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08040124
CITY OF CUPERTINO ' BUILDING DIVISION PERMIT °CONTgwaoRRINFURMATTON n BUILDING ADDRESS: PERMIT No. 1191 ELMSFORD DR FAST WATER HEATER 08040124 OWNER'S NAME: PERMIT ISSUE DATE HO CHIH—YUAN AND LIU HAD— 12601 132 AVE NE 04/17/2008 s%. r u (800) 454-8955 SANITARY NO. CONTROL NO. ARCNnECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH sup 6 LICENSED CONTRACTOR'S DECLARATION O O O O 1 Wmby aM.Nu I w thenad under prouWas of Chapter 9 mum umming Job Description settle suction 7akn of DivWon S of Ne Busiest and Profeatiort Code.and my iicesse is RMV/RPLC GAS WATER HEATER m to ten Ince and.ffat, t5 s I.le..an class Lie.a sf- Dam Contractor e ARCHrrECTS DECLARATION I understood my plans Nqt be used u public records 7 g✓� LlcueseJ Preteniond Sa OW NFA attempt ERDECLARATON COs 1 Wreby.Rete that I 1 esempt from he Camranah s:A nm taw far to COO O Whch following won.(Saito 71013,Busiest and w.daniolu Cale:Any city m aunty S$V which mquim a permit m cnnswc,sits.Wpmw,demolish,m mpsir soy mumum zi prim in its issuance.atm requires the applicant forsuch permit to file a.lgned statement Sq.Ft. Floor Area Valuation that he is licensed pursuant to the provision of Ne Connector',Liecnm law(CNptor9 �g (ammcncingwith Satitn]o00)of Division hof No[Insistant Profeuimu Cede)or $449 that he u exempt thereRom and the basis for tae alleged tmpthoe Any solation of �p Section 7051.5 by any applicant for r�it subjects the applicant to a civil penalty of 3 6 2 0 8 0 3 2:tl Number Occupancy e nuc mac man me hundred dollars P Y TYP 0 1,as ower of that property,or my employees with wages as their=to eanpenudon, will do the work.and Ne snutum W net Wunded moBusinessd for sale(Sa.Ilium,Business and Professions Cade:The Cocolelor's License law dots ant apply to an awtrcr of Required Inspections Impurity who build,m impmw Neter,and w ia does such work h W self m lMtgb his nuncneployme,provided that such improvements am not inuMed oroffernd fmsele.If. hetet,the building or Improvement ts mid within arm year of completion,the owner. builder wl0 tum this burden of pmsng that he did tet Wild or improve for purpose of asle.). . ❑1.as owrcr of the property.am exclusively combat with IRensed canuactma to construct IAC project(SIX.70".Business and PafeullaN Cade:)I'm CamaeW(a U, am Law dean not apply to an owner of property who Wilda or impmw theman.and who contracts for much pmjecm with a contractor(s)licensed pursuant to IW Contractor's Lie me Law. ❑lunesempiunda See ,Bd PCfm Niswon 0. Dau WORKERS COMPENSA71ON DECUMATION 1 be"a01m under Futilty,of perjury toe of the fallowing destaruianc I ham aid will commum•CWBcam of Cassenuo mIf-insure fer WmkeYa Compete retia,as provided for by Schon 1700 of the labor Code,for the performance of to work for which Nis permit is issued. ❑I haw and will maintain Warier.ComoeaWan Imurana,as required by Sued. 1700oftha lana Can.for the performancetfde weak for which this permit u luudl. ' My WerkNs Compassable.Ism.carrier and Pathic,number art: Came. Policy Na: CERTIFICATE OF EXEMPnON FROM WORKERS' COMPENSATION INSURANCE (Thal merlon tad not be completed if tic Permit Is foronc hundred dollars(SI00) or less) I artfy that in the performance of Na work for which Ni.permit Is Wad.I.hall not employ any person in my msmmrsu as be become subject in the Workers'Compewtim Laws of Califamia Dau Applicant NOTICE TO APPLICANP.IL afar making this Certificate of Exemption,you should Women subject to Ne Workers Compensation provisions of tis LAW Codc,you mus .,O forthwith amply with such provWnm or Nu permit shall the lamm ed ated. .Zi y CONSTRUCTION LENDING AGENCY [-� IWreby affirm Nat than is a amuuctioe lending agency forthsepurmance of '- > the work rte which this permit ts Wad(See.5097,Civ.C.) - WCL.Q Landers Name 7 z Landers Address („)Q L certify that I haw mad this application and use dou the abut information u LT.! . correct.I agree to comply with all city and county onlinamw and sma law totaling to Q rV^ building construction,and hereby authodaa sup ummatiw.of Nu city to enter upon Ne alone-matims d property for inspection"poma �,y'd IWC)aartG la Yw,indCnlNTy and Ftp Emotional the City of Cupert.a against N IlabllitW,jWgmenWarts and expesses which may In any way suers Maim,said City U z in consequence of the panting of Nis permit, ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Situation of Applst✓CoData HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will ths.ppliumtCupertino m tutus Wal Co areupant atom or handle htrdoss material u descentSe.by de Cupertino Municipal Code.Chapter 9.11,and the HedN and Safety coat,sectvs)z(.)± ❑Yes ON. All roofs shall be inspected prior to any roofing material being installed. Nstl the applicant ar futum Wilding oaupsnt mo equipmat m devlea which If a roof is installed without first obtaining an inspection,I agree to remove Wat hayadous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. t ❑Yes ON. I ban reW the hasendas materials regtomments undcrChaptur 6.95ofthe Cal maHalNRSafety Code.SIXlkm0505,)5553 and 25511.1 undersand this ifthe building does net cmrendy Mw a lawn,this it u my rapmt to notify the coapant of the mgmhemcomwhich amWmet Prior to issuance cis CcnifmamofOcap.my. Signature of Applicant Date Owner or mNoriasd Mont Dem All roof coverings to be Class'J¢."or better CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36208032 .00 DATE ISSUED. . . . . . . : 04/17/2008 RECEIPT # . . . . . . . . . : BS000004509 REFERENCE ID # . . . : 08040124 SITE ADDRESS . . . . . : 1191- ELMSFORD 'DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HO CHIH-YUAN AND LIU HAO-CHIEH ADDRESS . . . . . . . . . . : 1191 ELMSFORD DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4960 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 AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 106 . 56 VISA -------------- TOTAL RECEIPT 106 .56 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER Permit No: ��! 0'2400591 (office use only) City Of Cupertino Building hermit Application E-Mail: Buildinq-Permits(a)cuoertino.org (Address is case sensitive). Jobsite Address:1191 ELMSFORD DR Date: 4/15/08 Assessors Parcel Number: 3(0apSo32 , 0d Owners Name: HO, CHIH-YUAN Phone NO: (408)996-7625 Project Valuation: 449.00 Building Permit Info: Bldg Elect Plumb x Mech 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: 12601 132ND AVE NE E-mail:carolr@fpstwaterheater.com City, State & zip code: KIRKLAND, WA 98034 State Contractors Lic. No: 877489 Expiration Date: 5131/08 Worker's Comp No: 1761660 Expiration Date: 1211108 Carrier: Callfornia State Fund City of Cupertino Business License No: 29100 Credit Card Information Credit Card No: Expiratlon 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. aCOF Community Development 10300 Torte Avenue 11 Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 • CUPEf�TINO JOB ADDRESS: 1191 ELMSFORD DR PERMIT# 0 D g D I a OWNER'S NAME: HO, CHIH-YUAN PHONE# (408)9096-7625 GENERAL CONTRACTOR:FAST WATER HEATER COOMPA FAX# 425-814-9516 I am not using any subcontractors: 4/15108 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 Tile Owner/Contractor Signature Date •