address: `J Owner's Name: , Phone#: Contractor: Phon--: (r(e i License#: h�f &We- ale eaTers a5"1Dc Contact: Phoni;: (P b 1 Cupertino Business License#: cow LI IT WI Oa Building Permit Info: Bldg ❑ Elect . Plumb Mech t Job Description: Residential R1 Commercial ❑ pe-910V 90 Flon i% -reg Cost of Project: 1,500 -- Strapped 5v0 -- Strapped On Platform Bonded fft- New Location EJ-- Replace ment [911 Qty. if —Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERIVIITFEE Plumbing Permit Issuance PLUMBING BENERGY Energy ILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 ;ID Telephone(408)777-3228 CITY OF Fax(408)777-3333 %K TINO Building Department JOB ADDRESS:�d�(0 5 PERMIT# JSrr��n c: °<✓'t', _� j noZ OWNER'S NAME: m t rA e✓rtr PHONE# off-aS"�- ( .VI GENERAL CONTRACTO : FAX# I am not using any subcontractors: C;L d` 7 Signature Date Please check applicable subcontractors and complete the following information 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 er/Contractor Signature Date