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08030038BUILDINGDIVISION PERMIT CONTRACTQRfiIPi�'ORMA`CIQ �� BUILDING ADDRESS: PERMIT NO. 22250 HOMESTEAD RD FAST WATER HEATER 08030038 OWNER'S NAME: PERMIT ISSUR DATE ALLEN CHEN 12601 132 AVE NE 03/07/2008 ONE: SANITARY NO. CONTROL NO. ARCHTIEC IENOINEER: BUILDING PERMIT INFO REMOVE/REPLACE GAS WATER BLDG PO I O O LICENSED CONTRACTORS DECLARATION HEATER Job Description 1 barely affirm that I we Kneed under provisions, of chapter 9 (comm acing withScadm7O10)of Ivi o ofdo Bw uslaand Tart) i� App andmylkeoseu W fall lame IT !/ Lkanm Lk.I carte TSDECLARATION ARCHITECTSDECLARA ON 1 undarwnJ my PWa MVI W used as public records, Licensed Professional OWNER -BUILDER DECLARATION " 1 hereby affirm that I am aumpt Imre the Coruamor'. License law for du ' following maven. Station RD 13, Business and Pmfuskns Cadc: Any city or county which mquime a permit On carommat slur, improve, demolish, or repair my structure prior to its issuance, sure requires the applicant for such permit to file a signed statement that he is licensed purNml to lire proviBlON Of the Coalmebr's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 5 of the Business and Professions Cade) or that he is exempt therefrom and the bails for the alleged exception. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil Prouty of not mom than five lu bed dolun(5m ❑ 1. u owner of Ne propeny. m my employee with wgu u dteb mle eampeoudm, Required Inspections will do the work and the stromus, is mtinunded oroRartd forsale (Sac. TON, Builmu and Pons Coder The Comm roses License Law does t apply man owner of roretil property who build. or important thermn, and who daeaauch worthimmlror Waugh his own employee, provided that such improvements am an, intended oroRned ferule. if. however, the building W Improvement Is mid within am year of mmpledon, the owner. builder will Mw the burden of pmNng that he did ret Mid or improve for purpose of ask.). ❑ 1. u awmr of rhe property, w exclusively contracting with licensed mnuacrm. u cermcm the projea (Sec. TON. Sosiaw mod Professions; Code:) The Commerce, U. «nu law does not apply an an owner of property who builds or improves Neaten, and, who convacv for such projects with a mnuamortq licensed pursuant m tits commences License Law. ❑ lamuemptunder See .B&PCrur Ni.muan vertu Dau WORKERS COMPENSATION DECLARATION I hereby affirm under pwlty of perjury am of the fallavring decland. ❑ I Mve and velli a Cion of Came fur Warkees Campery urian, forbon Code. provided far Section 7700 of the labor Code. Ire the perfarmancm of the by 3700 r mi wait far which this permit is issued. , ❑ I have and will maintain Worker'. Compensation Insurance, u required by Section 3M of dm Inbar Cade for ft performance of the work fW which this permit is Issue My WaheetC In an wren Count" and Policy ns, te�r�://��17�� Carrier. Paliay Na.: Ct(�llLt) PI OP fEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thissection mad not bacompkted lfum Penna Is format Whomeldollms(SIM) ' m lees.) I certify that in the Performance of the work fm which this Permit is issued. I "I nm ' employ anypemmut in any commerce erce u in become subject in the Worl¢n' CompemWm Tawe of California Dau Applicant NOTICE TO APPLICANT:If. after making this Ccnifmcate of Exemption, you shoule became subject b the Wori Compensation provisions of the labor Cade you muss forthwith comply with such Providers or this permit shall be donated ranked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that Nem Is a construction lending agar y for the performance of the wart its, which this Permit Is assts d (Soo 3097, Civ. C.) Lenders Num Lenders Address I Curly that I haw rid Ws application and sum this Our above ado matio t u ' cannot. 1 agme to comply with all city and county ordinances and Bate laws reading On building construction. and hereby authorian mpmxenutivu of this city to cme"pon the alrom-mentioned property for impecdon purposes. (We) agree to uve, indemnify and keep humlev Our City of Cupertino against Ilabilifimjudgement, cru and expenses, which may in my way accrue agilut said City in consequence of the gmndng of this permit APPLICA NDERSST�ANNDSSSANDWILLCOMPLYCWIITTT)Aj{{{yyI,NON-POINT SOW, DNr1I'✓FSf�� Issued by: Date LI —r Re -roofs �✓ Signnurco ppUcoevc. Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the appllcml ar rot. building oecepml.mre unbundle hazardous material u defined by du Cupenina Munim Cod, Chapter 9.1x, and the Health and Safety code. Saslow x(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Yu NN If a roof is installed without first obtaining an inspection,agree to remove Will the aPplicmt or future Wilding occupant em equlpmml or dcvuas which ,l emit haumnus air contaminants u do ed by the Bay Amo Air Quallty Management all new materials for inspection. District? Yn u Ihaveatad What nmaWialamquimrncnuumkrCWpur695orWCalifon- niaHcalth&Softly Code Suriats25S05,25533W2555e.lmWemmdthmifdc Wilding Joey an cumndLbve a umnr durt it or my rupooilWlitY torwify ge oceyWnn of Yu It a" he arm ivaance ar, Cvtihate Signature of Applicant Date All roof coverings to be Class's" or better ownerdunredagenl Dow • • CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot:, APN ........: 32651003.00 DATE ISSUED.......: 03/07/2008 RECEIPT #.........: BS000004107 REFERENCE ID # ...: 08030038 SITE ADDRESS .....: 22250 HOMESTEAD RD SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: SylviaM COPY # : 1 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 106.56 --------------- 106.56 VOICE ID DESCRIPTION -------- ---------------------------- 518 WATER HEATER REFERENCE NUMBER -------------------- 3519 VOICE ID DESCRIPTION -------- ---------------------------- OWNER ............: ALLEN CHEN ADDRESS ..........: 22250 HOMESTEAD RD CITY/STATE/ZIP ...: CUPERTINO, CA 95014-0115 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 ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 106.56 --------------- 106.56 VOICE ID DESCRIPTION -------- ---------------------------- 518 WATER HEATER REFERENCE NUMBER -------------------- 3519 VOICE ID DESCRIPTION -------- ---------------------------- From: 03/02/2008 08:06 CITY OF CUPERTINO '. WATER HEATER OuP iN0 PERNIIT APPLICATION FORM t19R6,3C031r #575 P.006/014 394830 APN # Date: 2/28/08 Building Address: 22250 HOMESTEAD RD Owner's Na1ne: Phone #: (408)773-1785 CHEN, ALLEN Contractor: Phone #: 800-454-8955 FAST WATER HEATER COMPANY Fax #: 425-814-9516 Cupertino Business License #: Contractor State License #: 29100 877489 Contact Phone #: 800-454-8955 Carol Randall Fax #: 425.814-9518 Building Permit info: ld Elect Plumb x Mech Residential x❑ Commercial ❑ Job Description- Remove/Replace Gas Water Heater Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement Valuation: 449.00 Green Building Check must be completed and attached to this application. Green Building Points achlevedr From: 03/02/2008 08:07 #575 P.007/014 CUPER,TINO CITY OF CUPERTINO WATER HEATER PERMIT APPLICATION FORM 394830 Quantity Fee ID I Fee Description Fee Group Permit Type 1PCWHEATR Commercial Water Heater/Vant B PCWHEATR BSEISMICOM Seismic Commercial 13 I PRWHRA.TR Residential Watcr Heatewwt B PRWHEATR BSMMICRE Saismic Residential B PPERIMFEE Plumbing Permit P / / TRAVDOC , Tfavei & Documentation B BUSLIC Business License B 9 IZ�w CITY OF OUPEkTINO i Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department ., I am not using any subcontractors: Z444� 6-3 (7 log Signa6dre Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork I am not using any subcontractors: Z444� 6-3 (7 log Signa6dre Date Please check applicable subcontractors and complete the following information: z 6 Date 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 z 6 Date