08060077 (2) CITY OF CUPERTINO
BUILDIN.G.DIVISl@N PERMIT CQt\°ly�'1 tlA1 Q ��v
BUIIDINQ ADDRESS: PERMIT NO.
1.9866 BAYWOOD DR FAST WATER HEATER 08060077
OWNER'S NAME: FERMrr ISSUE DATE
JAMES LIU 12601 132 AVE NE' 06/10/2008
NE: SANITARY NO, CONTROL NO.
(800) 454-8955
ARCHiTECTPENGINEER: BUILDING PERMIT INFO
-BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION Job Description
wi I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing p
n<
with Salkart 7")of Division 3 afft Business;and Professions Code.and my licasse is RMV/RPLC GAS WTR HEATER
< in full force and cffrL
D io License Class Late.Is -
=p Dow Comracior
p7W
ARCHITECTS DECLARATION
WU 1 underhand my Plans shall Ise used as public records
g suss H Licensed Professional -
5 OWNER-BUILDER DECLARATION
in
i<m I Mrchy affirm Nat I am exempt from be Contractor's Licenm Law for the
C°O following rtsson.section 703 1.5,Business and Prefais oro Cods:Any city or county
$P which requires a petmit m construct.alar,improve.dcoman,or.pair any evunum
_=6 printw its issuance.auto requires the applicant for Such Permit to file a Signed nanmeml
s that he is licensed pursuant to the previsions of theConurwhLianseLaw(Chat 9 Sq.Ft. Floor Area Valuation
yF° (commencing with Section 7000)of Division 3 of the Bininevand Prefusiom Code)to $449
i 9
that he Is exempt therefrom and the bur for the alleged saemptioo.Any violation of
Schon 7031.5 by any applicant for•permit subjects the applicant w a civil penalty OfNumber Occupancy
amt moat Nan five hundred dollars(S50(1. 31630011 .W Pane Y Type
I,uowrcs of Uz property,rmy wPloym w"dh wagquUc'vmle campevaUm.
will do Ne work and the nm tum is not intended or offersd for sale(Sce.70H,Busixo
and Profeviom Cade:The communes License Law dor Out apply in an owom of Required Inspections
progeny who builds or imarow thea cont and who docs such wort himself or Uuough his
Own employers,provided that wen improvements art not intended oraeertd forsale.B.
however,the building or improvement is sold within sure year of completion,the owner-
builder will have the burden of proving that the did Out Wild or improve for purpose of
sale.).
❑1,as owner of the pmPeny,am exclusively..nur=ing with licensed cmmaadnts an
cratma the protea(Sec 7014.Buurtev and Professions Code:)The Consensuses l;-
cence Law dors not apply in m owner of praprny who Wilds or improves IW eam,and.
who coaumo for sarh projeea with a mnuacmr(s)licensed Pursuam w the Comumtor's --
License Law.
❑Ianexemp"nodn"See ,B&PCrorthumasm
Owner Date
WORKER'S COMPENSATION DECLARATION
40 1 hemby affirm under penalty of perjury one of the following drlaratimn:
I hamaad will mainainaCafid amofConown weelf-imurtforWorter'aCompen-
sation,an provided for by Section 3700 of the Labor Code,for the performena of the
wart for which this permit u issued.
❑1 have and will maintain WorgeYs Corope scum.Insurance,as rcgoircd by Senior
37W of he Limr Code,for the Performance of the wort forwhich this permit is load.
My Worker's Compemarian hauma artier W Pediry number arc:
Carver. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rlhHsection reed rot W complend Bike Permit is front hundred dollars(SIM)
or less)
1 cauly,that in the performance of tho work for which this Permit is Load,I+lull not
employ anypermn in any murcrm ss w become subject in be WorkeW Compensation
Laws of California.Dan
APpliam
NOTICE TO APPLICANT:IL after making this Ccninac of Eommption,you samaw
become subject in the Worker's Compcmation provisions of the Labor Cade,you a=
.J z forthwith comply with such Pmvuiaro or Nu Permit shall W domed revoked.
Lia O CONSTRUCTION LENDING AGENCY
[-+ I Wmhy aRrm that Nem is a comwetioa ladingagency far the Pallumnanauf
!Yi > the work for which this Pemnll Is issued(Sec.3097,Civ.C)
WM Q L<ndc's Name
z Lender's Aadvm<.
U O 1 cetUfy that I lout moa tha appliatiav atW sac this the above iNormatiun a
gy U Wilding ograwcn.and wire allcityand wpac ounimosand Sun tars relating e
-O U Wildingconstruction. hereby auNonrzrtpmacnutives of Nu citywamr upon Uc
G21 anbve-mentioned progeny for irupccinen purposes.
(We)agree to save,indemnify and keep harmless the City or Cupcnima against
Z incoiOe;Jna,ofthedilomints.linsmit calcines;which may in any wayaarue against said City
U z A PLICA rmc ar DERST Nof this petrels.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApphcanVConDiane Re-roofs
li.k7JIRDOURDOUS MATERIALS DISCLOSURE Type of Roof
Will Ucin Cufa m nefuu ni Wilding eaupantmort rand t e H ardoan mawnd
ss donned by the Cupertino Municipal Code,Chapter 9.11,and the HNN and Safety
Cousin,Salion 15531(a)7 �Na All roofs shall be inspected prior to any roofing material being installed.
❑Yea
Will Ne applicmt or fmum building occupant use equipmem or device which If a roof is installed without first obtaining an inspection,I agree to remove
dta'is
ser ct]Anus air coaaminsna as definal by me Bay Arta Air Quality Management all new materials for inspection.
Oyes ON.
I nava mal the haramaumawnaNmquimmems underCWpmr6.95ofthr Califat-
nle Halth&SarnyCWe Sectiro 0505,15533 am10534.1 wsCrsand thnifthe Wilding
dor.".may have is amem.Uut it u my responsibility w aadfy dice acupant of the
mquiremens which mon Fromm he=1 pw issuance ofacanra,¢nraapatq. Signature of Applicant Date
Owner or auOorbcd agent Dan I I All roof coverings to be Class'/."or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: B1k: Lot:
APN . . . . . . . . : 31630011 . 00
DATE ISSUED. . . . . . . : 06/10/2008
RECEIPT #. . . . . . . . . : BS000005063
REFERENCE ID # . . . : 08060077
SITE ADDRESS . . . . . : 19866 BAYWOOD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JAMES LIU
ADDRESS . . . . . . . . . . : 19866 BAYWOOD DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2317
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
Permit No: 0?U(P oa-7-7 406741
(office use only)
City Of Cupertino Building Permit Application
E-Mail: Building-Permits(c�cupertino.org (Address is case sensitive).
Jobsite Address:19866 BAYWOOD DR Dater 6/10/08
Assessor's Parcel Number: 3 3 00 1 1 . Q
Owners Name: LIU, JAMES Phone No: (408)218-0299
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: California State Fund
City of Cupertino Business License No: 29100
Credit Card Information
Credit Card No: Expiration Date: 4@W
Name on Card: Jeff Aidan
Visa ❑x MasterCard ❑ American Express ❑
• The Building permit application and a completed & signed
contractor/subcontractor form need to be submitted with each permit.
4
�., Community Development
10300 Torre Avenue
.l Cupertino CA 95014
Telephone(408)777-3228
CII. OF Fax(408)777-3333
lkPEI�TINO
Building Depl'artment
JOB ADDRESS: 19866 BAYWOOD DR PERMIT #
0 eUCQ 007 7
OWNER'S NAME: LIU, JAMES PHONE # (408)218-0299
GENERAL CONTRACTOR FAST WATER HEATER COMPA FAX# 425-814-9516
I am not using any subcontractors:_ ` 1/4e P 6/10/08
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