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08060229 CITY OF CUPERTINOazm • �* ss>=++ • - ' '' - ` m BUILDING DIVISION PERMIT �CONTRACTQRTIORMA">ZION" PERMIT NO. Bu1L�IgG.AQDRESS:ONNA LN FAST WATER HEATER 08060229 OWNERU'S�NAME: L PERMIT ISSUE DATE BRYAN SHU 12601 132 AVE NE 06/26/2008 ONE: SANITARY NO, CONTROL NO. (800) 454-8955 ARCHITECT/ENGINEER: BUILDING PERMIT INFO • BLDG ELECT PLUMB MECH mop LICENSED CONTRACTOR'S DECLARATION Job Description m tummy y affirm Nat 1 am licensed under protdm 1P voof Chapter 9(commencing with Section 7000)or Division 3otthc Business and Protesnomcme,aM my license is RMV&REPLC 'GAS WTR HEATER in full force and effm. D L i License Class Lic.» . Dale Comnclar n ARCHITECTS DECLARATION W U 1 understand my plans shall W used as Public recordist g G ti licensed Professional 3 OWNER-BUILDER DECLARATION 1 hamby M.Out 1 am exempt from the C.mr clor's License Law for the OO following mason.(Sation 7031.5.Business and Prefassioss Code:Any city of county S$ff which requires a Permit to..t,alter.improve.dcmnlish,or repair any stmeture —Z6 prior m its issuance.also reclaims the applicant for such Permit o file a signed statement ss that he is licensed pursuanttothe ton'Wonsofthe Common's L'im.Law(Chapter9 Sq.Ft. Floor Area Valuation stF•G (commencing with Semina 70)0)of Division 3 of the Business and Professions $449 Cade)or - f 2 R din he IS exempt themfmost and the basis for the alleged exemption.Any violation of Section 7031.5 by airy applicant fm a permit Subjects the applicant m a civil penalty of ssp7�Number Occas nos fume Short firm hundred dollars ISM 5 919 015 .Y7V Occupancy Type 0 1.as owtea of the property,Or my employees with wages as their sole comperuetian, will do On work,and don structure is not intended or offered for solo(Sec.R .Bassi rums and Poor..lons Code:The Contractor's License Law don nut apply m am owner Of Required Inspections property who Wiidsorimprowsthrscon.and whodatasuch work himselfserthrough his Own employers.provided chat such improvements are,not intended or offered for sale If. however,the Wilding or improvement is mid within ane year of completion,the ownes- builder .will haw On harlot of proving that ha did Out build ar improve tar purpose of sale.). 0 1.as owner of the property am exclusively commuting with licensed conmxtona to construct the project(See.7066.Business am Professions Code:)The Conotmen's Li- . cease law dos not apply to an owner of property who Wilds or impmws thereon,and who contracts for such projects with a contractors)licensed pursuant to One Contractor's Lum.Uw. O lameumptunda5ec. .BAPCforthumason caner Data WORKER'S COMPENSATION DECLARATION 1 hereby,affirm under penalty of perjury one of the following declarsuom: 0 I hsve and will maintain a Certificate of Cement to self-insure fa Wmi els Comprn- ,a6an.as provided for by Stevan 3700 of ds Labor Code.fa the perfonoatce of the wart for which this permit is issued. 0 1 haw and will maintain Wurkcrs Compensation Insurance.as required by Scotian 3RIOof the labor Cade,for the performance ofthe work forwhleh this permit is issued ' My Worker's Compensation Insurance carrier and Policy number art: Cartier. Polity No.: CEMFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Ofssectian need morhacampleted if t e permit is feronc hundred dollars($100) or less) I certify Na in Ne performance of the work for which this permit is Wood,I shall not employ any person in any manner so u se become subject to the Workers Compensation Laws Of California Data Applicant NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should become subjm m the Worker's Compensation provisions of the Lobar Code you mus _ ,J O foMwith comply with such pro.isloN or this permit shall W deemed revoked, zy CONSIBUCf10N LENDING AGENCY (••' I hereby of irm Nat chert is.comwcunn lending spoey for the p:rrormance of the work for which this permit is issued(Sec.3U97,Civ,C.) 14 Lender's Name Mz Landers Address V Q 1 calory Nat 1 low read this application and sate that the abow information is D.E correct 1 agme to comply with all city and county ondinancss and state laws relating to .� Wilding construction,and Woo yauthounmp u6mof Nuciryrpcmaupnntle and erty D.1 above-menudgmnt.mass far i expenses which may H 6s (We)agree to taw,indemnify and keep harmless the City of Cupertino against CA liabilities.judgments.the9 uand 9Ofpauesrail. may in My way corm agsimtsaid City !,,'� A cPLIC NT of the granting of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of ApplicaHAZARDO Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will theapplicant notMuni Wilding aapaptcore2,and Health and u de0Sec by the Cupertino Municipal Code.Chapter 9.12,and tie HesIN and Safety otic. Section 25532(e)t ❑Yes ❑Na All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ..it harardnus air contaminants as dcfnod by Ne Bay A.Air Quality Mansgcmcnt all new materials for i Dutrin7 inspection. DYes ON. 1 have read the haamdous materials requirements under Chapter 6.95 of the Califm. me Hoskin B SafctyCmO,Scomes 25505.25533 and 25536.1 atlapsad Nu iftha Wilding dams not camnlly has a tenant Nat it u my resproubility to notary,Nc mevpsnt of Ne requirements which muss me met prior to issuance or.Ceni6ese of Omapanry. Signature of Applicant Date Owner or rothaf3ed agent Data All roof coverings to be Class'A'or better CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35919015 . 00 DATE ISSUED. . . . . . . : 06/26/2008 RECEIPT # . . . . . . . . . : BS000005231 ' REFERENCE ID # . . . : 08060229 SITE ADDRESS . . . . . : 10582 LONNA LN SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BRYAN SHU ADDRESS 10582 LONNA LN CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4318 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 IPPERMITFE 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: O V u(, O� -408195 (office use only) • City Of Cupertino Building Permit Application E-Mail: Building-Permits(cDcupertino org (Address is case sensitive). Jobsite Address:10582 LONNA LN Date: 6/24/08 Assessors Parcel Number: Owners Name: SHU, BRYAN Phone No: (408)219-8070 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 City, State&Zip code: KIRKLAND, WA 98034 State Contractors Lic. No: 877489 Expiration Date: 5/31/10 Workers 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: - rUCW) 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 pem7it. Community Development OCOF 10300 Torre Avenue Cupertino CA 95014 Telephone(408)Tn-3228 • CUPEkTINO Fax(408)777-3333 Building Department JOB ADDRESS: 10582 LONNA LN PERMIT# 080L OWNER'S NAME: SHU, BRYAN PHONE# 408)219-8070 GENERAL CONTRACTOR:FAST WATER HEATER COMPA PAX# 425-814-9516 I am not using any subcontractors: 6/24!08 Signature Date Please check a licable subcontractors and complete the followin 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 Owner/Contractor Signature Date •