06050011 FlUILDING
OF CUPERTINO
ILDING DIVISION PERMIT 1?CONTR A70R INk'ORMATIQN
.+ ., -,fir. ;✓,.i';9.�,an fa -nl> 3'
ADDRess: AFFORDABLE WATER HEATERS RN0.06050011
47 TWILIGHT CT
EW NEWS NAME: PERMn ISSUE DATE
BOB SARGENT 24707 SAN FERNAND
PHONE:
SANITARY NO. CONTROL NO.
(661) 259-7131
ARCHRECT/ENGINEER: - BUILDING PERMIT INFO
BLDG EIFCT PLUMB MECH
0 0 0 0
±o o LICENSED CONIRACrOR'S DECLARATION
5ed 1 hereby affirm Nal l am licensed under provision of Chapter 9(commencing Job Description
UE with Section7")of Division 3 of the Business and Professioru Code.mad my Ike=is
mfull mteanriIf
WATER HEATER-REPLACE 50 GALLON-SAME LOCATION
Liavc Lac.e 6.17 V
q Da¢ Conuanor
E ARCHRECI-S
Pro 3g N
w U I undcrsund my plans she
W used az public tecords
a
o Licensed Pmfcssional
3 OWNER-BUILDER DECLARATION
M I hereby affirm that I am exempt from lie Contractor's License Law for the
A o following reason.(Section 103 L5,Business and Profcssinv Code:Any city or county
5_ which tequi.a permit m cnnsuuc4 alcor,improve,demali h,no repair any structure $1100
Z i prior m its issuance,also squirts the applicant for such permit m file a signed summem
s< thaWislicensed pursuant totheprovisions ofthe conlmema
raun,eLaw(chamcr9 Sq.Ft. Floor Area Valuation
ERI (commencing with Section 7")of Division 3 of the Business and Pmreuinns Cadc)or
9 that ase Is exempt therefrom and than basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Nr aPplkanuo a civil penalty of -5 April
nos mote than live hundred dolls(5500). T Occupancy Type
❑L,as owner of du property.or my employees with wags.as Nc4 sole compevishm.
will do the work,and On suumurt is no,unhurried or offered ronale(See.7131 Business id Inspections
and Professions Code:The Contractors Lime Law dna IA wrens Out apply to an mane,of p
property who builds orimproves themon,and whodoesauchwork himselfor through his �/
own emplaynes.provided thatsuch improvements are lmtinteMed oraffeed for ale If.h.um,,the building or improvement is sold within ane year ofcompictian,the owner. /�/ y�y''fyA
build.will have se hhim=of proving that W did ret Wild or improve for purpose of
ask.).
❑1.u odor of ct property,.B sines. dd contracting with licensed mmemers -
construct the project(See.o an Business and professions Code:) pr Conuaemr'a nd
cove Law docs rot apply e ts owner of property who ted p or improves Compac and
whocontractsLace for such projects with a contracmr(s)licenced pursuant b the Convutar's
License Law.
❑lam exempt under See .B&PCfar this roawn
ncr Dau
WORKERS COMPENSATION DECLARATION
1 hereby affirm under Proudly of perjury eco of her following d,mlarmiov:
I him and will maintain a CertiOcam of Cmuent to self-Insam for Worser'sCompen-
eadent is provided for by Section 3700 of the Later code.for the perform.of the
wart for which this permit is rood.
❑I have and will maintain Workers Compensation Insurance,as recruited by Section
3100 of the Labor Code.for due perfomanre of Ne work for which this pemt,is issued. '
My Worker's Compensation Insurance ani.end Policy number mr:
Cartier. `The— �Cr`+TI-- Policy No.: �067f�j&-7L)l
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('Ibis section reed ret W completed if do permit is(mane hundred oil=(SIM) r
or Less.)
I=mfy Net in the performance of the work For which this permit is issued.I shall in,
employ any person in any manner so as an Wcumc subject 10 de Worbcrs Comp.uadon
Laws of California.Dam
Applicant
NOTICE TO APPLICAFT:1f,after making this Conform of Exemption,you should
become subject to the Worker's Compensation provisions Of the Labor Cade you mus,
.Jz forthwith comply with such provisions or this permit snail be deemed revoked.
z OCONSTRUCTION LENDING AGENCY
Prhereby hcTm that them isaded30 lending agency for the Performance of
FC> the work for dnich this penin u iasned(Sc,.(Sec.JD97,civ.C.)
Lenders Namc
z Lmndeh Aridmu
U Q I certify Nat 1 have mad this application ail tam N.the salve infomatiun is
U. P cam¢I agree to comply with all city and county ordinances and stare laws relating to
QU building construction,and hereby autharne mp+esentatives or this city to enterupnn the
Fgs] almm Ontiunud property for inspccdon purposes.
py (We)agree to save,indemnify and keep harmless due City of Cupertino against
h liabilities,judgmcnts,costs and expenses which may in any way same gates,said City
U z APPLLICANT UNDERS AN Of
AND WILL COMPLY WITH ALL NON-POINT Issued by: Date l
SOURCE REGULATIONS.
�,24 Re-roofs
Sigentve of Alliin manor Date
AADOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding asupantmote orhandle havrEav material
as defined by the Cupertino Municipal Cod,,Chapter 9.13,and the Healdt and Safety
Ir. ❑ ON
Section 35533(x)? / All roofs shall be inspected prior to any roofing material being installed.
Yes
If a roof is installed without first obtaining an inspection,I
Will Ne applicant or future building Occupant use eyvipmenl or devices which g � agree to remove
emit hxvardnv air conumivnu uW rod by the Bay Area Air Quality Management all new materials for inspection.
D'suia?
❑Ya
1 have mad the,hcood.materials requirements under Chapel6.95 or Ne C.lifor.
ria Health A Sirdy Code,ScictiAs 25505,15533 and 25534.I undersand Nu ifthr Wilding
does of co endy hast a en Nati s my responsibility b notify do oecupant Of NC
requirements which must W Ipria,Jnuance ofacen11=0f die
of Applicant Date
C wner or nNamcO an Da¢ All roof coverings to be Class"B"or better
O
` CITY OF CUPERTINO
*em 3 of 6 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31631035.00
DATE ISSUED. . . . . . . : 05/01/2006
RECEIPT #. . . . . . . . . : 34203
REFERENCE ID # . . . : 06050011
SITE ADDRESS . . . . . : 19947 TWILIGHT CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BOB SARGENT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : AFFORDABLE WATER HTR
CONTRACTOR . . . . . . . : LEONCE ROUX LIC # 26850
COMPANY . . . . . . . . . . : AFFORDABLE WATER HEATERS 6,
ADDRESS . . . . . . . . . . : 24707 SAN FERNANDO RD
CITY/STATE/ZIP . . . : NEWHALL, CA 91321
TELEPHONE . . . . . . . . : (661) 259-7131
•
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
502FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
Community Development
10300 Torre Avenue
l Cupertino CA 95014
Telephone(408)777-3228
�UPEkTINO Fax(408) 777-3333
Building De artment
JOB ADDRESS: PERMIT #
Ali s 6
OWNER'S AME: PHONE #. 3 '
GENERAL CONTRACTOR:
I am not using any subcontractors: A04 /"6t,
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 / oh
O er/Contractor Signature Date
CITY OF CUPERTINO
WATER HEATER
OF
CUPERTINO PERMIT APPLICATION FORM
APN# 2 ✓7 S— Date:
Building Address:
I y Tw I" � r hr
Owner's Name: Phone #:
Rod SKr e_n-r- Noir- yHb- 3�J
Contractor: Phone: (c(e 1 License#:
hffDrdcx61P_ Worer 4 eure-rs 651 13 1 toa-731 I?
Contact: Phone: &tof Cupertino Business License#:
coT Lllr ( eField
Building Permit Info:
Bldg ❑ Elect Plumb Mech t7
Job Description:
c,u_ SWoxer NeaTer (Same doe 'Dn
Residential Commercial ❑
Cost of Project:
1 ( DO—
Strapped ;FT On Platform ❑ �p�Bonded
New Location ❑ Replacement "
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
( BENERGY Energy BUILDING
BUSLIC Business License BUILDING
•