08040065 CITY OF CUPERTINOaW
BUILDING DIVISION PERMIT ~mG01TRr ?CTR��Nk' RM,AIgI ,�
Bu a4lRdG,ApDgE6i0LBY AVE FAST WATER HEATER08040065
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OWNER'S NAME: C PERMIT ISSUE DATE
YE'E ROBERT Y AND MARY J TRUSTE 12601 132 AVE NE 04/09/2008
PHONE: SANITARY NO, CONTROL NO.
cxnEcrfENCINEER: RMV/RPLC GAS WATR HEATER BLDG BELECTCPERPLUMBO MECH
0 0 0 0
3wp LICENSED CONTRACTOR'S DECLARATION Job Description
rd u¢ 1 merely 7 affirm Nn 1 am limned under and
Irmons of s Cma 9(commencing p
Mwith Seorcea 7").f Division 30(00.Buvntas and Profetaions Codc.end my license I.
p N in full torte sed eRett
C'�? License Clwa
Dan_ On Corm
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ARCHITECTS DECLARATION
2 1 unMrsund my plana shall be uud as public rectums
6
5 G Licensed Professional
^ OWNER-exempt frDECLARATION
4 Q S 1 heresy.(firm that 11. exempt from the Contractors o License taw rar Ile
p o fallowing moron.(Section]031.5,Business and ve.de ions Cade:Any oily or county
$ which rtqubta•permit m emtaWCL pilo)improve,demWah.Or mash any r acme
ono
prior athei uccnwdpumantuimatheapplicant ofT Cchperm',Lto fLasete Ue(Wtemenl
�nthommonkenxed pursuant 7000)pmvisiooa 3 Ow Comsanessan Prolminn C Cede)
Sq.Ft. Floor Area Valuation
3 (cam a is Cog withthe efromdan and
th basis f r th the Business and on.Any
Cede)Cor
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at io ts exempt therefrom and De bests far the cualleged exempnt in Any viWation of
.1Section 7031.5 five
any applicant s(a pelmil wbjttU doe applicant m a civil penalty Of APN Number Occupancy mat more wan five hnedrtd dollars fssDD). panty Type
❑I,as"Car of Me property,ar my employees with wags an thetr sale compensation,
will
and dPro(ewlom Coda:The Contractor's License Law dean not apply bean Owner of Required Inspections
property who builds Cor improves thereon,aed who does much work himself or through his
awn employees,provided than such improvemenu art not intandeA oroRertd farsre.ir.
however,the building of improvement is said within ane year ofcompledon,the comas,
builder will haw the burden of prnving that he did not build Or improve for purpose of
ale.).
❑I.as awry of the Poniard,am exclusively convening with Bemued mnlnmon W
contract the project(Sec.7(144,Business and Profession,Cade:)M Contractors Li-
rove law doer not apply in an owner of property who build,or follow.tbeman,and
who contracts for such pmjecta with a contractor(s)Iimved pursuant to Ne Cantona s
Lice.Law.
❑IamesureptunderSee ,B&PCforadsseawn
Owtor Date
WORKER'S COMPENSATION DECLARATION
I hereby aflbm under roundly of Perjury one of the following declarations:
ham and will maintain•Cedilica ,or Consent 0o elf-Wum for Worker's Compen-
rkm,u provided for by Section 3700 of the labor Code.for the performance of the
far which ei,permit is owned.
0 1 haw and will maintain Worker,Compensation Insurance,as required by Section
370D of the labor Code.for we performance of the work for which ori,pemth is Issued.
My Workers Compensation Insurance Crier and Policy number am:
Omer. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(71d,semlrw reed not becompleud if tie permit Is faonehundrN dollue($100)
or lou)
I certify that in tie performance of the work for which this permit is issued,I shall not
employ any person in any mentor so as a become subject to the Warners'Compevatim,
Laws of California.DM
Application,
NOTICE TO APPLICANT:If,after making this Certificae of Exemption,you should
become subject be the Worker's compensation provision of tier lads,Cade,you Cur
.J Q forthwith comply with such Provisions Cor thin permit$hall be deemed Caked.
z�-" CONSTRUCTION LENDING AGENCY
y
[—t Ibemwh Mthi Nat Nero is.
sum(Secti097,lending agency for the perfurmerOCo of
ai L.work for which this permit ts issued(See.709'1,Civ.C)
C 14Q Lenders Nate
� z lender,Address
U Q I Codify that 1 haw mad this application orb some than the show information I$
Ig, wren.I agsoe to comply with all city and county ordinances am som lave mining to
building construction,and hemby suthaew rtprtsenative,of mis city in enter upon the
W
above-Communedproperty for andexamosesapill purraiwhich may
�y"a (We)agree m Cow,indemnify and keep harmless the City of Cesarean against
ayti Eadlisequar orthecad$nsoftnis ra which may lm my way venae agNnst old City
incouV^ APPLLICANT)UN ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. 9
Stgnuum of ApplitaHAZAR mor Data
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will We applicant no(mum building occupant ram orhandleMe Health amaterial
C de0ncd by dm Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code,Sc y. ON.25532b)7
❑Yta All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haardow air commivnts a defend by the Bay Arta Air COOL,Management all new materials for inspection.
Act?
❑Ycs ONO ,
Ihewmadthehva ousmaasiaumquimmenaunderChapw6.95oftheCalifor-
niaFk.lth&Safety Cade,Secdn25S05.25533am125534.1umlemadwrifwc building
data not cwmmly hew a torl veal It u my asp oodbility a ratify the accupant of we
roguimmema which most he at prior to iauancenracemfeateafpmwary. Signature of Applicant Date
All roof coverings to be Class'I "or better
Owner or mthoead agent o.lo� - g
CITY OF CUPERTINO
• 4 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31629027 . 00
DATE ISSUED. . . . . . . : 04/09/2008
RECEIPT #. . . . . . . . . : BS000004429
REFERENCE ID # . . . : 08040065
SITE ADDRESS . . . . . : 10299 COLBY AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : YEE ROBERT Y AND MARY J TRUSTE
ADDRESS . . . . . . . . . . : 10299 COLBY AVE
CITY/STATE/ZIP CUPERTINO CA, 95014-2421
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
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---- ---------------------------- -------- -------------- --------
518 WATER HEATER
Permit No: OS oaf t��-7v s 999334
(office use only)
City Of Cupertino Building Permit Application
E-Mail: Building-Permits@cdpertino.org (Address is case sensitive).
Jobsite Address:10299 COLBY AVE Date: 3/31108
Assessors Parcel Number:
Owners Name: YEE, ROBERT&JO Phone No: (408)253-7431
Project Valuation: 449.00
Building Permit Info: Bldg Elect Plumb x Mach
Job Description
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: 12601132ND AVE NE E-mail:carolr@fasMaterheater.com
City, State&Zip code: KIRKLAND, WA 98034
State Contractor's Lic. No: 877489 Expiration Date: 5/31/08
Workers Comp No: 1761660 Expiration Date: 12/1/08
Carrier: California State Fund
City of Cupertino Business License No: 29100
Credit Card Information
Credit Card No: 4417123041349530 Expiration Date: 11/10
Name on Card: Jeff Jordan
Visa ® MasterCard ❑ American Express ❑
The Building permit application and a completed & signed
contractor/subcontractor form need to be submitted with each permit.
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
OF Fax(408)777-3333
® CUPEOTINO
Building Department
JOB ADDRESS: 10299 COLBY AVE PERMIT#
OSoy oo�S
OWNER'S NAME: YEE, ROBERT&JO PHONE# (408)253-7431
GENERAL CONTRACTOR:FAST WATER 1HEATER,COOMPA�N FAX# 425-814-9516
I am not using any subcontractors:_ "' /�' 3131/08
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