08060077CITY OF CUPERTINO
QprT
CQt\°1jU&'tlA�1NFQ T10
BUILDIN.G.DIVISM PERMIT
BUIIDINQ ADDRESS:
PERMIT NO.
1.9866 BAYWOOD DR
FAST WATER HEATER
08060077 ,
OWNER'S NAME:
PERMIT ISSUE DATE
JAMES LIU
12601 132 AVE NE'
06/10/2008
NE:
SANITARY NO, CONTROL NO.
(800) 454-8955
ARCHITECT/ENGINEER:
BUILDING PERMITINFO
-BLDG ELECT PLUMB MECH
ON
LICENSED CONTsed a&,SDEnionof
Job Description
P
hap
I i.7 ) of Nn 1 em licensed under and Prof ss of Chapter 9 (commencing
withgearce JOfIcff=Divirion3ofthc Business; and Profession Code, and my license is
RMV/RPLG GAS WTR HEATER
in full forte and coca
License Class Lie. Is
Date Contractor
TI
ARCHECTS DECLARATION .
CL
I undersand my Plans shall W used as public records _
-
Located Professional
OW NER-BUILDER DECLARATION
I Mrchy aRrm that I am exempt from the Con"clo's License Law for this:
following moon. (Section 703 1.5, Business and Professions Cotic: Any city or counry
which m rtims a permil Ice consumer, shoo. impress, demolish, of mpoir any situation
print to its issuance, auto requires the applicant for Such Permit to file a Signed statement
that he is licensed pursuant to the previsions of the Contractor's Limnse Law (Charter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000)of Division 3 of the Busia...ol Prfessoms Code) or
$449
1 that M is exempt Quadroon and Ute basis for than alleged cnmptiow Any violation of
Section 7031.5 by cry applicant for • permit subjects the appl¢un as a Civil penally OfNumber
Occas
Occupancy Type
trot.. Nan Bsc hundred dollars (SN)%.3163
0011.W
I,uowmmes of the propvty,amy wPlaym w"dh wagquUr'vsolc campcnsaUm.
will do to world and the senators i, oot intended m offered Tor sale (STs. Milos, Busheass
and Professions Code: The Comeaces License Law dam Out apply as a s owner of
Required Inspections
progeny who Wildcat impmm theaccut and whodoessuch wort himselfor Wough his
Own employers, provided that men improvemenLL am not intended oroffemd forsale. ff.
however, the building or improvement is sold within aha yw of completion, the owner-
builder will hove the burden of proving that the did Out build or improa for purpose of
sale.).
❑ 1, as awmor of the Property am ca.ha mly...=I.& with licensed mmmseasrs an
comtmm the project (Sec 703x, BusineLL and Professions Code:) The Contaminates l;-
.
came Law dor not apply In an owner, of peoprny who Wilds or improm dmeseon, and.
...
who connacu fm,urL projects with. m ursafot,) beem and monsoon, as On Cmnu.nmes
--
License Law.
❑ l am caempL untlm See , B k P C for this mason
Owstet Date
'
WORKER'S COMPENSATION DECLARATION10
1 hereby affirm under penalty of perjury, one of the following declarsions:
I hamaod will mamlem.Carid meofComent mself-inmmforWorlmbCompen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of Nc
wort for which this permit is issued.
❑ 1 have and will m.iouin Waukee, Compensaslom Imuran¢, as recounted by Senior
37W of One IaWr Code, for the Norannuce Orion wort forwhicb this permit is Wood.
'
My Wortees Composaxom huuma carrier adi Policynumber am:
Carrier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis section hand m t be completed if Use permit is for oha hundred dollars (SIM)
nr less)
1 certify that in the Performance of the work for which this Permit is issued, I ahatl not
employ anypason in any, mwcrso as in become subject as ted Wartime Compematian
'
lawa of Califamia. Dam
Applicant
NOTICE TO APPLICANT: If. after making this Ccttinoom of acmmtion, you atmuw
become subject as the Worker', Compensation provisions of the Labor Code, you must
forthwith camPly with such Provisions or his permit shall W deemed crooked.
CONSTRUCTION LENDING AGENCY
1 Wmby aRrce that Nem i, a contraction lending agency for the Performance of
the wash for which th'u Permit Is Wood (Sec. 3097, Civ. C)
Lenders Nunc
'
,
Landers Addmu
' 1 cenffy that I have mad this application and sem Ihu the salve information I,
correct. l agree in cmePly wish all city and county mdinuuxs and,uLL tars totaling as
Wilding cowrvction, and bareby a ndionm mP.utim.f Nu city as enter upon the
Shove-m,j.d,. progeny farirupccsso ponscwhich
(Wer) agree to save, indemnify and keep harmless the City of Cupertino against
ms
a.the costs and! expenscamit. may in any weyamrue against said Cily
in f
of the linumiRSTA got thisPermit.WILL
A
APPLICANT
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Stgnaum of ApphUnVCo Dion,
HALmRDOURD0U5 MATERIALS DISCLOSURE
Type of Roof
Will applicant car fou Wilding e, a handle MnNom material
ss donned y t nd Chapter
she Cupertino Muvitlpal Code. pnpur 9.11, and the Heath and Satery
io
cnde, section 25532(a)]
I--] Y. [:]Na
All roofs shall be inspected prior to any roofing material being installed.
Will the applicmt or future Wilding occupant use equipment Or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
lus.minus air cmmEmin.nLL u dant l by the Bay Arta Air Quality Management
all new materials for inspection.
a solos]
Oyes ON.
I haus mal the hanNmumalerialsrequiremrM. underCWpter6.95ofthr Califor-
nis HUMA, SafnyCadc, Seai.25505, 25533 am125534.1 ummrsland use fine Wilding
does rot ctumnUY haw, a Leri. this it u my mspomiMlitY In ratify she occupuu of one,
requiremcne, which mus Wmcl psoras issuance ora Cenircam car. Ocmpuuy.
Signature of Applicant Date
I All roof coverings to be Class'/." or better
Gwner or authortzal agent Dam I
• 4 ITEMS OF 4
E
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: B1k: Lot:
APN ........: 31630011.00
DATE ISSUED.......: 06/10/2008
RECEIPT #.........: BS000005063
REFERENCE ID # ...: 08060077
SITE ADDRESS .....: 19866 BAYWOOD DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
106.56
---------------
106.56
VOICE ID DESCRIPTION
-------- ----------------------------
518 WATER HEATER
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
OWNER ............:
JAMES LIU
ADDRESS ..........:
19866 BAYWOOD DR
CITY/STATE/ZIP ...:
CUPERTINO CA,
95014-2317
RECEIVED FROM ....:
JEFF JORDAN
CONTRACTOR .......:
JEFF JORDAN LIC
# 29100
COMPANY ..........:
FAST WATER HEATER
ADDRESS ..........:
12601 132 AVE NE
CITY/STATE/ZIP ...:
KIRKLAND, WA 98034
TELEPHONE ........:
(800) 454-8955
FEE ID
----------
UNIT QUANTITY
------------- ----------
AMOUNT PD -TO
-DT THIS REC
NEW BAL
1BSEISMICR
VALUATION 449.00
---------- ----------
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
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
106.56
---------------
106.56
VOICE ID DESCRIPTION
-------- ----------------------------
518 WATER HEATER
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
0
is
0
Permit No: 0?U(P oa-7-7 406741
(office use only)
City Of Cupertino Building Permit Application
E -Mail: Building-Permits(�cupertino.org (Address is case sensitive).
Jobsite Address: 19866 BAYWOOD DR Dater 6/10/08
Assessor's Parcel Number: 3 ((0 3 00H. 0 Q
Owners Name: LIU, JAMES Phone No: (408)218-0299
Project Valuation: 449.00
Permit Info: Bldg Elect Plumb X
Job D
Remove/Replace Gas Water Heater
Contractor Information
Company Name: FAST WATER HEATER COMPANY Phone No:
Contact Name: Carol Randall Fax No: 800-454-8955
Address: 12601 132ND AVE NE
City, State & zip code: KIRKLAND, WA 98034
State Contractor's Lic. No: 877489
Worker's Comp No: 1761660
Carrier: California State Fund
City of Cupertino Business License No: 29100
E-mail: carolr@fastwaterheater.com
Expiration Date: 5/31/10
Expiration Date: 12/1/08
Credit Card Information
Credit Card No: Expiration Date: 4@W
Name on Card: Jeff Aidan
Visa ❑x MasterCard ❑ American Express ❑
The Building permit application and a completed & signed
contractor/subcontractor form need to be submitted with each permit.
CI OF
�UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
JOB ADDRESS: 19866 BAYWOOD DR PERMIT #
0 eUCQ 007 7
OWNER'S NAME: LIU, JAMES PHONE # (408)218-0299
GENERAL CONTRACTOR FAST WATER HEATER COMPAN FAX # 425-814-9516
I am not using any subcontractors: _ ` 1/ 4e 6/10/06
Signature Date
Please check a licable 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