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08080067CITY OF CUPERTINO ;r ;a��!�r.yy��v+♦♦pp� "�" - - - "x' `("CQLV°i Q1��'1 �1•�lYlli� N BUILDING DIVISION PERNHT l[t'JC xw AST. r 'sF w 'A BUILDING ADDRESS: 101.48 R:CDGEWAY DR FAST WATER HEATER PERMIT NO. 08080067 , OWNER'S NAME: PERMIT L95UE DATE ;)U-[TOR:LANO, JOHN 12601 132 AVE NE 06/11/2008 NE SANITARY NO. CONTROL NO. (800) 454-8955 ARCHI ECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Description 1 bempy arbou that l mo Hummed under provision of Chapter (commencing with Section 70f11)m`DiA km 3Ofthe B". ahtl Prolmodu Code, and my license is .Job RMV/RPLC GAS WTR HEATER In full force and affect. Liccmo Clan Lic.as Da¢ Camrxbr ARCHITECTS DECLARATION I understand my plan Nell w used as public records Licensed Professional OW NIR-BUILDER DECLARATION 1 hereby ARrm that I em attempt from the Contactors License Law far the fallowing mann. (Section 7031.5, Business and Pufasiom Code: Any city or county which require a permit to cmmmck aIle[ Improve. demolish, or repair my su eetme prim to its issuance. also mquires the applicant forsuch permit to rile a signed stsmmant Mad he is licensed to the of Contractors Lien Law Sq. Ft. Floor Area Valuation punumt provisions the (Chapta9 $449 (commencing with Section 7000) of Division 3 of We Business and Prof.uiom Code) at mad M is acmpt dmm(rorn and the hula for the alleged «emptfan. Any violation of ' 3 4 2 41012 Occupancy pane y Type Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty ofNumber rat seam Nan five hundred dollen (S500). ❑ 1, as owner of the property,w my employees who wags u their sale eompeuNon, Required Inspections em will do the work, and the structure ts hot intended or offered for ask 7044, Business and Proressiou Cade: The Connor's Liann m Law dohot apply an Owner of q p progeny whe builds tomorrows dmrton.aM who deusuchwork himmlfwtiuougb his awn employer, provided that such impravemanu art oat intended oranend for sal%If. however, Ne Wilding or improvement Is sold within am year of cempkuon. the owner- builda will have dee harden of proving that he did We Wild or improve for purpose or eek.). ❑ 1. as owmr of Me property, am eadardw],... acting wide licemed conuanors to construct the project (Sec. ]D44, Business and Pefaaiou Code:) The Continuum. U- w. law docs not apply man owner of proper, who Wilde ac improves desmon, and, who contracts for such pmjecu with arnntnctor(s) licensed pumunt a the Comemones License Law. ❑ I am uempt undo Sea , B S P C 1-lharason 0.. Dam WORKER'S COMPENSATION DECLARATION L hereby afMn under pntalty of perjury now of Me following declarations: I have and will maintain a Certificate of Consent to selfdnaure for WorlmesCmnpen- Under, u provided for by Section 3700 of the labor Cada, for the performance of the work for which this permit is tswed. ❑ I haw and will maintain Worker's Compensation Inmrma, u required by Section 37M.1 dee labor, COM, for the performance of Ne work for which this Penni, 4 issued. ' My Warrant, Compere d. lnmruam aniw and Policy number tae: Cartier, Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Thlssenlnn wed notwcomplemd Kthe permit is foram hundred dollars ($100) or leu) I certify that in the perfomnna of dee wort for which thin permit Is ism d. I shall not employ any person in my manner re u at become subject to the Workers' Compensation Lawn of Califomia. Dam Applicant NOTICE TO APPLICANT: If, after making this Ceninam of Emmpuon, yam should become subicct m the Workca't Compensation provloa i of the latew Cod% you most forthwith comply with such provisiam or this permit spall w denmed revoked. CONSTRUCTION LENDING AGENCY 1 Manby ai14m Wt them is a conwuction lending agency for Me Performance of dm work for which dds Permit ts (trued (Sec 3097, Cb. C.) ' Lemice. Name , Landers Addmas I certify that I haw mud this application and sum than the show information is correct. 1 agree a comply NN N City W county orWmnaa and some laws relating an building cmdru cbma. and hereby mthorim repremnudves or this city tomherupon the shove-mentioned property for inspection inquires (We) agree to saw. indemnify and kecp hmmle s the City of Cupertino agelo0 limilida, judgments. core and examines which may In my way acrnm agaimt aid City in consequence or the of s. APPLICANT UNDERSTANDS AmND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Type of Roof Signuurt of AppliaDam HAZARDOUS MATERIALSrr DISCLOSURE Wier Ne rat m (mum Wading an mamaiai wadMedia u tleMetl by the Cupenina Municipal Code. Chepmr 9.13, and dere Hulth and safety a C.p e. Chapter Hoolth Conn.3enlan 25533(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yu ❑NO If a roof is installed without first obtaining an inspection, I agree to remove Will that applicant or fumrt wmuse wilding atpam eyuipmcot or devices which It huaNnus air canumianu u dcfimd by the Bay Amo Air Quality Management all new materials for inspection. oisuics7 ❑Ya ONO I have mad the huardnwsmemdaiarequirtrrcnu under Cbapmrd.95 of dee Califon his Hcalthk Safety Cad. Seeumu25505, 25533 and! 35i34.1 undersand MEMO wilding does not currently haw a mnmk dist It is my hourewhility In redly the comment of dee requirements which run be=ll poor to iaumco of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class '%?" or better Ownv ' ' or wthorimd ager Dam ® 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT 0 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34241012.00 DATE ISSUED.......: 08/11/2008 RECEIPT #.........: BS000005734 REFERENCE ID # ...: 08080067 SITE ADDRESS .....: 10148 RIDGEWAY DR SUBDIVISION ...... CITY .............: CUPERTINO IMPACT AREA ......: OPERATOR: patg COPY # : 1 OWNER ............: QUITORIANO, JOHN ADDRESS ..........: 10148 RIDGEWAY DR CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2659 '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 ].PRWHEATR UNITS 1.00 24.48 0.00 24.48 0.00 1.TRAVDOC 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 ----------------- CREDIT CARD DOTAL RECEIPT : AMOUNT --------------- 106.56 --------------- 106.56 VOICE ID DESCRIPTION ------------------- 518 WATER HEATER 0 REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- • Permit No: Q ko (90 412493 (office use only) City Of Cupertino Building Permit Application E -Mail: Buildinq-Permits(a)cupertino.org (Address is case sensitive). Jobsite Address: 10148 RIDGEWAY DR Date: 8/8/08 Assessors Parcel Number. 342q i3OQ' -co Owners Name: OUITORIANO, JOHN Phone No: (408)757-5777 Project Valuation: 449.00 Job Description Remove/Replace Gas Water Heater Contractor Information Company Name: FAST WATER HEATER COMPANY Phone Contact Name: Carol Randall ® Address: 12601 132ND AVE NE City, State & Zip code: KIRKLAND, WA 98034 State Contractor's Lic. No: 577489 Workers Comp No: 1761880 Carrier: California State Fund of Cupertino Business License No: 29100 Fax No: 800-454-8955 E-mail: carolr®fastwaterheater.com Expiration Date: 5/31/10 Expiration Date: 12/1/08 Credit Card Information Credit Card No: ABB. _ 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. • OCIF CUPINO Community Development 10300 Torre Avenue Cupartuo CA 95014 Telephone (408) 777-3228 Pex (408) 777-3333 vin ent JOB ADDRESS:PERK Hr # v U 10148 RIDGEWAY DR C �-- .7 JOHN 'WATER HEATER I am not using any subcontractors: _ �LO%'"°�� 8/8/08 Signature Date Please check annlirahlP anhrnnirar+nra and rmm"larc fl,a fn71m,A",r inFn,.. eHnn. 1 66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Penin 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