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07100134?oa V U :z U ,<a '=z AFL ..1 iae �M W H •ae �a0 <m Q ^ (A' "� a i CITY OF CUPERTINO BUILDING DWISION PERMIT CT VER'S NAME: VERNAZZA LAWRENCE P JR AND ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. g License Class l� Date — Contractor YC D-Ify ARCHITECTS DECLAR 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby alTirm that I am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter. improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 not more than five hundred dollars ($500). ❑ 1, 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 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 sale. 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.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li- cense Law docs 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 reason O z� 4 aQ �z UO (L F, �U Ow 0-4 to U� ier Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. 1 have and will maintain Workers Compensation Insurance, as required by Section 0 of the Labor Code, for the performance of the work for which this permit is issued. ,vty Workers Compensation Insurance carrier and Policy number are: Carrier. t/� Policy No.: 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, l 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 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 the work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Lenders Address 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 building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection 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 in consequence of the granting of this permit. APPLICANT UNDE ANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULA S. (Q -1-07 14 C41v, Signature of A ant/Conuacter Due HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety lc, Section 25532(a)? ❑ Yes der Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes u 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building odes not curendy ha a tenant, that it is my responsibility to notify the occupant of the requircmcnts which ust be met prior to issuance of a Ccnificatc of Occupancy. (0-/.0 Owner or ad0fdrized agent Date PERMIT NO. AFFORDAELE WATER HEATERS & 07100134 24707 SIN FERNANDO RD (661)255-7131 PERMIT I55UE DATE 10/18/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description REPLACE 40 GAL GAS WATER HEATER, SAME LOCATION=GARAGE q. Ft. Floor Area 36212001) Issued by: Re -roofs $1500 Valuation Occupancy T Required Inspections Type of R -)of All roofs, hall 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 m iterials for inspection. J, �_ (0 - tie - 0 Signature 3f Ap6licant Date All roof coverings to be Class "B" or better r CITY OF CUPEkTINO d-7cDO) 3y CITY OF CUPERTINO WATER HEATER PERMIT APPLICATION FORM APN # C,0�laoo�i�� - -- - ----- Water Heater / Vent BUILDING PPERN FFEE Date: i ��- Building Address: I BENERGY Energy BUILDING BUSLIC Business License BUILDING Owner's Name: - V-( ►y, Phone #: yV� - 9 Contractor: Phony (e i a5'l _113) License #: jgffmcd GID e G"(e Contact: 2GT2fS Phone: (n b I Cupertino Business License #: cov l_+1T1 e -4,0A AO -10 5412 Building Permit Info: Bldg ❑ Elect Plumb Mech C� Job Description: Residential Ed pe-plaee Commercial ❑ Flo ca.S WCUT Wfwref- - ScAme- OCA1'i ur = Gc-i'c Cost of Project: sec) Strapped On Platform Z Bonded New Location ❑ Replacement 191" Qty. if FPS Deccrintion Fee Group L� 11121V1G l w 11/ BPWHEATER - -- - ----- Water Heater / Vent BUILDING PPERN FFEE Plumbiniz Permit Issuance PLUMBING I BENERGY Energy BUILDING BUSLIC Business License BUILDING CITY OF CUPERTINO 4 ITEMS OF 12 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk.: Lot: APN ......... 36212009.00 DATE ISSUED.......: 10/18/2007 RECEIPT #.........: BSC00003023 REFERENCE ID # ...: 07100134 SITE ADDRESS .....: 84' SEPTEMBER CT SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER VEFNAZZA LAWRENCE P JR AND REN ADDRESS 84- SEPTEMBER CT CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4125 RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY/STATE/ZIP TELEPHONE .... AFFORDABLE WATER LEONCE ROUX LIC # 26850 AFFORDABLE WATER HEATERS & 2407 SAN FERNANDO RD NEWHALL , CA 91321 (6(1)259-7131 FEE ID UNIT QUANTITY IMOUNT PD -TO -DT THIS REC NEW BAL ---------- ---------- BSEISMICRE ------------- VALUATION ---------- 1,500.00 ---------- 0.50 ---------- 0.00 ---------- 0.50 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 PRWHEATR UNITS 1.00 24.48 0.00 24.48 0.00 TRAVDOC 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 CITY OF %'UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: X 4 3 PERMIT # 0-71 DO13`k OWNER'S NAME: Q -m VP-rr, a ZZ, PHONE # off - 4 6- S GENERAL CONTRACTOR: h4 Wi k C Ak FAX # '' T st(dY�50 _ I am not using any subcontractors: m t- I " a Sig mature Date Please check annlicable subcontractors and com >lete the following information: Owner/ Contractor Signature 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 Date