08100156 CITY OF CUPERTINO -
BUILDING DIVISION PERNUTCUi�I:'CR`AC'T(ZR IIVI''ORMr�T�O-� .N
BUILDING ADDRESS: PERMfT N0.
1113 HUNTERST N PL BETTER WATER HELTERS npi nni 56 '
OWNER'S NAME: PERMIT ISSUE DATE
qUARLENR 351 RELCA.TQ DR
41,NE: A 0. CONTROL NO.
(408) 250-6672
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIF,CT PLUMB MECH
w00 LICENSED CONTRACTOR'S DECLARATION Job Description
Z C I hereby affirm m 0ce
dual 1 sesed under provision of Chapter 9(comoreming P
<tJ with Secure 7")of Division 3 oflhe Business uW Cand myliee�is
Put imm�raaaneerrect "G �j ZI.
INSTL 40GAL WTR HEATER IN GARAGE, SAME FOR SAME
;g? Licensea Lic.g
F O Da¢ ' COmrutar
e an CHItECTS DECIA r or
1 understand m sh
nd mY plans he used u records
cnrda
3 U
y0y Licerued Professional
y 3 OWNER-BUILDER DECLARATION
0 I hcmby affirm that 11. exempt from Pr fessions Cram:
Licevc law for the
00 following uuce a (Section TOILS. t,mass and ere,Professions Cal.:Any city structure 3$ which its iss s a permit to construct,aIle;improve,demolish.t or mash any smclum
that xisO cuane..ar an,to the meappin of far snehpecmr's Ucc sc Laeouammal
£ thommenecevcdpuntion7 )ofDivision
ivismsfineCanuinessandProfisw(CWpter9 Sq.Ft. Floor Ar(a Valuation
y�s 'a Ise ne xurept Section and of basis It,the
a ag Business and Profession Code)or
Nu k e exempt thuerrom and lh a.:.fa the alleged exemption.Any violation of $800
Section 7031.5 by any applicant for a permit subjcN the apPluant 10 R Civil penalty Of APN Number Occupancy Type
nut mare than five hundred dollars(55W1 36221008 . 00
0 1,as owner of die Property,or my employees with wga u tk'm sets cempeaation,
will do the work.and the smctam is not intended or offered for age(Sec.1041.Business Required Inspections
and Pmfusiem em
Code:The Canuah Livnneownere ns
se Law does t apply to an of q P
property who builds or improvees thereon,and who does such worthimsel f orthrough his
own employee,provided that such improvements art not intended aolresed for sale 11. -
however.thebuildingorimproro mast is old within arc you ofecmpleum.live oweu-
builder will have the burden of proving that he did Out build or improve for purpose of
am.)_
0 1,as Owner of the property,am esclmivelY contracting with licensed contractors m
commucl the project(See.7044.Butimv of Professions Code,)The,Conuacures U.
cove taw does not apply to an owner of property who builds or improves Netmn,and
who contracts for such Projects with a cone asar(s)licensed pursuant to the Conuacires
License taw.
0 l atn naernpr under See ,B&PC for this moon
Ow ser Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pevlty of perjury,ane of the following dad adomv.
1 have and will maintain a Certificates of Consent to self-insure for Warkcrt Compm.
on,a provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Woroes Compensation Insurance,a required by Stenon
3700 of the labor Code,for the performance of me work for which this permit's issued.
My Workses Compensation Insurance carrier and Policy number
.,are-
Code,.
rtl:t�o,/��
Code,.. fiAC.&f(nwil'� Poliry No.: {1lClvr T
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(no xoom reed notbeennphned if the p.it is[area.hundred dollen(51011)
or mail
1«nify that in the performance of the work for which this permit is issued.1 shall not
employ any Noun in any concur an am became subject to me WorteW Compensation
laws of California.Dam
Applicant
NOTICE TO APPLICANT:IC after making this Ccrtifom of Eaemption,you mould
become subject to th.WOrkcYs Campervauun provisions of do tabor Cede.You mus
forthwith comply with such provisions Or this Permit shall Ise deemed revOkcd.
z0 CONSTRUCTION LENDING AGENCY
[—i 4 I hereby ammtNt mem is acovtructim lending aFacy for the performance of
!Yi > the work for which mass permit is hued(Sec.3(19'1,Civ.C.)
W 0 Lander"Name
7 Z Lenders Address
U Q 1 curtly that 1 have red this application and sum that the above information is
LT.F cortecl I agree p comply with all city and county ONinsoces ad scam laws relating to
0 Wilding consumerism.and hereby vthoriv representatives of the city m mmrupon the
r W shove-mentioned property for inspection purposes .
F C (We)agree as ave,indemnify and kap harmless the City of Cupertino against
y liabilities,jWgmcaa.cam and eapevcs which may in any way acme against said City
UZ in consequence or the granting or this permit.
`-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Z t-r .e
SOU �yREGULATIONS
yis� —��—�
1611-310 F Re-roofs
Signature of Appliart Conmacmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future Wilding oceupant same or hanNc haallov material
as,defined by the CuMnim Municipal Code.Chapter 9.11,and the Health and Safety
Code.Sectinnu531(a)? / All roofs shall be inspected prior to any roofing material being installed.
C Ya t<
Will the applicant or future building occupant term equipment of&viw which If a roof is installed without first obtaining an inspection,I agree to remove
t hnaallov air canmmivna u dcri ed by dm Bay Are.Air Quality M.......I all new materials for inspection.
r
OYa o
I have and the baaMous mamulalsnequirements under Chapmr6.95of tWCalifor-
maHWdt&SafuyCode.Sectios25505.25533 maIM34.1 understood thuirma,building
ones rpt carendy hoe•mnat.lim it is my msporuiMlity to neufy ft one pant of she '
regal cntswhichto 1 poormmu anCerurpamaaa Signature of Applicant Date
All roof coverings to be Class'W'or better
Owner a authorvrd agent Dam
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36221008 . 00
DATE ISSUED. . . . . . . : 10/23/2008
RECEIPT #. . . . . . . . . : BS000006451
REFERENCE ID # . . . : 08100156
SITE ADDRESS . . . . . : 1113 HUNTERSTON PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SHARLENE LEW
ADDRESS . . . . . . . . . . : 1113 HUNTERSTON PL
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5068
RECEIVED FROM . . . . : FRANS CARTWRIGHT
CONTRACTOR . . . . . . . : FRANS CARTWRIGHT LIC # 26514
COMPANY . . . . . . . . . . : BETTER WATER HEATERS
ADDRESS . . . . . . . . . . : 351 FALCATO DR
CITY/STATE/ZIP . . . : MILIPITAS, CA 95035
TELEPHONE . . . . . . . . : (408) 250-6672
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW 'BAL
---------- ------------- ---------- ---------- ---------- ---------- ----
1BSEISMICR VALUATION 800 . 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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ------ ------
CREDIT CARD 106..56 VISA
---------------
TOTAL RECEIPT 106. 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-- ------------------ ------
------------ ----
518 WATER HEATER
Community Development
�F 10300 Torre Avenue
ij Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building Department
JOBADDRESS:Setpv S7r/ 6�C� PERMIT # O 1 v U 1 �
Ill 3 Fi'N N '>V Q
OWNER'S NAME: 0 Ge I-OV PHONE # Oy 7,50-4W-2-
GENERAL
0- 7-2GENERAL CONTRACTOR: 0%V- FAX # Al'o
I am not using any subcontractors: /C/2
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 oefn rzW%1'I- - H47,�7rr-S
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
d z--3 a
Owner/Contractor Signature Date
CITY OF CUPERTINO
« � WATER HEATER
OCUPEkTwO PERMIT APPLICATION FORM
APN # 3 �Pa / C�O� O O Date: /o /1'34
Building Address: /�
//13 HU��S� P4#-,-J 6- 4/t 4 V
Owner's Name: Phone #:
Sy4+2.rtWF Lew A,
Contractor: Phone #: .
Fax #:
Cupertino Business License #: Contractor State License #:
�yffelL/
Contact: Phone #:
�s G4�r✓�-�6�� - dull ys u -4G 7-z
Fax #:
Building Permit Info:
Bldg ❑ Elect Plumb Mech
Residential Commercial ❑
Job Description: N 6k+Aa el
Strapped On Platform Bonded ❑ New Location ❑ Replacement
Valuation (cost of project): g QED
Project Size: Express ❑ Standard ® Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to
the application or if applicable, include in plan set & the sheet index.
Green Building Points achieved: Ci
Revised 6/16/08
CITY OF CUPERTINO
« ' WATER HEATER
CUPERTINO PERMIT APPLICATION FORM •
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BSEISMICOM Seismic Commercial B
IPRWHEATR Residential Water B PRWHEATR
HeaterNent
1BSEISMICRE Seismic Residential B
1 PPERMITFEE Plumbing Permit P
1TRAVDOC Travel & B
Documentation
1BUSLIC Business License B