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08060031 CITY OF CUPERTINO " F•& m�+aF I ^� ' ''- BUILDING DIVISION PERMIT CONTRA CT01 INF,URMATION afa#AT: +... ..ty ;�ssaxa 4✓r,..,,,=.1 ?ad n PERMIT NO. Bm1,9 ,5pD NE�r9RMANDY WAY FAST WATER HEATER 08060031 OWNER'S NAME: U PERMIT IS SE DATE DONNELLY EDWARD S AND LORRAINE 12601 132 AVE NE 06/04/2008 'IMNE: SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO RMV/RPLC GAS WTR HEATER BLDG ELECT PLUMB MECN 0 0 0 0 uo0 LICENSED CONTRACTOR'S DECLARATION ,I u C 1 hereby affirm that I am luxosed under Provisions of Chapter 9(mmmendng Job Description Ct Section 7")of Division 3ofNC Bud.and Profeuiuns CcO.md my lice.is i wish in full voce and effect. License Clue Lie.as =t-I Date CamruSor q swwyu ARCHI'ECTS DECLARATION ``2< 1 undcodmd my plana shall W used as Public ccnNs JyU y 0'^ Licensed PNfewoNl . OWNER-BUILDER DECLARATION E I hcrehy affirm that I am exempt from the Contractor's License Law for the E p O following moon.Section 7031.5,Business and Profession Code:Any city ar county 3$ which holt.a permit to eonmacl,altci improve.demolish.or repair try Nosed. Zi prior to its issuance.also mgmbu the i icanl for such Permit to rile a signed summent �0 that he is licensed pursuant o Use provisions of Use Contractor's Uccmc Law(Chapter 9 Sq.Ft.Floor Area Valuation (commencing with section 7000)of Division 3 of thc Business and Profusions Cod:)Or $ Nat he is eumpt themrrohn and Use:basis for the alleged euaopdon My violation of Section 7031.5 by any applicSut for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type or not me Yuri It.hundred dollars(SSW). - P Y YP ❑1,uo wofthepsoputy.mmywploycuwishwageuYCGsolee=m =dw. and Professions and the ser Come or'sLndede Law clu flan,a(Sec.7054,Budnw and Pmfuslou code:The Conmctoh License laic dons tot apply to an owner of Required Inspections property who builds orimprow thereon,and whodoesahchworkhimsel(ortlwugh hu ' own emPloyw.pmvidcd this such improsemcnu tie not inreMN oroRerW fm s.le.R. bother.she Wildingwimprovementussold withinot ycsr of improve for purpose of builder will have the WNcn of proving that he did not bwltl or improve for puryese of sark 1,u awns of the propertym aexclusively contracting with licensedeontrutas to comtmct dm Pmject(See.7044,Business aM Profusions Code:)The Conuacmrs Li- cents Law docs not apply w an owner of property who Wilds or improv damem,,rid. who contracts for such projects with a contractor(,)licensed Formant in the Contractors Lim.law. ❑I turn exempt under See ,B h P C for Nu won Owner Dau WORKER'S COMPENSATION DECLARATION 40 1 hemby a i m under penalty or perjuryane of the following decluatiom: ❑1 have and will maintain a Ccrtirieemor Canscm to selr iasure for Worlu is Cmnpm. salon.u provided for by Section 3700 of the Labor Code,for the perfennan¢or the wart for which this Permit is issued. 1 haw and will maintain Worker's Compensation Inamena•as required by Section 3700 of the labor Cade.for the peRarmame of she,were,for which this pamhn us issued. My Workers Compensation lnmruMo carrier and Policy number me: - Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Moos section need Out he completed irthe permit is former hundred dollars(SIM) or leu.) I Mondry that in the Performance of the wart for which this Permit is issued.I shall ooh employ anyperein in any mannerm as to become subject to the Wortrrs'Compematian Laws of California.Dam Applicant NOTICE TO APPLICANT:If.arc,making this Cenirhmu Of Exemption,you should become Subject to Ne Workers CampensaYon provisions Of the Labor Code•you must .,O forthwith comply with such provisions or this permit shall he dcemed revoked. ZN CONSTRUCTION LENDING AGENCY - [—� 1 thereby affirm Nat Nem its consmunimn lending agency for Ne perform==or C h7 the work for which this permit u United(Sec.3097.Civ.C.) 0 lender's Name .7- z lender's Address L J Q I coolly Nat 1 have mad Ni,application and sum on,she above information is Ls.E' conch.l agree to comply with all city and county uNin.and sou laws relating to . 0U Wilding construction,and hereby andodne reprexnutiru of thus city in enter upon Yee r W shove-mentioned property for iuooldOn puquoses. L~ 4 (We)acme to save,indemnify and trop humless Ne City of Cupertino against to Iiabilihiu,jadgmcnts.cuu and N.which may in any waY....,a solaid City f the U Z PLeRs pConot. APICANTUNERSTANDS Of AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of AppliceHAZARDOU Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Willy t apCuKmtm forum Wildingt Chaps atom Or handleIHealloadmamri,l Us deRnN by the Cupenihw Municipal Code.Chapter 9.13.utl the Health antl Safety Code,sermon 35533(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yu ONO Will tk applicant or future Wilding aavpant um equipment or devices Mich If a roof is installed without first obtaining an inspection,I agree to remove emit harardnus air conominanu as defiscd by the Bay Area Air Quality Management all new materials for inspection. Dimict7 P 0Yes 0 N 1 have mad Ne by Nousmamrialssquimmenu underCNpmrh.95 ofthe Califor- maHeal"Suiely Code,Sections 15505,35533 and 35534.I mccrsund thmifthc Wilding Jaen not currently have a tenant.that itis my respmuihility,to notify dm ouupant or the requirements which mom W net prior in issuance of a Cmurcam ofampene, Signature of Applicant Date owner ar amtharipetl.sem Date- All roof coverings to be Class'%q."or better CITY OF CUPERTINO • 4 ITEMS OF 8 PERMIT RECEIPT - OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36611153 . 00 DATE ISSUED. . . . . . . : 06/04/2008 RECEIPT # . . . . . . . . . : BS000004996 . REFERENCE ID # . . . : 0800'0031. ' SITE ADDRESS . . . . . : 7551 NORMANDY WAY SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER DONNELLY EDWARD S AND LORRAINE ADDRESS . . . . . . . . . . : 7551 NORMANDY WY CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5222 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 AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 213 . 12 VISA --------------- TOTAL RECEIPT 213 . 12 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER • 406116 Permit No: (office use only) O p / DO / City Of Cupertino Building Permit Application 0 �P • E-Mail: Building-Permits@cupertino.org (Address is case sensitive). Jobsite Address:7551 NORMANDY WAY Date: 6/4/08 Assessor's Parcel Number: 3&(p ///673, 00 Owners Name: DONNELLY, EDWARD Phone No: (408)252-2782 Project Valuation: 449.00 Building Permit Info: Bldg Elect Plumb x Mech 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 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: 4417123041349530 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. S, Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CI OF Fax(408)777-3333 16UPERTINO Building De axtment. JOB ADDRESS: 7551 NORMANDY WAY PERMIT# OWNER'S NAME: DONNELLY, EDWARD PHONE # (408)252-2782 GENERAL CONTRACTOR:FAST WATER HEATER COMPA FAX# 425-814-9516 I am not using any subcontractors:_ �'` _f'*/ 1�a_ela 6/4/08 Signature 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 W g g nk tal ck • Owner/Contractor Signature Date