08070154 CITY OF CUPERTINO
BUILDING DIVISION PERMIT yVoCLR At1Q,LttY1 ��rV1\
"'L5"TOoT"RODRIGUES AVE FAST WATER HEATER 08070154
OWNER'S NAME: PERMIT ISSUE DATE
DANIEL O'KEEFE - 12601 132 AVE NE 07/22/2008
NE: SANITARY NO, CONTROL NO.
(800) 454-8955
ARCHRECT/FNGINEER: BUILDING PERMIT INFO
BLEG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION O O O O
M8Scott.
1 thereby"'W"that I se.licensed muter pmvialons of Chapter 9(comma.ci.g Job Description
with Sc tt.7")ofl)iH oo 3 ofthe Bulw••send Pefes6ms Code,and my licenses RMV/RPLC GAS WTR HTR
In full fora and alrca
j 4 Z_ License Class Lin.Jr
Dab Omica mr
kg- ARCHIIECrS DECLARATION
Wu 1 underaand my plum Nall be used u public records
y G Licensed Professional
OW NER-BUILDER DECLARATION
i E 1 hereby Arm that 1 am cacmpl fern the Cemracloes License Law for IW
O o following madom(Section 7110 U.Business and Professions Code:My city or county
3$ which mquirea a Permit to consenarl Aw.Wprnw,denuf ah,or rtpair any arsumure
_Zy prim'm as issome,Am asPires the applicant for such permit to file a Signed sommem
<
that heisliccmedpunuanllolhePovisionsoftheConbacbr'sUmnrcLaw(Chapter9 Sq.Ft.Floor Area Valuation
�$ (commeminSMi Sccdon]000)of Division3ofdm Businenand Profesdiom Code)m $449
.- dm he a weep thmafmm and the India for We alleged eaemptlo,MY violation of
Section 7031.5 by any applicant for a parmll wbjccu me applicant in a civil Penalty ofN Number
nm mora Nan 11.hundred dollars(M). 369 3 2 0 4� Occupancy Type
O L at owner of the popery,m my employce,with wgm at lWh ante eomPeruaden,
wmmmeworkanems,eCoreamtmLnaaeLAWdoes nabpslyinanB�b„ Re/uiredInspections
and Property
who
lds.CultTh CnnVCWt,License lam ch an[apply b N uwlCr is q
onsmem whe s,pmArimpmvmlMmnove who dmnoahwmrk Aimsellmthmugh his
ow.employces,pmNmdthatsuchimpm id wham not ear ofomoBered the ale If.
however,me Wilding m WPewmmt Is mid within ons Wildw imixebtio..the an=.
Wilder MO haw ilm buNce of pvHng Out he did net hdW car impomo,fm pump¢or
sake).
0 1.u owrter a the propmy.am endmiwly contracting with licensed contractors to
constmcl the Project(Sec.7B1d.BulineII and Pnefessiom Code:)The Conbaebra LI-
ce.Law does not apply in m.of popery who Wilds or improwa Thereon.and,
who ammo fee such projecs with a conlracbrp)licensed paean,to the ContrameYs
License law.
Olameaempummn Scs, ,BBPCfmthi.mason
owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby aOWrn under Penury of perjury nrb of the(allowing dedarWor¢
1 haveendwillmaintain•Cenificabof CIrom.bself4aw.forWerkm'aComp.-
were t, pmvimd Permit
Sectien 3]00 of the tuber Code,far the Per(ormanco of Ihe
work for which thea p+mir s luted.
0 1 law and will maintain Workmes ComPensadon Insurance,u mquised by Semon
3700 of tha Mbar Code,for dm nrrmonance.fthe work for which this Permit Is leaned.
MY Worker's Compensation Insurance artier and Policy number am:
Cartier Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thissecdon aced not W cmnplcbd lime Permh is fern hundred dollars(5100)
Or hat)
1 anify,that in thn Mr..or fun work for which this Permit is issued.I shall ma
employ any Person in any sooner as to become attract to the Workma Compensation
Laws of California.Data
Applianl
NOTICE TO APPLICANT:If,after making this Certificate of Burrow.Into should
bceome mmicn m the WerkeYn ComPeenhdon provisions,of IW labs Code.yen
.,O forthwith comply with such provisions or mu Permit shall W deemed mvokcd
'Z y CONSTRUCTION LENDING AGENCY
F•- Ithereby affirm that ummi,awmlmetionleading spasyfor the errorm of
6i dte work for which min Permit It is,ad(Scc.309],Ci,C)
0 Undoes Name
U z Leaders Address
U O I certify that I low rad this wlicseien and mm fuse We aWw boronmader is
Ir„F cmr m.l agm2 b comply with all City YM cowlY.6.and'We laws mlaling b
U Wilding construction,and hereby authoriz:mpresantadms orths city b enter Iran.led
yaWw-mendtnedpropnt Ins"mown purymses
(We)agree b sew,indemnify and kap harmless the City of Curnrdno against
CTI incainot.jedgma th,cmtaand espenseaerit. may In serymyaccra against said City
U z in APPLICANT
of the granting of this permit
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Stgnamre of Appli _HAA2:ARDOUS MATERIALS DISCLOSURE Dab Type of Roof
Will the applicant or fulme Wilding occupant arum or handle harallom comm al
as de0ned by the Cupertino Municipal Code.Chapter 9.13,aHeth aland Safety
Code. Oy.cetion ❑N.
2sm2p)] and the All roofs shall be inspected prior to any roofing material being installed.
Yes
Will IW applicant or future Wilding occupant use Nulpmenl or devices which If a roof is installed without first obtaining an inspection,I agree to remove
�S ImOord us air contaminants as defined by the Bay Am,Air Quality Management all new materials for inspection.
O alp ON.
I haw read the hamado s materials Imryimmens unmr Chapmr6.95 arthro Califor-
niaHUIth&Sdcly Cam,Srcuons25305.25533and25534.1mubrsta.dthaifthe Wilding
does not cmmnily haw a bnanh that II is my rommombilily th notify the occupant of tha
myuireme.m which most be met Prior to ismarm of a emti0cab or aapney. Signature of Applicant Date
Owner or mthom<d agent Dam' '
All roof coverings to be Class's"or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 369 32 041
DATE ISSUED. . . . . . . : 07/22/2008
RECEIPT # . . . . . . . . . : BS000005540
REFERENCE ID # . . . : 08070154
SITE ADDRESS . . . . . : 20032 RODRIGUES AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DANIEL O'KEEFE
ADDRESS . . . . . . . . . . : 20032 RODRIGUES AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
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
12PERMITFE 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
•
101�� 410824
Permit Na:
(office use only)
City Of Cupertino Building Permit Application
E-Mail: Building-Permits(cDcupertino.org (Address is case sensitive).
Jobsite Address:20032 RODRIGUES AVE Date: 7/22/08
Assessors Parcel Number.—36q l 0
Owners Name: O'KEEFE, DAN Phone No: (949)492-4233
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: Carrfornia State Fund
City of Cupertino Business License No: 29100
Credit Card Information
Credit Card No: V9101119111aftExpiration 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.
Community Development
s. 10300 Torre Avenue
5014
Telephone Cupertino0) 77 73228
CI Fax(408)777-3333
`CUPEkTINO
Buil I ffing De cutm.ent
JOB ADDRESS: 20032 RODRIGUES AVE PERMIT 0
OWNER'S NAME: O'KEEFE, DAN PHONE# (9049)492-4233
GENERAL CONTRACTOR:FAST WATER HEATER COMPAN FAX# 425-814-9516
I am not using any subcontractors:_ - " / � ' � 7/22/08
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
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date