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08070100
CITY OF CUPERTINO .:zl BUILDING DIVISION PERMIT COF�F.CRACTOR NF0RMAT110N t11 .'w s D0. PERMIT NO. 8UIL0 ITH� F8LKESTONE DR FAST WATER HEATER 08070100 OWNER'S NAME: PERMn TIEDATE M I'CHAEL HOUSTON - 12601 132 AVE NE 07/15/2008 NE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO RMV/RPLC GAS WTR HETR 'BLDG ELECT PLUMB MECH 0 0 0 0 O o LICENSED CONTRACTOR'S DECLARATION Job Description mC 1 hereby affirm that 1 am licensed under Provisions Of of Chaplet 9(commencing P =W with Section 7000)of Div Wan 7 of NC Business soul Profession Code,ad my licenseis << in full forte and effem License Clan Lic.N Dau Cont. 47W ARCHITECTS DECLARATION W U I understand my plans atoll be used u public records 6 gwt; Licensed Pmfissiansl OWNER-BUILDER DECLARATION f I herebya?sin Nn I am--Pt from dm Contnnoflaw for License lafor tit a O fallowing mason.(Section 7111 1.5,Business artd Pmfessiom Codi:Any city or county $ which requires+permft to trnmucl,time impmw,dimalish,nr repair,any structure prior 0,its Wuanci.also requires the.pplicant for such permitto file.signed statement that he is licensed pu.1 to the pmalion Of de,C--metars U..Las,(Chapter 9 Sq.Ft.Floor Area Valuation i (commeneingwiNS=don7000)of Division7ofthe Busines.and Ptnfeuiom Code)ar $ that he u exempt 0crtrom and do bait for the alleged exemption.Any violation of Section?031.5 byay.pplicatforapennhsubjects ft ppliessmto.cNilpenalty of APN Number Occupancy T ant mart does five hundred dall+n ISM P )' YPe 0 Laawnerof Ne Property army employees with wags ade4solecompenauon, willdothewmnk...dthesavatumhmtinundedoro@rtdforside(Sa.701a,Business Required Inspections and PmfeVin.Gods:The Coa4YtaY.I.ICJLY dao Out daDal apply m e ns N.of q p property who hal Id3IX ImPrarcJ NOeaar and who da.such worn hhneelf of ilmough his awes smPlayca,provided that such mapnowmenu ae notintendW an@red for side.If, however,the building or improvement is and within ons]ear of completion.the owner. Wilder will haw the hander of proving Nat le did not Wild to impnvve for purpose of ahiJ. 0 1.as owner or the Finnerty.am exclusively contracting with licensed conusaam to construct the project(Sec.7Ws,Business and Professions Cade:)The Conhsmr's U. cense law it.Dot apply in an Darter of property who Wild.or impernis thereon.and who comrial for such projects with aconuacmr(s)licensed pussuant to the Contunoes License Law. O larelemptuncier See .B&PCfarthumaon Owner Due WORKERS COMPENSATION DECLARATION 1 hereby anon ander penalty of perjury oro of tate following declarations: 1 haw am will maintain aCerufiou of Covera in alf-insure far wine es Compere sztian,as provided for by Sada.7700 of the labor Code,far use performace of the work for which this permit is issued. 0 1 haw and will maintain Workes's Cumnereauon lauran¢,as mgmmd by Section 7700 of the labra Code,for the performance of the work for which this permit is issued. ' MY Walker'.Compeaauon Insurance carrier and Policy number arc: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE flits xNon need tatbecomphoed if the permit Is faone hundred dolls.($100) or hist) 1.reify that in the performance of Nc work for which this pcmail u issued.I sbail trot employ any pcssan in any mmaneran as m become abject to the Workers'Compewdon Laws of California Data Applicat NOTICE TO APPLICANT:IL ager making Nu Cmdr.clue of Eaemption.you should become subject in the woftes Compensation Provisions of the labor Code.you most .J 0 foMwith cmhPIY old a each Pou0sioor No pcpnit.haN be darned noodled.? " CONSTRUCTION LENDING AGENCY [—t .�. 1 hereby aRmi that them is a cotuuucunn lending for the Performance of Ci > the work for which No Permit Is issued(Sec.709'1,Civ.C.) 1 Q fandef.Nam. . Z).z laMcts Address U Q h certify that 1 haw read this application and stale that the show information h Ly E correct.l agree In comply with all city and county ordinances aM suer laws relating in _C) building combrimuon,and hereby audariae rtpreaenuuws of Nu city to enurupan use +bow.mrnudgm pmpinY for iapeeuon Purpose. F y (Wes)agree m arc.indemnify and keep harmiesa the City of Cupertino against Z lieconsequence cnaensuand of dusesp.p which may in any myaccrue against aid City V Z m coarguertce of Ne granting of No ptimit. '—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S44Date SOURCE REGULATIONS. SIP..o(ApplicaHAZARDO Dale Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII the applicat or future Municipal o aeupat r 9 1 orhandle the hmardoa material Cods, by the Cupenitm MuniciWl Code,Chapter 9.12 and tk Health and Safey code.section 255724)7140 ❑Yes ❑No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or fuwm building occupant use cyuiPmenl IX Jcvices which an inspection,If a roof is installed without first obtainingiection,I agree to remove .� sharardna air contaminants ss derined by the Bay Area Air(hulity Management all new materials for inspection. 0Yes 0Na I hone mal the havdwsmalerols mquirtmcw tmdcr Chepler6.95ofthe Califon nuH not cu Safety Cade,Sasias25505.255)7andn5574.1ta nutty da Jaes not currently Mrc a tense that it u my responsibility b wtifY Ne occupenr of the requirements which most be met prior to issuance of a Ccoircau of Occupancy. Signature of Applicant Date Owner orauthorsisd agent DaleAll roof coverings to be Class'%W'or better CITY OF CUPERTINO • 4 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36211003 . 00 DATE ISSUED. . . . . . . : 07/15/2008 RECEIPT #. . . . . . . . . : BS000005471 REFERENCE ID # . . . : 08070100 SITE ADDRESS . . . . . : 7968 ..FOLKESTONE DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MICHAEL HOUSTON ADDRESS . . . . . . . . . . : 7968 FOLKESTONE DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4959 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 10.6. 56 0 . 00 106 . 56 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER • Permit No: 0 80� ()C)409515 (office use only) City Of Cupertino Building Permit Application • E-Mail: Building-Permits(a)_cupertino.om (Address is case sensitive). Jobsite Address:7968 FOLKESTONE DR Date: 7/14108 Assessor's Parcel Number. �in.?, i X 003 oo Owners Name: HOUSTON, MICHAEL Phone No: (408)480-0874 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: 12601 132ND AVE NE E-mail:carolr@fastwaterheater.com i City, State & zip code: KIRKLAND, WA 98034 State Contractor's Lic. No: 877489 Expiration Date: 5/31/10 Worker's 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: 44i7123041349530 Expiration Date: 11/10 Name on Card: Jeff Jordan Visa © MasterCard ❑ American Express ❑ The Building permit application and a completed & signed contractorlsubcontractor form need to be submitted with each permit. Community Development 10300 Torre Avenue. Cupertino CA 95014 Telephone(408)777-3228 OCIOF Fax(408)777-3333 • CUPERTINO Building Ile artmenf JOB ADDRESS: 7968 FOLKESTONE DR PER.MIT# OWNER'S NAME: HOUSTON, MICHAEL PHONE# 408)480-0874 GENERAL CONTRACTOR:FAST WATER HEATER CrO�MPA�N FAX# 425-814-9516 I am not using any subcontractors: _ - J��"""""� 7/14/08 Signature Date Please check applicable subcontractors and complete the follo'wig information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork - Cement Finishing Electrical Excavation Fencing Flooring.Carpeting Linoleum/ Wood Glass/ Glazing e 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 •