The URL can be used to link to this page

09100129CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7736 OBSIDIAN CT CONTRACTOR: AFFORDABLE WATER PERMIT NO: 09100129 HEATERS & 'ER'S NAME: KUSTERS JOHN A AND SHEILA J 24663 RAILROAD AVE DATE ISSUED: 10/21/2009 OWNER'S PHONE: 4082536141 SANTA CLARITA, CA 91321 PHONE NO: (661)259-7131 ❑ LICENSED CONTRACTOR'S DECLARATION I— � PLUMB License Class CO K' Lic. # � Z � `� g BUILDING PERMIT INFO: BLDG ELECT T_ f- MECH RESIDENTIAL COMMERCIAL Contractor %% Date I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE WATER HEATER WITH TANKLESS, (commencing with Section 7000) of Division 3 of the Business & Professions SAME LOCATION Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $3500 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 36218025.00 Occupancy Type: APPLICANT CERTIFICATION I 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities, judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Issued by: �` 13. !' 2-/J-'�- 9.18. G Q 10 Z d �t Date RE -ROOFS: ❑ OWNER -BUILDER DECLARATION 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 all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self -insure for Worker's California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain Compensation, as provided for by Section 3700 of the Labor Code, for the compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & performance of the work for which this permit is issued. Safety Code, Section 25532(a) should I store or handle hazardous material. 1 have and will maintain Worker's Compensation Insurance, as provided for by Additionally, should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code, for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Sections 25505, 25533, and 25534. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Owner or te orized�gent: d / Z le. Date: Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued (Sec. 3097, Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct. I agree to comply with all city and county ordinances and state laws relating tr ' 1ding construction, and hereby authorize representatives of this city to enter Lender's Address I he above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date 5 ITEMS OF 35 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36218025.00 DATE ISSUED.......: 10/21/2009 RECEIPT #.........: BS000008982 REFERENCE ID # ...: 09100129 SITE ADDRESS .....: 7736 OBSIDIAN CT SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER KUSTERS JOHN A AND SHEILA J ADDRESS 7736 OBSIDIAN CT CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4111 RECEIVED FROM ....: SCOTT W LITTLEFIELD CONTRACTOR .......: LEONCE ROUX LIC # 26850 COMPANY AFFORDABLE WATER HEATERS & ADDRESS 24663 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 ---------- 1BCBSC ------------- VALUATION ---------- 3,500.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 3,500.00 0.50 0.00 0.50 0.00 1PPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1PRWHEATR UNITS 1.00 25.00 0.00 25.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 ---------- 0.00 TOTAL PERMIT ---------- 110.50 ---------- 0.00 ---------- 110.50 0.00 VOICE ID DESCRIPTION VOICE -------- ID ---------------------------- DESCRIPTION -------- ---------------------------- 518 WATER HEATER IC CUPEkTINO CITY OF CUPERTINO WATER HEATER PERMIT APPLICATION FORM APN # U Date: �U(�/ (01(-7(69 Building Address: C) Owner's Name: Phone #: �,T(3vnv, tL,�-kS �trs L4 o � a-15-3 - (at L41 Contractor: Phone #: Fax #: %b (- 01 Cupertino Business License #: Contractor State License #: ,�- b 91" 0-17 3 6 ff Contact: Phone #: �&I - � 6-j - a 54A + C. G�'I�'(` 1--! �"�'I � � fps. Fax #: Building Permit Info: Bldg ❑ Elect [ Plumb Mech Residential Commercial ❑ Job Description: �G� t,Jc.-��rv,�4 el w' �t'l� �L e P lT Glvv�Q, i C9 ch �`� 8 r Strapped On Platform ❑ Bonded New Location ❑ Replacement Valuation: 5(� 0 — Green Building Check must be completed and attached to this application. Green Building Points achieved: ei CUPERMNO CITY OF CUPERTINO WATER HEATER PERMIT APPLICATION FORM Quantity Fee ID Fee Description FeePermit Grou Type 1PCWHEATR Commercial Water HeaterNent B PCWHEATR BSEISMICOM Seismic Commercial B 1 PRWHEATR Residential Water HeaterNent B PRWHEATR BSEISMICRE Seismic Residential B PPERMITFEE Plumbing Permit P TRAVDOC Travel & Documentation B BUSLIC Business License B azo.: CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: I '-13(e 0hoL t-\,\ L+ PERMIT # 0 �v OWNER'S NAME: p h v\ k -z r S PHONE # L(a� GENERAL CONTRACTOR: ujc,fiPr Peo, FAX # I am not using any subcontractors: () 1-7/()15 Signature Date Please check atmlicable subcontractors and complete the following information: Owner/C retractor Signature 1L)// -7r Al 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/C retractor Signature 1L)// -7r Al Date