06050012 F
TYOFCUPERTINOBUILDING DIVISION PERMIT CONTRACTOR INF.ORMAT=IOy + .n ., a ��: =DINCADDRESS: AFFORDABLE WATER HEATERS & PMnNo06050012
749 BROOKWZLL DR
ERS NAME: PERMn I55UE DATE
MCGHIE DUANE B AND GENE M 24707 SAN FERNAND 0
PHONE:
SANITARY NO. COmROL NO.
(661) 259-7131
ARCH=IENGINEER: BUILDING PERMIT D O
BLDG EIECf PLUMB MECH
166 LICENSED CONTRACTORS DECLARATION JOb Description
zzC 1 hereby,form that I un licnwi under pnotia«u of Cheptf 9(motmrmint
W NN Sccdon7000)at)i.iion J of the Budnev orad l doatmoa Cool,, my Rce,sV
Lwlf.artd�= ' WATER HEATER-REPLACE A- 1�GALL'ON�SAME LOCATION
inens Tic... F .J'o $y��
M Dat
IGawaaor f
�qq ARCHRECR D_CLA N
V Ivn�rsund my pWu wRmu¢au puhl Na rr rl ^
c LiCcued Pmressboal r I �GL�
OWNER-BUILDER DECLARATION
I botchy air.Wh 1 am campt Imm hb<Cams oes licmte taw far Nc
OO foltnainttason.(Sccd 71DIS.B,,in-and Pmfawas Cock:Any city Or county' �. 900
3$ nice squire,,pooh m cenuneL aWi,inopmla,bnndHb.«mpav any Rr«wm
_2 error m'as iaurce.ilio mqulres the ippliaa r«such PCrmih�a Ok aitrcd itar<mrnt -�� 4a
< Nn ft Baena purmeu m Ueprovision Of tbC Contractor's Luse fa.(ChW-9 Sq.Ft. Floor Area (fU V Valuation
Sr$ (earomcneint Mth S«tiea 7000)of Dwition 3 Of Ne Buanns and Pnore¢ioru Cock)« v
- this le h.,x the j.and Ne hut,for the ilicii d nrmpuon My viaatlOo of
Sccdan 7031.5 by any Witcaru em
for a plt nthe tbit= a iticmt m a Ciyd Prouty Of r Occupancy Type
ooh nowt tmn Bw htmdtcd Galan($SW}
D L u.of the pt.?.Iy,or my wploy«a vXb.ap u Net not Caoprmadoe.
will ,Nc work W Ne roue,mei,notmvodcd«awed for saic sm 70 u.Boca. Re tired Inspections
aM «
PtOresau Cadre The Canuac r$I;«ns Lar don not apply in an ester of 9 p
Property rbc,hulas Or rnopmes Ueae,and rho des s chv M.-If«d .,b his
mvp cmploycet pewkcd this sock Impameraeu are not N cccJW«OBerW f«sales If.
hO.ever,the balWioS«"vopmsemeu a mid WNin ate)ear ammpkda.Nc wm-
buOOcr wiB hate Ne Ehvdm of Ptm'1^t neer he dW tw bwtl«inopmve f«propos a
aelc)
D 1.a,mmcr Of Ne projn rty.w o Onively coetractint rah Bnmed meurton to
comers to p,cci(Sec 7064.Brod.aOd Raresaom Cade:)The Co caac ars Li-
.la.doermtMAY tm.aF-POrtyw boom«unpm.c,Ncrtao.and,
,,bo contncu f«such pmjr=a ih acomc acmr(s)lined Perm+^r on the Cneuarmrs
LIQ V..
❑lam hemp«hd ee .B&PCforNia.
mer DoeS- I—OL
IORKERS COMPENSATION OECI.aRAT10N
1 hereby dirm ender pevaRy a!PcJ«l hoe a th falhrviot dM^^��
D Ibs.e,od dcdfor ySe tnrUOot dCa Labor slranmm f«Wform Campeo-
utas u pwided f«mi Satbn J'!00 a the Libor Cods far to pafaamucn a the
rcrk fm.huL his pmnit Is ismc4
D 1 bate amt will maintain Worbers Campensulan Imv,na.n rNmW by SCCIMA
J700af on,lab«Code,I.tho pcR«mrseerr the wort for b this permh ulnuctl.
My Workers Cm mazattioa htnuanCc Carie W Patty rumen art:
Canfc. Pally No,
CEIMFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE a
rRu acct.aW can Ie ampk BUB pcmh U fc,.hvntrN dollars(5100)
mhos)
I amf7 Net in the p«f«man¢of the rob r«rbicb Nis Permit 1,Lmcd,l auB o«
employany pc.N any.roarm asa biome mbfmmNeWW C«npvmdm
Ino or Ciifnmia.Datc
Nancy
NOnCE TO APPL WorioIf,Gtrnoakintads ,,wos or a Ecemptirolyesihakl
baamc mbja,m Ute Wanc�r,C«nPcmtion ormit"a Ile lab«Coat yes notes
.J O raMMN comely with such pmvWons or Nu pmanit shill nc d«.meE mwitca. '
Z � CONSnUCTION LENDING AGENCY
[-.... I bacny affrm hu dere u a cunarucilm Ivdins ateay far to Perrarmuae a
C'> the wok r«.hie this Pcrmit is iaued(Sec.3047.Ch.C)
LQ G] Maar.Name
z Iande/a Aadrns
U 0 1 a oify Nu 1 h,vc rod W.appliaim and nut tbu thc,botc Nfarrnatian h
p, cmmct 1 atra tO comply with all city not Canty ordlwta„nd sou Is.s tcluint u
C) builtlint coeurvcuon."hcmby mNarix o:p ..ti of this city to ctncr upon Uc
0. ahu mcndOad Mo rty for Inspcmon pu,pasca
(We)ohne to sate,indemnify aha kap barmk9 Nc City of copertinn aj W
Hh liabilities,)oattnenu.cans ancicx uu which ma/In any.,y aCvto Maim said Cit
UZ in cvhsgmce of tint grandnt of this p is
^ APPLICANT U FAST DS AND W ILL COMPLY Wr H ALL NON-POM Issued by: Daze
SOURCE RFLU TIO
t ldi! 4'('01 Re-roofs
Sitcuam ofA k HVCaunnar ERIDat
— AZIRDOUS MATAfS URE DISCLOSType of Roof
Win ft tt liact or futre bwWo¢u«vpuLL sane«hand"bavNpu—nd
m cca a by the Cupcnino Moold Cocic.ChaWr 9.11 arta the Health and Swcr
-Odc.Se 25533(.)7 All roofs shall be inspected prior to any roofing material being installed.
Dy.
Win Ne applicun«mt«e Imildint 02mpano ere e9haPmtmt«m.+ae rhino If a roof is installed without first obtaining an inspection,I agree to remove
emit hvardtws air anumimnu u by Nc Bay Area Air Qw Iry Muotctw:a all new materials for inspection.
Dvuic7
Cl Ya
I hate noad Ne wmaerWasgsicmcvu umtr CTapaMS93ortbe Ullfm.
nla Halth&Safuy Cad_ , 'tau 0505.25533 aro 0534.1 wgcauM tut Bae bolting
a«a nes ctmerWy ba. Gal Nat It a My reapanilbuit t,eery tc oaigmh a the
m.P,i,enema wh+cn« 'emuormina,«x oh cwre,t aomhpmCr. Signature of Applicant Date
I -U.b All roof coverings to be Class"B"or better
Owac or auV_ . h Date
CITY OF CUPERTINO
IO 4 of 6 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36921007.00
DATE ISSUED. . . . . . . : 05/01/2006
RECEIPT #. . . . . . . . . : 34203
REFERENCE ID # . . . : 06050012
SITE ADDRESS . . . . . : 10749 BROOKWELL DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MCGHIE DUANE B AND GENE M
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4608
RECEIVED FROM . . . . : AFFORDABLE WATER HTR
CONTRACTOR . . . . . . . : LEONCE ROUX LIC # 26850
COMPANY . . . . . . . . . . : AFFORDABLE WATER HEATERS &
ADDRESS . . . . . . . . . . : 24707 SAN FERNANDO RD
CITY/STATE/ZIP . . . : NEWHALL, CA 91321
TELEPHONE . . . . . . . . : (661)259-7131
0
FEE 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
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
________ ____________________________ ________ ____________________________
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
Community Development
10300 Torre Avenue
a ; ' �' Cupertino CA 95014
Telephone(408) 777-3228
CITY F Fax(408) 777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #��0��/�
j07H� 13roc+V-wPll nr -
OWNER'S NAME: , c �,; PHONE #
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: 16W4 3-r-06
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
S-r-b6
Owner/ ntractor Signature Date
CITY OF CUPERTINO
WATER HEATER
•CUPERTINO PERMIT APPLICATION FORM O�oQSDO/dZ
APN# 7/^a / �D Date:
Building Address:
f5rooy--Wel Or,
Owner's Name: Phone #:
5e_ar mLG ► ;e_ yob- 3-5aL- 41 `{ �
Contractor. Phone: ale 1 License#:
brfDrd66le oTe ec -rs 13 I (off-) 3L
Contact: Phone: bbi Cupertino Business License#:
coV- LiTrIe(: eld 5 o7au
Building Permit Info:
Bldg ❑ Elect Er Plumb d Mech
Job Description:
ReMC.e_ yo atlon WATer Homer (SQme dee ;zn
Residential Commercial ❑
Cost of Project:
�juu,
• Strapped On Platform IJ Bonded
El-
New Location ❑ Replacement Eg
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMTTFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING
•