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08050065 CITY OF CUPERTINO BCILDING DIVISION PERMIT BUILDING AgDRESS: PERMIT NO. 1157 SCOTLAND DR FAST WATER HEATER 08050065 OWNER'S NAME: PERMIT L4UE DATE JINGHUI WANG 12601 132 AVE NE 05/06/2008 NE: SANITARY NO. CONTROL NO. ARCHITECTrENGINEER: BUILDING PERMIT INFO RMV/RPLC GAS WATER HEATER BLDG ELECT PLUMB MECH uoo LICENSED CONTRACTOR'S DECLARATION lob Description u 1 bunchy affirm that 1 am licensed under provisions of Chapter 9(commencing with Section 7")of Division 3 ofthe Business and Profcssiuns Code.and my Beeneis in full fame and erf.L p�? License Class Lle.d n1- Dae, Coulmew, ARCHITECTS DECLARATION U I understand my plans shall W used at public mord g a Licensed Professional 3 OWNER-BUILDER DECLARATION I Wreby alErm that I am amoupt from de,Contractor's Lleame Law for thd C C O following mason.(S.W.7031st Business and Profeasums Code:Any city or county e m Pi which ruquima a Permit to construct,cher,improve,demonh,or repair any nruetum yzi priortor.issuan¢..Isumgtb..tlk applicant for such permit to rile a signed suWment < thu W is uecnsed pursuant W the provision of the ConacWYs license Law(Chapter 9 Sq.Ft. Floor Area Valuation Y�C (commencing with Suction IWO)9 Division 3 of thd Busixu and Proteaian Code)or i`<$ that he is eusnpt therefrom and the heads for the alleged aernption My Notation of Section 7031.5 by any applicant for a permit subjects the applicant W a civil penally of APN Number Occupancy Type rot roam than five buMred dallars(g3110). P Y YP 1,an owner of the property,or my employes with wages as their sok compensation. will do Use wort:and the struc,um tarot intended o tafertA for sale(See.10th.Bush... and Professions Cads,The Contractors License Law does net apply W an owrca of Required Inspections Property who builds a improves thctdon,and who does such wart Waterer through his ownempl.y .provided that such improverrcou tae not intended oroRued forsale.Ir, however.thd Wilding or improvement is sold within one year of completion,the owner- - builder,will have the burden of proving that he did not build or improve for Purpose of sale.). 1,as owner of the property.am exclusively contracting with licensed contractors W construct Use project(Sec.1004.Business and Profession Cade:)The Contractors W- come Law does not apply W an owner of prepeny who Wilds or improves thereon.and. who contracts for such projects with a consomar(s)licensed pursuant W the Contractors License Law. ❑l am exempt under See ,B k PC for this mason ' Owner Dau WORKER'S COMPENSATION DECLARATION 1 hereby arlhm under penally of perjury,one of the following declaration: 1 haw and will maintain a Can imue fConsent he self-inure for Worke,'sCmopmm- sntion,as provided par by Section 31700 a the labor Code.ren the padcannut¢of the wort for which this permi,u issued. ❑I have and will mainuin Worker's Compensation Wurana,as mgWred by Sectme 3100 of the L Wr Cade,for the peRormanec of de work for which this permit ts issued. ' My Workers Compensation Laurance artier and Policy number H: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu authors need not W completed if the Permit is turned hundred dollar(SIM) or less.) I Certify Thal in the performance of the work for which this Permit is issued.I Shall net employ any person in any manrerso u W become subject to 1W Workers'Compensation Laws of California Date Applicant NOTICE TO APPLICANT:IL after making this Certificate of Esemption,you should become subjon W the Walker's Compensation previsions of the Labor Cade,you most .JO Forthwith comply with such Provisions of Nu permit shall W deemed revoked, Z y CONSTRUCTION LENDING AGENCY 5 � Ihereby air.that themuaconivuctimn leading agmry for ft performance of C w�. the wart for which this permit u issued(Sec.3097,Civ.C) Q Landors Name =z Le kes Address U O 1 cavity thct 1 have rod this application and sued dtas the sinew Information u U, Pcoons.1 agree W ad comply with all city scounty endurances and sue,laws modes W l O U Wilding conwcdon.send hereby authorim mp esenutiws of Nu city W on=upon the aWw-mendoned property fan Lupcnion purpo¢s W (We)agree W saw.indemnify and keep barrnlees de City of Cupertino again, c/3 inconsesjnce of tu,eowand opus•-•which mayinanyway aaauc againtsaid Ciry U 2 inconsequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Signature of Applicant/Contractor Data Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or forum Wilding occupant store or handle harudous material as defined by the Cupertino Municipal Cade.Chapter 9.13.and the Health and Safety Code,Stiction 15532(a)? ❑Yo ❑No All roofs shall be inspected prior to any roofing material being installed. Will thea hent or future Wilding occv If a roof is installed without first obtainingan inspection,I agree to remove pP g pain y A equipment or Mann which P g District?ardnua air conumiwn as defined by rhe Bay Acta Air Quality Management all new materials for inspection. ❑Yo C1 No I haw read the ha ankam materials mquiremenu under Cha sw 6.95 of the Cslike. nu lical"safety Cade.Sxtian 15505,25533 and 25534.1 unndermand dmtrunk Wilding doss rot currently have a scram,ties it u my responsibility W notify unk occupant of tie requirements which muss W met Prior W issuance of a ce himaw of Occupancy. Signature of Applicant Date Gw.,.1..dmn.dagent Dae, All roof coverings to be Class'A!'or better CITY OF CUPERTINO • 4 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36229020 . 00 DATE ISSUED. . . . . . . : 05/06/2008 RECEIPT # . . . . . . . . . : BS000004682 REFERENCE ID # . . . : 08050065 SITE ADDRESS . . . . . : 1159 SCOTLAND DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JINGHUI WANG ADDRESS . . . . . . . . . . : 1159 SCOTLAND DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5061 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 • Permit No: 9 R0!50(3('003064 (office use only) City Of Cupertino Building Permit Application E-Mail: Buildinq-Permits(a)cupertino org (Address is case sensitive). Jobsite Address:1159 SCOTLAND DR Date: 5/2/08 Assessors Parcel Number: 0 c�O Owners Name: WANG, JINGHUI Phone No: (408)257-0326 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: K)RKLAND, WA 98034 State Contractor's Lie. 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 [Nalme edit Card No: Expiration Date: 11/10 on Card: Jeff Jordana © MasterCard ❑ American Express ❑ The Building permit application anda completed & signed • contractor/subcontractor form need to be submitted with each permit: Community Development 10300 Torre Avenue Cupertino CA 95014 CI OF Telephone(408)777-3228 C U PEkTI NO Fax(408)777-3333 Building De ' cutment FGEN;ERALCONTRACTOR- DRESS: 1159 SCOTLAND DR PERMIT R'S NAME: WANG, JINGHUI PHONE# (408)257-0326 FAST WATER HEATER CIIOa�MPA FAX# 425-814-9516 I am not using any subcontractors:` �'Ld `��`9 "` 5/2/08 Signature Date Please check applicable subcontractors and com Tete 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 i Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date •