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08050067.zi F W D U0 UO_ OF U Fa Uz CITY OF CUPERTINO E O y G 9 Oforthwith y i7 BUILDING DIVISION - PERMIT PERMIT COAFFI2AGTOR INFORMATION BUILDING ADDRESS: PERMIT NO. 10239 E ESTATES DR FAST WATER HEATER 08050067 OWNER'S NAME: PERMIT ISSUE DATE CHRIS CHONG 12601 132 AVE NE 05/07/2008 NE: SANITARY NO. CONTROL NO. (800) 454-8955 ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONnRd DECLARATION Job Description 1 ,(Ohre that I am under. 9 (commencing ft BO under previsions of P with ion 70 of, Code, to=7OkBof Division3of du Business and Profcstions Code, and mylicenais REIN%/RIJI,C' GAS WATER HEATER ll forla and Affect. Lfull License Class Co , Dale Gon DECLARATION ARCHTIECTS DECLARATION 1 uMervand mY plans shall W coed a public rteoNa _ Licensed Pmfesumul OWNER -BUILDER DECLARATION ' I hereby alarm that 1 Am escmpt from Ilse Conuecues License Law for Uc following rtaan. (Salon 70315, Business and Roleasiom Cade: Any city w county which rec uiret a Permit m comm c. alcor. improve. demolish, m repair any Moslem prior ler its issuance, also requires be applicant for such permit to rile a signed statement that hculicensed the ofthe Contractor's lJaveLaw (Chap=9 Sq. Ft. Floor Area Valuation purmanitoprovisions (commencing wiNsection 7000) of Division 3oftimBusinenandI'mmasions Cade) or $449 that W u eampt dlmnfmm and the basis for the alleged ea sairimn, Any violation of Salon 7031.5 by any applicant for a permit Subjects the applicant to a civil penalty of Number Occupancy Type yp not muse than fin hundred dollars (5500). 3 6908009 .�( p y ❑ I, As owner of tke property, or my arnployces with wages as their sole comperuadon, will do Newark Co dos an, (San. 7014, Buniws c he Com snots Liens ar Lawrt Owner of Cade: The Canuaar's Law ret apply No Rty, Required Inspections wh bu nd who uch r property, who wed wife, Nmugh his eh wtiod! s, provie d that suchves im rove. loyas,pmNded am not w far ale U, sumentlazed vemmuinons earn hmens.Own pr cmpledod dieowner- Imilder illbanthebuimpmsemvingmewiNinoneyeanofmproeforn. Aselder wiR low the burden of proving Nat W aid Out build e, improve (us purpose of sale.). ❑ 1. ss.. of the property, NO anharively conu,etmg with licensed camoss an N construct the prejm (San. 7014, Busmen and Professions Code:) The Conuaswes Li. muse Law does not apply m m owner of property who Wilds or maimens thereon, ash. who contracts for such projects with amntrudm (,) licensed purpose m me, fbnuanme, Limine law. ❑ lannexcmptmrder See ,BAPChn Numasoo Owner Dau WORKER'S COMPENSATION DECLARATION I hemby affirm under penalty of pede, ore of the following declarations: 1 haw And will maintain A Cenificau eComem to anlf-i.sure fer Worker's Compost- adon, u pmvidcd for by Section 3700 of do labor Code, for the performance of Ne wok for which this permit is issued ❑ I have and will maintain Worker's Compensation Insurance, a mquimd by Seeeon 3700 of Nc labor Code, for the performance Alum wok for which this permit is issued ' My Worker Campensits. Insurance carrier hand Policy number she: Cartier. Policy Na, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This cation Iced not W cmnpletea if the permit is fusono hundred dollars ($100) . or less.) _. 1 may Vel in the performance of Ne wok fur which this permit a issued. I still not employ any pone. in any manners a m bemmo abjat to the Workers' Compensation Lawn of Cercuma. Date Applicant NOTICE TO APPLICANT: If, after making Nu Cenifieate of Exemption. you should become Subject A, Ne WokeYs Compensation previsions of the Labe, Code, you most comply with such isellMns us this IMuL shall W dmmed levnkcd. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the pofumlance of tic wok fur which this p .it u issued (San. 3097, Civ. C.) Lender. Name lenders Address I certify that 1 ban cad this application and All that IW above irdmmatiun is correct. I agree As comply with all city And county mdi.ances and suss laws relating in ` Wilding cons UN, And hereby Authorise repmlenrstirG of this city to Now upon IW a Ww.mmWSM pmpeny far inspection porymes (We) agree N saw, indemnify And kap harmless the City of Coltman against IiaCOnZCq,jWgmc and espesues which MAY in any w'AY oma against pie City the grafi In eanseganee of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS, Re -roofs Srgnalum of APpbnnUCanmcmr Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding occupantnom or handle hmWoa material As deflned by the Cupenina Municipal Code. Chapter 9.13. and the Health and Safety Code, 0 VC. . 25532(a)1 ❑Ye❑Na. All roofs shall be inspected prior to any roofing material being installed. Sun the, Applicant or future building occupant ata e m pP b p y prem or which If a roof is installed without first obtainingan inspection, I agree to remove pe Mona �trAo Wines air contaminants u dcfinctl by du Bay Area Air Quality Management all new materials for inspection. ❑Yes ON. I haw mtl Ne harardouamham;ais requirtmcnuumkr Chapter195 of Ne Cali(oe nu Hcalthk Safety Cede Sause:05(15. 25533 And 15534.1 uMcmand thatiflhe building does ret currently ban a (mane than it is my resporstiNlity N maily the occupant of the requirements which Most W mel prior N iaWana of, Gertifieste oroccupacy. Signature of Applicant Date , All roof coverings to be Class 'W or better owner urmmarioce agent DaN' * 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN .......1: 36908009.00 DATE ISSUED.......: 05/07/2008 RECEIPT #.........: BS000004685 REFERENCE ID # ...: 08050067 SITE ADDRESS .....: 10239 E ESTATES DR SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER ............: CHRIS CHONG ADDRESS ..........: 10239 E ESTATES DR CITY/STATE/ZIP ...: CUPERTINO CA, 95014-3312 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 0 Permit No: O0 OSDC��-f03163 (office use only) ry City Of Cupertino Building Permit Application ck 5 1 E -Mail: Building-Permits(d) cupertino.org (Address is case sensitive). Jobsite Address: 10239 E ESTATES DR Date: 5/6/08 Assessors Parcel Number: �W ?Dciq - DO Owners Name: CHONG. CHRIS Project Valuation: 449.00 Building Permit Info: Bldg_ Jon uescri Remove/Replace Gas Water Heater Phone No: (408)863-0689 Plumb x M Contractor Information Company Name: FAST WATER HEATER COMPANY Contact Name: Carol Randall Address: 12601 132ND AVE NE City, State & zip code: KIRKLAND, WA 98034 4 State Contractors Lic. No: 877489 Worker's Comp No: 1761660 Carrier: California State Fund of Cupertino Business License No: 29100 Phone No: Fax No: 800-454-8955 E -Mail: carolr@fastwaterheater.cam Expiration Date: 5/31/10 Expiration Date: 12/1/08 Credit Card Information Credit Card No- 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