08070048 BUILDING DIVISION PERMIT aCrONTRAGTpRIAIF ,RMATI�N ,
BUIT0 DDRESS: PERMIT NO.
7�� SAGE CT FAST WATER HEATER 08070048
OWNER'S NAME: PERMIT ISSUEDATE
lk F] SH DOUGLAS D AND MARION A 12601 132 AVE NE 07/08/2008
NE: (800) 454-8955 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMMECH
O O LICENSED CONTRACTOR'S DECLARATION
4 F 1 based,affirm that 1 am licensed under pmvi bms of Chapter 9(mosomdug Job Description
with Sweden 700U)of Division 3 of Ne Dudneaand Pmfestiom Cade.and my licence is RMV/RPLC GAS WTR HTR
^ w in full farce and effect
5 License 0. Lte.0
e.q Dmt Contracts,
ARCHITECTS DECLARArION
[ 1 undersand my plans mall W urA as,public records
31U
got Licensed Pmfesstanm
5OWNER,BUILDER DECLARATION
1 Wrtby affirm that 1 am exempt from Ne Contractor's License,law for me
Coe) following reason.(Section 7(31.5.Business and Professions Code:Any city or county
S$ which requimt a permit to cmmmcL alter.improve.dcmolIah,w repair any Rmclum
prior m its issuance,also requires IW applicant far such permit Lfile a signed suament
—ZsQ maths is licensed widuSpurmant
Ilh.tome of Di4oneor the eBoth rind Proflaw(s hapter Code)
Sq:Ft. Floor Area Valuation
F 3 (cat ta,is ng ,K 5enirom and
of India
r the
al aSeineasand.Any
lash.If $449
_
at he u exempt ars,from and the baso for the alleged es Beam, .Any violation of
ammo]door by airydred dent fora permit subjects the appBanr W.tivil penally of Number Occupancy Type
nm mom man five hundred lotion(5300). 3 5 9 0 6 013 .� P Y YP
1,uaweer of tie pmpeny.mmy wplcym wdh wsg.alhvsole compewflon.
win do IW mol,aad the awctum is net intended or offered for sats(Sec.7t m,Business
and Professiaa Code:The Conlnctres Llan¢law dens not apply m an own.of Required Inspections
property who Wilds orimprows mer em,and whodaeseueh wart himemlfornumugh his
oder.,toy=.provided Nan such improvements are not inrerWed erruffered feasale U.
however.me Wilding or improvement u sold within one year of completion,the owncr-
builder win have the Inomm of proving that he did not dual or improve for purpose of
sae.).
❑1.as..of the property,sm exclusively convecting with licensed contractors to
construct the project(Sec.7014.Business and Professions Codu)The Contractors U. .
cense law dens not apply to an owner of property who ddlds or Improv mermen.and
who contracts for such projects with a canteaaar(s)licensed Foramen to IW ContractNs
List.law.
❑Ismeaemptunder See .BRPCImthureaoo
Owner
WORKER'S COMPENSATION DECLARATION
I be eby+Qm under pnulty of perjury one o(tire foltswing declmllons:
Date—
of hs.e and dgl maintain a Certiemta of Conscm ts self insum fmwarkefsC.N.
ration,as provided for by Section 3700 of the Iasor Code.for the performance of me
work for which this permit is issued
❑1 her and will maintain Worter's Compsmadon Insurmm,u Inquired by Section
3700 ofthc lalmr Code,for me perfernamcc offle work forwhich mu Permit is iaued. '
My Worker's Compensation Inwrance artier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Oris mctlm need net W completed if do permit Is forone hundred dollars(5100)
or less.)
1 certify that in the performance of IW work for which this permit is brand.I than not
cmployanyperson In my maorcr an as to become subject code Workers'Compeam an
Laws of cslifomia Date
Applicant
NOTICE TO APPLICANT.IL after making this Certificate of P emption.you should
dews subject to the workers Compensation provisions;of the labor Cade,you most
.J z forthwith comply with such provisions or this permit shall W deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I hem alfum that mem is a comrection lending a
[+ by j FneY forted performance or
Ixe dolt for which mu permit d issued(See.3097,Civ.C.)
a.E lL ender's Name
D z lenders Mamss
V O 1 certify that 1 have read this application and sea mat the above information is
tL correct 1 agnea to comply with all city and county ordinantta and a=laws nemng m
.0 Wilding construction,and hereby authadm rtpmsmuuvrs ofmit city to cater upon the
rty,
amilideenud,or pmpcsu for sapenton purposes
y (We)agree ts save,indcmnifY and keep hmmless flue City of Cupertino against
Z incintialudgmeau.eosumaapemawhieb may in mYu'+Y aattmagdmisaid City
V z APPLICANT
NDER TAN of muD MiL
WILL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINf Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of AppliceHAZARDOU Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant no future Wilding ec.Chaptsrom"handle andthe
hamrdom material
C deflocd Sm le me Cupertino Municipal Code.Chapter 9.13,and the Healer and Safety
code,s.tion:ss3z(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicam or future building occupant use equipment or devieca which If a roof is installed without first obtaining an inspection,I agree to remove
.n hu❑Yrs Na
arm vdnair conuminaa a defined by due Bay AmaAir Quality Management all new materials for inspection.
Dimrim7
Oyes ON.
1 have reed the haamma remniaU on uiremena uaderchapar 6.95 of the czlirm.
nu Healm&Safcty Cade,S.6.25505.23533am1255k.1urvlcnu ifdc building
does err cm emly Wm a temnk that it is my responsibility m wofy me omupen of me
requirements which most W met Oct In issuance oft Ccancate of Ocespmcy. Signature Of Applicant Date
Owner of authorized agent Date All roof coverings to be Class'N'or better
CITY OF CUPERTINO
. 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35906013 . 00
DATE ISSUED. . . . . . . : 07/08/2008
RECEIPT # . . . . . . . . . : BS000005361
REFERENCE ID # . . . : 08070048
SITE ADDRESS . . . . . : 906 SAGE CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . I . . . . . . . . .. FISH DOUGLAS D AND MARION A
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4217
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 106 . 56 VISA
---------------
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- ----- --- ----------------------------
518 WATER HEATER
•
D 0106 i-I! (a 403308
Permit No: O
(office use only)
City Of Cupertino Building Permit Application
• E-Mail: Building-Permitsi2cupertino.org (Address is case sensitive).
Jobsite Address:906 SAGE CT Date: 7/7/08
Assessor's Parcel Number. O (P
Owners Name: FISH, DOUGLAS Phone No: (408)253-7915
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@fastwaterheateccom
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: 1211/08
Carrier: California State Fund
City of Cupertino Business License No: 29100
Credit Card Information
Credit Card No: 4J1Jj11J@1MW 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.
Community Development
10300 Torre Avenue
ertino CA 95014
Telephone(408)777-3228
i:OF Fax(408)777-3333
+CUPER,TINO
Builffing De artm.ent
JOB ADDRESS: 906 SAGE CT PERMIT#
OWNER'S NAME: FISH, DOUGLAS PHONE# (408)253-7915
GENERAL CONTRACTOR FAST WATER�HEATER COMPAN FAX# 425-814-9516
I am not using any subcontractors:_ - _ / '�¢P 717/08
Signature Date
Please check applicable subcontractors and complete the followin information:
SUBCONTRACTOR BUSINESS NAME B J SINESS LICENSE #
Cabinets &Millwork —
Cement Finishing
Electrical
Excavation
Pencing
Flooring:Carpeting.
Linoleum/ Wood
Glass/ Glazing _
• Heating
Insulation
Landscaping
Lathing
Masonry .
Ornamental Sheet Metal
i
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
•