08060178 CITY Ok'CUPERTINO
BUILDING DIVISION PERMITa rOun •9,:lT-RACTORANFORMATIO
a .:mak;.ra i, s.a.•:„`x'�' v"^..l•;nd ,
PERMIT NO.
BU'9'I'�Dg�S:PTOE LN ' AFFORDABLE WATER HEATERS & 08060178
OWNER'S NAME: PERMYf ISSUE DATE
SARJEANT MARK P AND MAUREEN I 24707 RAILROAD AVE 06/24/2008
NE:
SANITARY NO. CONTROL NO,
ARCHITF.CfsENGiNEER: BUILDING PERMIT INFO
REPLC 50 GAL GAS WTR HEATER 'BLDG ELECT PLUMB MECH
0 O O O
u00 LICENSED CONTRACTOR'S DECLARATION lob Description
sd U F I thereby affirm that 1 am licenxd under provisions of Chapter 9(commencing P
'raj with Seetion 70M)of Division 3 of NC Business aM Profeuimm Code,.M my licensee
N in full forte an ;f(a L 2 '
z Wcense I s Lk.a
-h,❑ Dao: Contractee
n ARCHTfECI'S DECLARATION
LL 1 undcmand my plans shall be used as public records
JOU
g 0 Licensed Professional
OWNER-BUILDER DECLARATION
E 1 therebynaso alum that 1 am exempt from Ne Comnno/s e:Any c Law for the
p O following waa(Scum]03L5,Business and Rofexsians Cade:Any city or enemy
which its acquires a permit to emnIlk alar,improve,demnlet are a sig ed atrumum
_Z< prior to its issuamc.also mquim the applicmtforsucM1 permiuo fileasigneJ summon
Icommun ingwitpurwanuoumprovisions 3the eBuxwr'andprofLaw(Cbapm9 Sq.Ft.Floor Area Valuation
rtom-$ that M inci.gwith Section 70W)ofviveionJ of theBusinessand ProfessionshCould)ur
-
that he is cxernpt theufmm and tic base for Ibe alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects da applicant to a civil penally of APN Number Occupancy Type
not mom Nan five bundred dollars(SIM.
❑1.u awme of the Property ee my emPloyeas with wage a the'v sale compennatian,
will do Inc wart and Ne swcture b not intended eeoReted fmsale(Ss,.]0th,Busirma
and Pmreaaiaas Cade:The Canmcanrs Lianas law does rot apply w an mover of Required Inspections
property who Wilda or improv thereon,andwhodassuchwork himtelfor through he
Own employees,provided that such improvements as not immoded oraRered feesole.R.
buweves,the Wilding or improvement is sold within one year of completion,the owner-
Wilder w10 have the burden of proving that he did not Wild or improve for purpose of
sale.).
❑1,u ownm of the property.am exclusively'co ns eamg with licensed com amore m
mnstroct the,project(Sec.7066.Business and Professions Cade:)The Cmuaemrs Li-
ecose law does,not apply to an owner of property who Wilda or improves thereon,and
who contnce for such prejecu with a cantrxmr(s)licensed .at as the Contractors
License law.
❑I and exempt under See ,B A P C fm this mason
Owner Data
WORKER'S COMPENSATION OECLARATION
I hereby aDim under penalty of perjury area,of the fallowing declarations:
1 heve and will maintain a Cenificam of Comeot in self-fume for Workers Comport-
nation.as provided fm by Sanson 37W of the labor Code,for the performance of the
week fm which this permft is issued.
1 have and will maintain Workers Compensation Inwnna,as tryuired by Section
3700 of the Labor Cade,for Ne petfomanec.t Ne ,it forwhich this permit is issued.
MY Worker,Compensa6 ,Inced.carrier aM Poliry number
Carrier. Poliq No.:��� 7 y�g7
CERTI CATE OF EXEIvIMON MOM WORKERS'
COMPENSATION INSURANCE
(Thusec im Iced mtbecompeted if the permit is froom hundred dollen($lW)
or les)
1 certify On,in the perfomancc of the wart Ire which this permit a blued.I shall not
employ any perm.in any manmr ad as in become subject to the WorkeW Compensation
Laws of Califamia.Dam
Appllssnt
NOTICE TO APPLICANT.If,afmr making this Ceruficam of Eacmpdon,you should
become suhjem in the Workers Compenskuon provisions of the Labor Cade,you most
.J z forthwith comply with such provisions or this permit shall be doomed revoked.
E”' CONSTRUCTION LENDING AGENCY
[-t Ihemby f.whih thi dmdmaeacamSectinnknding agency for the perfomence of
E
the wart roe whim the pcmn is issma(Sea.3097,civ.c.)
IC7 Q Lender,Name
z lenders Address '
U Q 1 certify Nu 1 have mad this applicadon ssW sum drat the above information Is
(L P Comm-I agree In comply with all city and county uNinamv and aisle laws mlaung to
0U Wilding couwcuan.and hereby authorise mpruenurm of this city to enter upon the
li mrc-menuamd property for inspection asxi purposes
H y (We)agree w rove.indemnify mrd kap harmles the City of Cupciuno against
to incomacquece, fh,coatsmd expense which may in my way accrue agsinstnaid City
Uz incense AN'r ar DEMsTting of 9rtn, q S
t� APPLICANT UNDERST AND WI MPLY WITH AL NON-POINT Issued by: Dale i Ci -b
SOURCE REGUTA �
stgnawm ar ApplianVC/ - �61- Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding accupmtswm oe handlo hn'allous mamriJ
as defined by dm Cupertino Municipal Code.Chapter 9.12,and the Halm and Safety
Cade.Section 25532(1)7
�yex P� All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will Ibe applicant or future Wilding ta:cft B1use equipment of devima which P g
nit hosardnus air conumisunu u d y the Bay Ama Air Quality Managcmcnt all new materials for inspection.
Diane?
❑Yes Nu
I have romcheh ,Nom materiae mquimtrcm undcrCTupv:r6.95of0mCalifor-
nia Health A,Safcl d•r ccuons 25505,25533 and 25534.1 understand that if the Wilding
docs Out exorcist hi.that it is my Iespomibility as notify use occupant of the
requi o whi m b t orwissuarecofaCmiRcam of0
4 y�l �f p; Signature of Applicant Date
9 `�( All roof coverings to be Class'%Q"
Owner ar naw onmd aCcm Dam' g or better
CITY OF CUPERTINO
• 4 ITEMS OF 20 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35932056 . 00
DATE ISSUED. . . . . . . : 06/24/2008
RECEIPT # . . . . . . . . . : BS000005201
REFERENCE ID # . . . : 08060178
SITE ADDRESS . . . . . : 7470 TIPTOE LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SARJEANT MARK P AND MAUREEN I
ADDRESS . . . . . . . . . . : 7470 TIPTOE LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5819
RECEIVED FROM . . . . : EDDIE D NALLEY
CONTRACTOR . . . . . . . : LEONCE ROUX LIC # 26850
COMPANY AFFORDABLE WATER HEATERS &
ADDRESS . . . . . . . . . . : 24707 RAILROAD AVE
CITY/STATE/ZIP . . . : SANTA CLARITA, CA 91321
TELEPHONE . . . . . . . . : (661) 259-7131
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- --- - ----------
1BSEISMICR VALUATION 1, 100 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1PRWHEATR UNITS 1 . 00 24 .48 0 . 00 24 . 48 0. 00
1TRAVDOC 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 CUPERTINO �.
WATER HEATER
CITY or
CUPEkTINO PERMIT APPLICATION FORM
APN # o Date:
5Z4 - 6 0 lr
Building Address:
'7q '7n Ti � +o +Z LN.
Owner's Name: Phone #:
marls SAfJPFnf Lf OU- As-7- 31 -1S
Contractor: Phone #: 661- 1 Sq - 71 3 1
Affordable Water [}e-Afer'S
Fax #: 6(61 - Mq - 9 56
Cupertino Business License #: Contractor State License #:
a 6>sS0 6�-1364f
Contact: Phone #: 6,41 - j.59. o Sa-o
Sco-r-r LitfileFielal
Fax #: 661 -�5�- gSS6
• Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech ❑
Residential Nf Commercial ❑
Job Description:
ke Ptace 9 cs buci-rer µeArer
c, rv.0 lOfai-,`o., _ G6>,rU)2
Strapped On Platform ❑ Bonded New Location ❑ Replacement �f
Valuation: i
1100 —
Green
1uu —
Green Building Check must be completed and attached to this application.
Green Building Points achieved: .
Community Development
10300 Torre Avenue
It 5' .
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
`UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
- 7q '70 TiP-ro& LtJ• J-G6/'00-4
OWNER'S NAME: Marr ckr i eo�nr PHONE # y0 = .5 -31-7
GENERAL,CONTRACTOR r6k3k- 'Veit- FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fericing
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