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08070101
uo� t[ �iLL j ya2 ^n'u C g6y •CC Km6 m—a Y�g i CITY.OF CUPERTINO "4NVOP�a=� 1 ' BUILDINGDIi'ISION PEytyyyyT 1\L'?q 014 s` BUILt�l�cbg9gRE;�;:LLSON AVE FAST WATER HEATER PERMIT NO. 08070101 OWNER'S NAME: PERMIT ISSUE DATE WONG, JULIE 12601 132 AVE NE 07/15/2008 NE: SANITARY NO. CONTROL NO. ARCHITEC (ENGINEER: RMV/RPLC GAS WTR HTR BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION O2SCr1 Job Description 1 we by affirm Nat I am licensed under provisions of Cleaner 9 (commencing P with Section 7") of Division 3 of the Business and Professions Code. and my license is in full forte ad effect. License Class Lk.0 Da¢ Comactor ARCHITECTS DECLARATION 1 at ere dj my plans shall be bad as public records Licensed Prokscional OWNER -BUILDER DECLARATION I hereby aRrm that I sue exempt from the, Comrctofs License Law for de following meson. (Section 7031.5. Business and Pmfessiam Cede: Any city of county which requites a Permit to construct, altar, improve. demolish, or repair any sumoro prior b its issuance. also requires the applicmt for such permit to rile a signed statement is licensed to the of the Commcmr's License Law (Chapter 9 Sq. Ft. Floor Area Valuation than he puraant provisions I (commencing with Sccdon 7") ofDivision 3 of the Business and Professions Code) or • that k ut exempt therefrom and the beau for the alle mi exemption Any violation of APN Number Occupancy enc P Y Type Section 70315 by any applianl for a permit subjects the applicant to a civil penalty of not mole than rive hundred dollar (1500). ❑ I, u owner of the propwy, m my employer with wages u theta ale compertadon, Required Inspections will da the work. Nd the enncmR mnarinaded araffmcd fmaale(Sen. 7W. Busi eas and Rafessiat Code: The Comtrxc ses License Law den, rot apply b in owner of property who builds a improv thetmn, and who dues such work himself or through his own employees, provided Nat such improvements tae Out intended molfemA formic. If, however, Ne building or improvement Is sold within ane year of completion, the owner. builder will leve dla burden of proving that he did not build or improve for purpose of side.). ❑ 1, as owner of Ne property. an exclusively comosming with fttnad conuacan in cometmn the project (Sec. 7009. Business and Professions Code:) The Cenamlor's Li- caus law does not apply In an owner of property who builds or improves themed, and who contacts for such projects wild acenuacmKs) licensed pursuant to the Contractors License Law. 1 ore exempt under Sec . B & P C far this season Dwmer Dale WORKER'S COMPENSATION DECLARATION 1 hereby alErr under pointy of perjury, one of the following decuntions: 1 have and will malnei t a CmadiW6 of Consent le self-lafua for Warka's Comfort, ation, as provided fm by Section 3700 of the labor Code, far the performance of de work for which this Permit is issued. , 1 have and will mainland Worker's Computation Werra, u nquised by Section 3700 of the labor Code far dere performace ofthe work far which this permit is issuN. ' My Workers Compensation Wunnce rimer ad Policy number tae: ' Cartier. Policy Ne.: CERTIFICATE OF E)(EMPTON FROM WORKERS' COMPENSATION INSURANCE . mussecdc n need not bu completed lithe permit is forms, hundred donors (1100) or kis) 1 codify the, in the performance of the work for which this permit is issued, ) shall not employ any Person in any reamer a as m become abject to de, Wahcn' Compenauan Laws of California. Dan Applitnl NOTICE TO APPLICANT: IL after making this Ccrudicas, of Exemption, you should become subject m the Wallace, Compensetimn provisions of the Labor Cade, you must ' fod mvild comply wild such Provisions or this permit shall on dcemed revoked. CONSTRUCTION LENDING AGENCY issconstruction lending agency for Ne perfunnauce of 1 hor , whaRrm pethere ' work for which this permit u issued (Sec. 709'1, Civ. C.) La Lasses Name lender's Address I readily dust 1 have tad this application and sem that the above inmmma de Is cmtct- 1 agree m comply with all city ad county Ordinances and stale laws totaling he building construction. and hereby authorize repmseadive, of this city to color upon the shave-renudned property for inspection purposes (Wc) agree to an. indemnify ad keep harmless the City of Canadian against liabilities,judgmentsu casts and expenses may in my way sgid City ttrailm sta r in conancn gce of the grounds of the Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. Re -roofs Signuum a(AnplicmdCanummr Dem HAZARDOUS MATERIALS DISCLOSURE Type of Roof Willy futurebue ingCo me h al r,are or duadand sd t e Cupautor as dcfimd by dw CupeNno MumciWl Calc. Chapeau 9.11. and the Healld and Safety haps the Health Seely Code, S,ctimn 25532(a)7 ❑Yt El No All roofs shall be inspected prior to any roofing material being installed. Will th, applicmt or furor Wilding Occupant use equipment o dcviaa which If a roof is installed without first obtaining an inspection, I agree to remove mit hazardous air concomitants as defined by the Bay Ara Air Quality Management all new materials for inspection. P District ❑Yt rlNo Ihavcremf the hndooll maerials requirements undarChaper 6.95oftheCalifor- ran Health & Safety Code, Sections 25505.25533 and 25530.1 mdmand dutir do building does not centrally has a,nen, that it u my reanonsibility to notify the occuprl of the requirements which most be met prior m isaewe of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class 'V' or better Owner oraathorixadagent Data • 4 ITEMS OF 8 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 39708055.00 DATE ISSUED.......: 07/15/2008 RECEIPT #.........: BS000005471 REFERENCE ID # ...: 08070101 SITE ADDRESS .....: 19075 TILSON AVE SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER .............. WONG, JULIE ADDRESS ..........: 19075 TILSON 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 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 ITRAVDOC 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 TOTAL RECEIPT : AMOUNT --------------- 213.12 --------------- 213.12 VOICE ID DESCRIPTION -------- ---------------------------- 518 WATER HEATER REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 0 r� L E Permit No: O Uc)% D / 0 410321 (office use only) City Of Cupertino Building Permit Application E -Mail: Building-Permits(aCugertino.org (Address is case sensitive). Jobsite Address: 19075 TILSON AVE Date: 7/15/08 Assessors Parcel Number. �q �p kc)55 00 Owners Name: WONG, JULIE Phone No: (408)517-8889 Project Valuation: 449.00 Permit Info: Job Description Remove/Replace Gas Water Heater Contractor Information Company Name: FAST WATER HEATER COMPANY Contact Name: Carol Randall Address: 12601 132ND AVE NE City, State & Zip code: KIRKLAND, WA 98034 State Contractor's Lic. No: 877489 Worker's Comp No: 1761660 Carrier: California State Fund of Cupertino Business License No: 29100 Phone No: 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: 4417123041349530 Expiration Data: 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 n. 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 •CUPEkTINO Building Denarfm.ent C JOB ADDRESS: 19075 TILSON AVE PERMIT #n O / I 0/ 1 OWNER'S NAME: WONG, JULIE PHONE # (408)517-8889 GENERAL CONTRACTOR: FAST WATER HEATER COMPAN FAX # 425-814-9516 I am not using any subcontractors: _ �'` / udP 7115/08 Signature Date Please check applicable subcontractors and comnTP+P flip Owner/Contractor Signature 0 Date SUBCONTRACTOR . BUSINESS NAME T BUSINES5 LICENSE # Cabinets & NEHwork 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 0 Date