07050247 CITY OF CUPERTINO
BHILDING DIVISION PERMIT G R I Of MUTI0N*
fPERMIT NO.
BUILD PL AFFORDAME WATER HEATERS & 07050247
OWNER'S NAME:
PERMIT ISSUE DATE
FOTOUHI BAHRAM 24707 SAN FERNANDO RD 05/24/2007
AE: (661) 25 -7131 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
p O LICENSED CONTRACTOR'S DECLARATION Job Description
Ut- I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Zwith Section 7000)of Division 3 of the Business and Professions Codc,and my license is
REPLACE 50 GAL GAS WATER HEATER/GARAGE
?`4 w in full force and effect. �'
? License Clas^ Z_Lic.8
E Date Contractor
ARCHITECTS DECLARATION
i a< .1 understand my plans shall be used as public records
)yU
U.y Licensed Professional
y OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
00 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
Zy 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 q.Ft.Floor Area $1300 Valuation
r F (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or
i r3 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 A��jj Number Occupancy Type
not more than five hundred dollars(5500). 3264403 L .t1�
[11.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 forsale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of fl p
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 Contractor's Li-
cense Law does 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.
❑L am exempt under Set. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of to Labor Code,for the performance of the
work for which this permit is issued.
&ftave and will maintain Worker's Compensation Insurance,as required by Section
of the Labor Cook:,for the performance of the work for which this permit is issued.
My Worked ompensatio/��n Insurance carrier and Policy number are::
Carrier7Z e^i� Policy No.: Z Ob
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rhis 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.1 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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z' CONSTRUCTION LENDING AGENCY
(�►�-� I hereby affirm that there is a construction lending agency for the performance of
p! �✓ the work for which this permit is issued(Sec.3097,Civ.C.)
aQ Lender's Name
2 Lender's Address
U 0 I certify that 1 have read this application and state that the above information is
w h— correcL I agree to comply with all city and county ordinances and state laws relating to
Vbuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
CL (We)agree to save,indemnify and keep harmless the City of Cupertino against
hF- liabilities,judgments,costs and expenses which may in any way accrue against said City /�
V'Z- in consequence of the granting of this permit. Date L, tC' 7
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS. J 1� I
ek;y- r Y " Re-roofs
Signature of Applicant/ConArklor Dare
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya �(J'to
Will the applicant or future building occupant Liss equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new mi.terials for inspection.
District? y y
❑Yes to 1'
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
niaHealth&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building (�6�
does not currently have a tenant that it is my responsibility to notify the occupant of the
requirements which mu met prior issuance of a Certificate of Occupancy. $IgnatUIe() Applicant Date
14 -�'- � L�`D�' All roof coverings to be Class"B"or better
Owner or authodAelfagent Date
CITY OF CUPERTINO
3 ITEMS OF 12 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32644031. 00
DATE ISSUED. . . . . . . : 05/24/2007
RECEIPT #. . . . . . . . - : BS000001455
REFERENCE ID # . . . : 07050247
SITE ADDRESS . . . . . : 10592 ESQUIRE PL
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER FOTOUHI BAHRAM
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1318
RECEIVED FROM . . . . : AFFORDABLE WATER
CONTRACTOR . . . . . . . : LEONCE ROUX LIC # 26850
COMPANY AFFORDABLE WATER HEATERS &
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
-------- ---------------------------- -------- ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
CITY OF CUPERTINO
WATER HEATER
an /� C of (.-� ;��J 6a 61�
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
36--? 1 s
Building Address:
Owner's Name: Phone#:
1�cti1.,�am ruu� ►' W0y- 4y01- (oU(
Contractor: Phone: (-(a t License#:
Affr)r&610- aTe acres 4'51 -713 1 (09131 e
Contact: Phone: (Pbl Cupertino Business License#:
cow Li IT Q1�-o
Building Permit Info:
Bldg ❑ Elect E�— Plumb d Mech
Job Description:
Residential Ef Commercial ❑
2 aeeSuMe 1 ocC,r�'n� = Gw'c� e
Cost of Project:
13DB `
Strapped On Platform Bonded
New Location ❑ Replace ment E91,
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERN FFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING
Community Development
10300 Torre Avenue
41
` Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPE�TINO
Building Department
JOB ADDRESS: PERMIT #
( L fJLwire PL
OWNER'S NAME: ->, p PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and co,m lete 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
- -�- / - � >
Owner/Contractor Signature Date