08030077CITY OF CUPERTINO -�s�A,$TRx
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BUILDING DIVGION PE1�lY1KT
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BulLl1l"MTE"YPRESS DR
FAST WATER HEATER
P�08030077 ,
WNEWS NAME:
PERMIT ISSUE DATE
HWANG CHI-WEI AND CHING-FA
12601 132 AVE NE
03/14/2008
ONE:
SANITARY NO. CONTROL NO.
AR CHRECURNOINEER:
RMV/RPLC GAS WTR HEATER
BUIIDINO PERMITINFO
BLDG EMCs PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 becby affirm Inn 1 Am licensed under provision of Cbapur 9 (mmmencing
_ P
with Section 7009) of Divixi 3efdm Bud^...and Profeuiu atWmy"mmu
in full ferco um err
Lice Lu. g
Dam Conlncutr
ARCHRECIB DECLA A ION
1 understand my plans Nall Ire used As public record,
Licensed Professional
OWNER -BUILDER DECLARATION
1 Wmby glum that I em uempt from the ConusnofA Licenis law far the
following reame. (Section 70313, Battens and Profession Code: Any city or county
which requires a p orl, Y construct, Blur. Improve. demolish, or repair my structure
prior to its iuvanco. also requires dm.ppHcant for such permit to rile a signed ataumem
dm is licensed to the of the Conummr's Limnc Law 9
Sq. Ft. Floor Area
Valuation
W punoanl provision (Chapter
(commencing with Section 7000) of Division 3 of lW Business and Profession Code) or
dui W i, exempt Outermost and the basis for the al4yed excmpUm. Any •lolatim of
APN Number .
Occupancy Type
Statim 7031.5 by any, applicant for a permit subjects du applicant Y a avu pcnahy of
nut mom Nae Bw hundred decries (SUM
❑ Lasowns of IW property. or my employees with wagea Y Ibelr sole eommusnlon,
Required Inspections
d the suunuse ts des waRcmd fosae (Sly 7014.Budnw
Newoes
maldo
C rt owmr of
and Corr: TW CanlrxwY, Limme law
tons Li rot Moly
en wine W work himselrolhrough his
prmetYwW Wildsoimproveu thenenve veno ch f
.
ama.wn
own en, That IL
ooRerN fessalthe
impmvemanu Art not ear
etc car.
Ne Wilding ordenrowmemamid within ung year orcwnpetim. imam
h the wm
or
Wilder will have W WNan of proving Nu be did mI Wild or improve for pugose of
trews
YIe.)
Q 1. As ower of the Property. am exclusively corseting with limned conmeen to
mminii de project (Sec. 7044. Business Aad ProreWem Code:) Thr CWUWWes Li -
o ate law twos no, apply Y an owner of property Amu Wilds or improves thereon. and,
wind cmuac t for such projects with amnu emar(s) Remind purnme t to Ne Con sscleYs
Lace. Law.
❑ lumnemptundesec ,B&PCrorddsmsaen
ate Dau
WORKERS COMPENSATION DECLARATION
1 hereby arm under perolty of perjury ono oftee following de tursho s:
❑ 1 have and will mtlnuin a CeniBcam ofC..Atm YIf-imam for Worime.Compm,
Won. Y provided for by Section 3700 of the Wer Code, for Na performmlm of use
work for which this permit is Issued.
❑ I haw and will maintain Wof es Compensation Imwanse, Y rryvimd by Sectio
3700 ofthe labor Code, for the performance ofdm wort fw which On perms is ium0.
'
My Wm1me o p a0 Iasun co "slier and Policy n loge
,
Cartier: �� Policy No.: �
�NER �/�
LE ATB OF EXFMPP0N FROM O ERS'
COMPENSATION INSURANCE
(This met. reed wt W cmnpemd if the permit Is for. hunOrW dall. ($100)
or less
1 canify that in do per(mmmm of use work for which thea Pmmle Is lewd, l shall rare
employ anypermn in my manor. As to Wmma subject Y tW Wmters' C^mpenYdm
I.A. err California. Dau
AppBom
NOTICE TO APPLICANT: If, afmr making this Certificate of Exemption, you ahold
become subjm to the Workefs Cotepemidme provision of the lanes Cade you mule
fomhwith comply with such provision or On permit Mall W deemed rewkrd.
1
CONS RUCf10N LENDING AGENCY
I hereby tram that there Is a cmcunctim lending agency for the perfurmume of
the nodt for whim the permit I. ensued (Bet. 3097, Civ. C.)
Landes Nuns
Lander' s Address
1 comity that I have reed this application and sure that dm above information Is
'
correct. 1 apse to comply with all city and cony ordinances and some laws mining to
Wilding constroNon. and Wmby mthoiae rcimumnudves of the city to mor We the
1 ,neve-mendoned property for Inspection purPolel.
(We) agree to save, Indemnify atm keep harmless the City of Cupertino agaiml
1 ilmllltln,judgments. emits and expencs which may In any way aLSNC Against Yid City
to conscqueece of the &=Ong of this Permit.
I APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOUR 710th$,
Re -roofs
Type Of Roof
sigmtun err AZARael0
NA2ARD0 ATERIAIS DISCLOSURE
WIII w (mum Wading e. w NMIe haYNow mamrial
Y defined Cupertino Chanea9.1
Ne Cupertino Mun(clpel Cade. Chepur 9.13, and the Health and Safely
y the
erre, B--Wn2s632(a)7 f
Section
All roofs shall be inspected prior to any roofing material being installed.
❑rat ,J°"a
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicml w rump Wilding Occupant use equipment w devices whuA
cath hevsNnw Air.morinmu Y doff by IW Bay Arc Air Quality Mmagement
all new materials for inspection. '
Diatr ct7
❑ Yca u
I law mad the hesNmsmamriats mquhcmmts underCMpur6.95 of theGliror-
nuHmlthkSalmyCod-.Srmdwu25X15.25533" 25534. I understand theifthe Wiithng
-
dma rot no, new A mount. cul It u my maponsihilhy u ratify the pant of the
uhmtwWmetpriarutisanecofaCenileamerOc la
Signature of Applicant Date
All roof coverings to be Class '%Q." or better
-
Owmr r rived agent DA
•
•
4 ITEMS OF 8
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31630061.00
DATE ISSUED.......: 03/14/2008
RECEIPT #.........: BS000004161
REFERENCE ID # ...: 08030077
SITE ADDRESS .....: 10521 CYPRESS DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
213.12
---------------
213.12
VOICE ID .DESCRIPTION
-------- ----------------------------
518 WATER HEATER
REFERENCE NUMBER
--------------------
#3537
VOICE ID DESCRIPTION
-------- ----------------------------
OWNER ............:
HWANG CHI-WEI AND
CHING-FA
ADDRESS ..........:
10521 CYPRESS DR
CITY/STATE/ZIP ...:
CUPERTINO CA,
95014-5079
RECEIVED FROM ....:
FWH ACQUISITION CO
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
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
213.12
---------------
213.12
VOICE ID .DESCRIPTION
-------- ----------------------------
518 WATER HEATER
REFERENCE NUMBER
--------------------
#3537
VOICE ID DESCRIPTION
-------- ----------------------------
From:
03/10/2008 12:50 8818 P.002/007
CITY OF CUPERTINO &OJ D ?j O D -?3 5837
WATER HEATER
PERMIT APPLICATION FORM
APN# ()C)Date:
3/10/08
Building Address;
10521 CYPRESS DR
Owner's Name:
Phone #: (510)551-7356
HWANG, ANDY
Contractor:
Phone #: 800-454.8955
FAST WATER HEATER COMPANY
Fax #: 425-814-9516
Cupertino Business License #:
Contractor State License #:
29100
877489
Contact:
1
Phone #: 800-054-8955
Carol Randall
Fax #: 425-814-9516
Building Permit Info:
Bldig Elect
Plumb x Mech
Residential ❑x
ComnzTcial ❑
Job Description:
Remove/Replace Gas Water Heater
Strapped ❑ On Platform ❑ Bonded ❑ Now Location ❑ Replacement
Valuation:
449,00
Green Building Check must be completed and attached to this application.
Green Building Polots
achieved:
0
From: 03/10/2008 12:50 #818 P.003/007
CUPERT1NO
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
395837
Quantity
Fee ID
FecDescrlption
Fee
Cron
permit Type
IPCWHEATR
Commercial Water
Heater/Vcmt
B
PCWHEATR
BSEISMICOM
Seismic Cararnamial
B
I
1MWHFATR
Residential Water
Heaw/Vcct
B
PRViEMATR
I
BSIISMICRE
Seismic Residential
B
PPERMnVEE
Plumbing Penmt
P
/
TRAVDOC
Travel &
Documentation
B
BUSLIC
Business License
B
0
CITY OF
OUPEPTINO
•
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
--
.,
.l�liG.►,M
BUSINESS LICENSE #
EH� MQIV
Cabinets & Millwork
Cement Finishing
I am not using any subcontractors: 0
Signattk Date
Please check applicable subcontractors and complete the following information:
caner/ ddntractor Signature
m
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
caner/ ddntractor Signature
m