06060004 CITY OF CUPERTINO k° '•^ y "'�'"`` TM��" °' '
BUILDhNG DIVISION PERMIT p�C,ONTRACT, Qft 1WO�RMATTON'
BUILDING ADDRESS: BETTER WATER HEATERS "E'(MIr NO'06060004
19985 BRENDA CT
OWNER'S NAME: PERMrr ISSUE DATE
A I
SHAO CHANG JEONG 351 FALCATO DR. 06/01/2006
E SANITARY NO. CONTROL NO.
(408) 250-6672
ARCHrtECf/PllfsINEER: BURRING PERMIT INFO
BLDG ELECT PLUMB NEGH
0 0 0
�0 LICENSED CONfRACrORS DECLARATION - Job Description
m 1 tO,Oby aHlno bis 1 w IixmM u°da V.,baaat a Chaper 9(.rnencin, P
'i" rithScctbn 7001))of Divimn3afbc Btu«s and Prof mcoom, ntrlkmtxu
arw r« M a« g 28.1 REPLACE WATER HEATER
gay—�—°.L �� �L �
ARCHRECI'S DECLARATION
i I.M OdmypWa NWl bc,rada publk rtc«tlh
,yU DECLaRATTON
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0� LicmeJ PNfeadonal JUId �/ (`
5 (\ 1 bcmby hIr.Ibis w Oxco pF mm the C°nu Vl LIm,¢IAw f«Nc 2oOt�
I c o fallowing m O_(Sccuon 703 1.5,Badncu and PNfcmnm Coda:My Oily«county
$ .,bice rmnfau.Pmmit to c«mam,,Wer.I OP daradHh,m mpcir any auavvrt $800
-zr PA.0 its i+oanOO.a4°rc9acetdo.ppL.1I.smhpmmiL to fk.altmd aa,wma
• < bubcI.licctasMpormantlobOS.ifbnaafdeCo w--&,Li..I w(Chaptc9 Sq.FL Floor Area al
3�9 (commencing. Section 7000)Of On ision7 of be Bu antiPmfrsima Cade)«
an
a,ao aOt be base r«be.tn,ea®pleN Any vW.uoe d
NO
Sadm 7W1.5by boom uod f«a peml,wbjma be.ppfiant n a db pwhY Of r Occupancy Type
as nt«e,b,a h.a b,mdrtd adwa(150(f.
❑1.uaw,caf It popray,«myu°Plm/�wib mtouthen ode compmaadm, '
.ondaba.en.wd,Tb,C �mtjL wLa.OloOs apply
a.,e Of Required Inspections
hM P yviaon Calc:The titatona ndrn lav don cot hi n an awgh ut
prape,ty.ba WJNalmp,mabeeo,c.,WwEo. Ibo.«k blmselfor bar sa this
manw.t,Obo,pNv1or npnJaol atent i,"d Orttz Mtincot Onadrd«dfertd r«oak.I,
bowma.be balldint or jOn Ofa°m°ih hold did arc yell of c,apronO or EKOpo o.,cf
builder.N baa+,M Maden d pNvinL that be did m bmtl«vnpN.e r«I,ntp°'<M
sak.1
0 L a w„n a be P,apmy.w ndutivrly consa.'alnL With 0cemed comma b
Ommoct be pro OO,(Sec.7044.Bt.,OO,a and Paratium Code:)Tec Cml.oana u
Oona La.don not,P,ty n a o.w N pope y.ba bdlda or OOP haoOOO.and.
wbo can,raca far a"A W*M wnb.cmr uaru)Iiunsd po'a.nl,o de Coouannrs
Llome La..
❑Iweawpvoda Sre ,Baperbr lartam
O.rc W to
WORKIBis COMPENSATION DECLARATION
I bmcby affunt mtler penalty a peryay me Of,he fdbwint'—�
I W.eaM.01 nuint,in.COnif.a Cm.ent In alf4maurc for Owor .cornpen-
.on.u pNWded(or by S..7810 of dt Lothar Code,for be pOdana m of the
work for vhic4 bis ptml,u hued.
❑1 baa+artd.01 noomin Women.Compcoa .Inwaac,a rty,drtd by Semon
37 or th lab«CaJO,I.be perfomu«n of be an or ich this p,nb ulaaN.
My W°hens on 1„v,rulCe o,riu ad Policy„wbtx art:
' CERTIFICATE OF EXEMPnQV FROM WORKERS t
COMPENSATION I RANCE
(Tbu secnm,ted oat ba to npkmd Ibe anot h forme hu„med Eobara($100)
or leas)
I«t,ify Wt in da pc .,ax of thho wa,i for which els permb is istna4 INWI nn
tmpbry any person In any m•°, s�l ���°Nbiolt On beW Wk. C«tpOnwJna .
Applicant,
NI
N
NOTCE
OIICE TO APPLICANT.If.Cnomakintthis Cen of of Labor Codyon i1 On.
Tw
became Nbfem y ,he Wore r CaOOS W tbm proHn«u d b°Labor Code,yon moa
.,O f«th.ib m,nPlr web trach Pat'id°n«bio permit W.II ho deemM math. '
z CONSTRUCTION LENDING AGENCY
[—t r I bmeLl allhm this there la a ca,w,acGm lmdln,agency ford he M1afamat¢a
p: > ,he.«h for which this puvdt in ia,td(See 7097.Ch'.Q
W z ISMcnt N.me
� ,z laMcfs Adbev
U 0 1 a fy Jut I have mad this aPPIl .and not that the abat udarrnation ta
U.E conch I atrt On emglr wW,JI ci,y and cantly aNi,arcu.nd Nue lava mlnint on
C) Wildiag cmuvonim aM bcmby aut,orim mprcxmui,ca of bis city m°nam upnn dt
>+ 4above-mentiw,ctl progeny for i 'ttiun purywev
Hve
(We)at=to a ,indcmtrdfy aM p humlea dt City aC°pcnim again,
(A IiaMB,ki)°dP°c°u.caasaM UT"^whlN m.Y In wY vayamve,L,IvataW CJry
U Z in conmqumo of the Land.1 of bis M.IL '
^�
APPLICANT UNDERSTANDS ANDVLL C PLY WITH ALL NON-POINT Issued by: Date —dL
�1 Re-roofs
Sltna,Wa of AppllonlCmUoOnr Disc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W,0 the ap'iiant or fuaac b„Idlnto ,V.L N«a«baMle bmNoo;nuoc al
as deflasl by Jc Copenino Municipal Cob.Gaper 9.11,and the HW d,and Safmr
Code.S«don 15571(.)? All roofs shall be inspected prior to any roofing material being installed.
C3ybat No If a roof is installed without first obtaining an inspection,I agree to remove
W U dt applkaa
Or future bdWlnt« rat use toot'namt or dcvkca w b
«nth 6.aNan alr on,wiaunu n&need by the Bay Ara Air Q ai,y Man.Lcmcn, all new materials for inspection.
D v 7
❑Yn ❑Na ,
I h.ae rod dt hanedom ntaletlall rtqu'verrcm ta,Jm CTaptr 495 dee Cahf«.
trio Holo&Safyy Code,Sas«u15505, my pond 1itya,dorytthaldt EuiBSvt
d°ah n«mooned)bac,an,an�dw b u my rtipgmbilily t ratify dt ocmgan,d the
cowl _ mia°�'°C1 �• 1tl1C0f Signature of Applicant Date
Don. All roof coverings to be Class"B"or better
owmr«N,narvcd. d
'a
mmunity Development
10300 Torre Avenue
I' Cupertino CA 95014
Telephone(408)777-3228
pF Fax(408)777-3333
*�UPEI�TINO
Building Department
JOB ADDRESS: q R or a Cfi_ PER�� O o oS
OWNER'S NAME: PHONE # '(Ge- 6 72
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
— Com✓ C/~ O
Signature Date
Please check applicable subcontractors and complete the followinginformation
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
1
r,
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36943002 . 00
DATE ISSUED. . . . . . . : 06/01/2006
RECEIPT # . . . . . . . . . : 34640
REFERENCE ID # . . . : 06060004
SITE ADDRESS . . . . . : 19985 BRENDA CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SHAO CHANG JEONG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : BETTER WATER HEATERS
CONTRACTOR . . . . . . . : FRANS CARTWRIGHT LIC # 26514
COMPANY . . . . . . . . . . : BETTER WATER HEATERS
ADDRESS . . . . . . . . . . : 351 FALCATO DR.
CITY/STATE/ZIP . . . : MILIPITAS, CA 95035
TELEPHONE . . . . . . . . : (408) 250-6672
�EE ID UNIT QUANTITY AMOUNT 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
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 84 . 02 298
TOTAL RECEIPT 84 . 02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
CITY OF CUPERTINO 0(-00(-o CGO �
a, WATER HEATER
CITY OF
•CUPEf�TINO PERMIT APPLICATION FORM
APN #
Building A
Owner's N e: Phone#:
Contract (ti a ' lPhon .fob 2S� 6 License
: 1
Contact: T�Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect Plumb Efl� Mech
Job Description:
Residential Commercial ❑
Cost of Project: g�
Strapped On Platform Bonded
New Location ❑ Replacement
Qty. if
A licable Fee ID Fee Description Fee Group
1 BPWHEATER Water Heater/ Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING