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06050068 (2) • CITY OF CUPERTINO BUILDING DIVISION PERMIT �_, 'iDY2T�NF�0I2 �A TtJN r BUILDING ADDRESS: DALLAS CARLOCK PLUMBING S RKMITND'06050068 7733 OAK MEADOW CT OWNER'S NAME: PERMIT ISSUE DATE ARNOLD DE LEON 16721 MADRONE AVE 05/09/2006 NE: SANITARY NO. CONTROL NO. (408) 354-5413 ARCHI=MNOINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH boli LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby afar that I em thousand under provisions,of Chapter 9(commencing Z with Section 700M of Dimon 3 oftk BuvnevaM ProfeWam Cade,and my license is in full to mdeaeet. REPLACE WATER HEATER WITH TANKLESS j�Z License Class Date Contr Fi Contractor A®L E® ARCH'IEC,S DECLARATION I I understand my plena shill rk used used as u public records y. eQt; Licensed Pnfmsian) � C sea3OWNER-BUILDER DECLARATION 2006 m 1 hereby•?rm that I mrr,exempt frothe Contractors License Law for the C U O O falbwing mason.(Soden 70313,Busiws a Rofessiam Cab:Amy city m munty IRE which requires,a permit m enno ruct,)mit improve,demolish•m repair my avuctum _ $2800 zpdarm is,issuance.also tequlnm duo applicant for such permit to file aalgned statement �< Btuheislittmedfunctions wthe provitlouofftconuacme.Ucc eiaw(Charter9 Sq.Ft. Floor AT Valuation $ (ammeaing with Section 7000)of Division 3 ofdne Busieeasand Profcssiam Com)or — Nal he a exempt therefrom and the basis fee the alleged exemption Any violation of Section 7031.5 by any applicant for a permit mbjccm the applicant he a civil penalty of r - Occupancy Type ,rot more than five handind dollars ISM ❑i,as owner of the property,or my employcm with coges as their role compeaseden, will do due weak.and doshuature is not Intended or Offered for sem(Sec.7044,Busmr, Required Inspections and Profession Countesses lim en Codc:The Couesses mits Law dal appy wn<r he an aof q P pmpeny who Wilda or improves demon,and who doessuch weak himself or through hie own employees,provided dust such improvements am not Intended mronervd for sok.IL however,the building or improvement is mid within one you ofcornpbdes.gm owner- builder will he"Ne burden of proving that he did oat build or Improve for purpose of cab.). ❑I.u owrcr of the property,w exclusively ammcting with Unmvd mntrraeas to carutm n true Project(Sec.7044.Business and Profession Cade:)Tim Contractors U. cense Law dean not apply to m owner of pmpeny who builds or improve thereon.and, who canmcu for such projects with a mntrac orris)Ransil Panama to the Convenors ' Llama 4w. ❑I am eam under See .B&P C for this reason Owrcrr ``— Date 5-ey" 4 WORKERS COMPENSATION DECLARATION I hereby affirm under penally Of perjury ons W the following dalmatians: I have and will maintain aCertificata of Concent be self-ldwre for Workers Compen, action,u provided for by Section 3700 of the Labor Code,for du performance of dm work for which this permit u leaned, ❑1 have and will maintain Workers Compensation Insurance,as required by Section 3700 M the Labor Code.for the performance of due work farwhlch this permit U issued. My Workers COmpenutbn bs,unince artier and Policy number am: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE r (Thbaalan need not becompleted if the permit Is formic hundmdde0an,($100) or las) 1 anify dist b the parsecs of the we&for which this permit is bound.I shell an employanypers nuymwnerwasl comewbjeetwdm Workere Compem don IJWl mf Calif Disc - /fs NOTICni NOTICE PPLIe :em atommaking n p Certificateofof Exemption,dyou slmost becomewit subject to the Workers Compensation a this permit duo Is,bar Code.you most .,O faMwithmmplY with wed,,provWoas aNu permit shad,be damns invoked. ,'�.,t••' ► 1MnbY afar CONSTRUCTION LENDING AGENCY [tiduu then us..do.leading.,mcy for de Nafurmm of ai ^ the work for which this permit is issued(Ss,.3097.Ch.Q GQ Lenders Name 2 Landers Address U Q 1 anify that 1 ban read this application and sato thin the about infornlun is U+H conect.I agree to comply with all city and county ordinances and sum laws mining to Q U building consWction•and hereby authods mprmenmtiw of this city in coma open the W shave-a ntiunsd Property far impoNan Purpmes G (We)agree to sea,indemnify and kap harmless the City of Cupcninu ageimt rw rA lubilitia,judgmenta,eom and expenses which may In any way see=sgalmt said City in consequence arms gnndng ofibu Permit. t•'t APPLICANT U RSTANDS AND ILLY/ L COMPLY WITH ALL NON-POINT Issued by: Date SOURCE R J ATIONS. �(s�� may; T Re-roofs Signamte Of plicandConvaeser Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building oaupamnae or handle henNour material as deflned by de,CupeAns Municipal Cade.Chapter 9.12.and the Haldu ad Safety - Code,Section 25532()1 All roofs shall be inspected prior to any roofing material being installed. 0 Y ❑No 40 Will the applicant or future building Occupant on equipment or dcvi=which If a roof is installed without first obtaining an inspection,I agree to remove emit hoaxed.air conumimom as defined by the Bay Ara Air Quoity Management all new materials for inspection. District? Oita ON. I haw read the haxeNwsmamsisis requineme sunderChmW6.95aftheCalifer- nu HcelN&Safcly Code.Sadan25305,25533 mW25534.1 understand lhadmic building data ren urntly hew a anent, t It u my 104p0nsibility in mdfy dm Occupant Of dm nasi enuwhichmumbe toloumeeofeCeninamoOccY Signature of Applicant lDate �' � auronuduadmtlegem wee All roof coverings to be Class nB„or better CITY OF CUPERTINO WATER HEATER • CUPEkTINO PERMIT APPLICATION FORM APN# 3 le W— 2LPOJX] Date: Building Address: .-77 .3 Dp�IJ�H �� Cfi Owner's Name:1"40 Id e- Phone#: off 777 r�3Z L�� Contractor: n rta� P4,Li Phone:y� A30 X63 License#: Contact: ( Phone: Cupertino Business License#: Alm Building Permit Info: Bldg ❑ Elect IT Plumb 2� Mech O" Job Description: 12 I 4.e F'e la Le W GL r ��✓� �/ �,✓� Residential W Commercial ❑ Cost of Project: Z pD4 Strapped El On Platform LJ Bonded Er New Location ❑ Re lacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY Ener BUILDING BUSLIC Business License BUILDING • CITY OF CUPERTINO eem 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36626008 . 00 DATE ISSUED. . . . . . . : 05/09/2006 RECEIPT # . . . . . . . . . : 34309 REFERENCE ID # . . . : 06050068 SITE ADDRESS . . . . . : 7733 OAK MEADOW CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ARNOLD DE LEON ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5201 RECEIVED FROM . . . . : ARNOLD DE LEON CONTRACTOR . . . . . . . : CARLOCK, DALLAS LIC # 21790 COMPANY . . . . . . . . . . : DALLAS CARLOCK PLUMBING SER ADDRESS . . . . . . . . . . : 16721 MADRONE AVE CITY/STATE/ZIP . . . : LOS GATOS, CA 95030 TELEPHONE . . . . . . . . : (408) 354-5413 *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 3516 TOTAL RECEIPT 84 . 02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • Community Development 10300 Torre Avenue v Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 JOUPEkTINO Building De artment JOB ADDRESS: 7733 &,L R e eeb41 C+ PERMIT # Z5 os-- Obi f-. OWNER'S NAME: trovtel PHONE # t -?77-j 13Z GENERAL CONTRACTOR: FAX # I am not using any subcontractors: _ - 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 Owner/Contractor Signature Date