08030037 CITY OF CUPERTINOwcy��a..+�a
BLALDING DFPISION PERMIT
BUILDING ADDRESS: PERMIT NO.
10200 HILLCREST RD FAST WATER HEATER 08030037
OWNER'S NAME: PERM"ISSUE DATE
GLEN WEGNER 12601 132 AVE NE 03/07/2008
ONE: _ SANITARY NO. CONTROL NO.
ARCIU11=1ENGINEER: BUILDING PERMIT INFO
REMOVE/REPLACE GAS WATER 'BLDG ELECT PLUMB MECx
3 O pHEATER
LICENSED CONTRACTOR'S DECLARATION
r� 1 hereby"ran that I um licensed under provision,of Chapter 9(commencing Job Description
Tj with Section 7000)ofOiNnan 3 of ft Beat. and Ra(easima myliccmeu
in roll farts art
a�,3 full fares
Ga.IMar
ARCHITECTS DECLARATION'
I underwa my plea Nall ed used as public rtrnrb
5esti LKen¢d Professional
OWNER-BUILDER DECLARATION
9 I beinhy aRrm that I Am eumpt from the Commcears License Law for the -
afollowing mown.(Section 703 I.S.Business and Pmfmcdons Calc:Any city or county .,
3 I which inquire a permit to cnvuvct.Blur,improve,demolish,or repair my suucture
Z� prim to its iasuenea,alto mqul.theapplicant for each permit to file a signed sammmm
g < that heislicansodpursoanttotheprovisionsordeConvaeorsLicense Law(charter 9 Sq.Ft. Floor Area Valuation
? n (commenting with Section 701)(1)of Division 3 of the Business and Professor.Codc)ar
3. Nu he 3 uempt thertlmm and the basis for the alleged ewmption.Any violation of
Section 7031.5 by any applicant fm a permit dubjeos the applicant he a civil penalty of APN Number Occupancy Type
not mart than fin hundred dollars($500),
❑I,u owner of 0u property,m my employee with wage u xk(vele 044.8 Non.
will do lesions and the he Oona x mal Liana a AW do Lorc t Apply
owner or
W Rarwim bas coir:Th Gnusocon.Llano law Eos rot appy lf rt awns car _ Required Inspections
man
Property lobo aiprovid mprovea dempr and who Am nouchwvhhimatt red through his
own emplayw,provided that ver Improvements ase not Ieuaed mattered ran sae If,
.
however.Nebuilding Wake
proving
Is mid withinamyear ormproeiforthe owner-
Asiltle will law W buAdm of pmvinp that k dltl not build or Improve far purpose of
esu.).
. ❑1.As owner of the property.am acludnlY contracting with licensed mntreemrs to
cwtmu the project(See 7044,Business and Professions Cade)M Conuaaoh U.
cent Law,doe at apply in an awnA,of property who build,or improve Nemo..rod,
who contracts for such projeeu with a mntmcur(a)licensed pumwnt In the Communes
Llceve Law.
❑I am exempt under See ,B&P C fm this maven
Data
WORKERS COMPENSATION DECLARATION
I hereby,Bine under Mmalty of perjury,am of the following deeluaw:
❑I bare as w01 maintain A Cerdflcasar Co..,in salf-iuum for Worker'Camper.
satire,as provided roe by section 3700 of ase Labor Code.for Ute performance of the
work for which Nis permit is isaua.
❑I have and will mainWn Worker's CumpeasaVan Insunnm,as Acquired by Section
5700 of the labs Cede,for the performance of W wast far which thi,permit is Issued. '
My Workers a ensetion Wer era 'm and Polity nbeam:
u
Culler PoIUY No.: 1
C RTI CATE FEKEMPIION FROM 0
COMPENSATION INSURANCE
(This section med mtheeomplcud ifthe permit is fa'one hundred dollars($100) '
A,leu)
1 cemifv, dist in the pmrormaeco of this work ran which this permit is issued.I shall am
employ any person in my manner an As At become abject in the Worlat'Compensation
Lams of California.Data
Ayplicuu
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
become subject in the Woteh Compensation previsions of the LaWr Code,you nowt
.,z fc rdlwim comply with each provisions m this permiL mall be deemed invoked.
z Di CONSTRUCTION LENDING AGENCY
F+^ I hereby Affirm that dem isa,ouvucdrm lending agency far the pufarmaree of
!Yi> the work for which this permit Is iuued(Sec.5(197,Civ.C)
IgA Q Lander,Name
7 z lander,Address '
U O 1 tW fy that 1 Nn read this appllcLfm lea sum that the above Information A
G4 E rnrma 1 agree m diw
comply with all city And county aress and sues Mining sting u
0 Dr.'! building camu Khan,and hereby amharice mPmsenudns afthu city m mm,upon Ne
[i7 above-mendmetl property ran inspeedon p.,poxr.
gy (We)agree to save,indemnity and keep hu meas the City a(Cupertino Against
y
liabilities judgments.cads and expensed which may in my wayeccme against said City
U Z in consequence of the smaung or this permh. -
^' APPLICAjj??UNDERSTANDS AND WILL COMPLY WITH LL NON-POINT Issued by: Date
SOULATIONS.
Re-roofs
Signature or lien ana DoE
xA7A 10US MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building ouvpart Amm m bandle areadau materia
As defined by ase Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
Cause.Such.
.25532s)' Na All roofs shall be inspected prior to any roofing material being installed.
WIII the applicant or ran building occupant taw equipment or asses which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha,dlaw car cantsminanu defined by the Bay Arta Air Quality Management all new materials for inspection.
Davie?
❑Yo u
I have mad the baurdms daH inquhcmcnts ardor Clupur 6.95 of the hlifon
nia llexlthk SaetyCede,Sex=BM5,35533 and3 534.1 mdumua thuifthe building _
chosen torte Aly bun A unam.that It u my me'rellelity u Of the spent err d n
inquiinme wrocipiormisananceofaCenirmu:afoc Signature'ofApplicant Date
(�
gent All roof coverings to be Class'%¢"or better
owner arm ori m'
• CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32616089 .00
DATE ISSUED. . . . . . . : 03/07/2008
RECEIPT #. . . . . . . . . : BS000004106
REFERENCE ID # . . . : 08030037
SITE ADDRESS . . . . . : 10200 HILLCREST RD
. SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . .
I
OWNER . . . . . . . . . . . . : GLEN WEGNER
ADDRESS . . . . . . . . . . : 10200 HILLCREST RD
CITY/STATE/ZIP . . . : CUPERTINO, CA
RECEIVED FROM . . . . : FAST WATER HEATER
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
----------------- --------------- --------------------
CHECK 106 . 56 3519
---------------
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
From— 03/02/2008 08:07 #575 P.008/014
CITY OF CUPERTINO 395593
WATER BEATER
�UP I�TiNO PERMIT APPLICATION FORM
APN# /P G Date:
U �-1 . vU 2/28/08
Building Address:
10200 HILLCREST RD
Owner's Name: Phone#:(408)257-8284
WEGNER, GLENN
Contractor: Phone#: 800454-8955
FAST WATER HEATER COMPANY Fax#: 425-814-9518
Cupertino Business License#: Contractor State License#:
29100 877489
Contact: I Pbone#: 800454-8955
Carol Randall
Fax#: 425-814-9518
tJ
uilding Permit Info:
ld Elect Plumb x Mecb
esidential x❑ mmCoercialob Description:
Remove/Replace Gas Water Heater
s
Strapped ❑ On Platform ❑ Banded ❑ New Location ❑ Replacement
Valuation: 449.00
Green Building Check must be completed and attached to this application.
Green Building Points achieved:
From: . 03/02/2008 08:07 #575 P. 009/014
395593
CITY OF CUPERTINO
NATER HEATER
•UPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee I Permit Type
Group
iPCWHEATR CommeTmal Water B PCWHEATR
Heater/Vent
BSEISMICOM Seismic Commercial 13
I PRWHEATR Residential Water B PRW13EATR
HeaterlVemt
/ BSEISMICRL Seismic Residential B
PPERMlTFEE Plumbing Permit P
AL I
TRAVDOC favel & B
Documentation
BUSLIC Business License B
Community Development
10300 Torre Avenue
J Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEPTINO
Building Department
JOB QDRES PERMIT #
OWNER'S NAME: IPHONE #
GENERAL CONTRACT FAX #
I am not using any subcontractors:
Signatdre 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
its
l.,� d3G7 0q
OwnerrContractor Signature Date