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08020003 (2) CITY OF CUPERTIINO ad - BUlLDINGDIVISION PERMIT C�OIVTRACTQRINFOR FORMATION BUIL 1 PERMIT NO. �g g TRESTON DR FAST WATER HEATER 08020003 ER'S NAME: PERMIT ISUEDATE SKIBBINS EUGENE F AND GENEVIEV 12601 132 AVE NE 02/01/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INTO RMV/REPLC GAS WTR HTR BLDG ELECT PLUMB MECH 0 0 0 0 uo0 LICENSED CONTRACTOR'S DECLARATIONS Job Description UM 1I hereby affirm tat 1 am licensed under provisions or Chapter 9(commencing P m wiN5ec1ion'I")Of JafNCBminwand of dmy license.. �< in full forte and art= MCI Llc.N 0 Dem Con DELL e a as CHREOECL LTS AROil' 11WI y I condescend my plans shall be used as public record. - J yGov Licensed Pmfcuimed 3 OWNER-BUILDER DECLARATION y 1 kmhy affirm tat I am ca t form one ComanctaYs Keen¢Law far One, C O o following mason.(Section NO 1.3,Business and Profusions Cole:Any ohy or mhaty S$ which tequlrm•permit ro mementoes.alcor,improve,demolish,lir repair any m etum x ry^ prior to its issuance,also requires the applicant for each permit in file signed statement xx< that he is licensed pursuant to the provisions of the Otmacum'.License Law(Chapter 9 Sq.Ft.Floor Area Valuation F� (commencing wit Section 70110)of Division 3 ofte Business and Profession.CmIc)or Q $ tat he ueumpt tcmm foe B froand to basis re alleged kxempdon.Any violation of Sectlm 7031.5 by my applicant for a permit subjects to applicant to a civil penalty of APN Number Occupancy Type not more than five handed dollar.($300). ❑1,uownv Ol tls porperty,mmy"oployees wit ngnsu me4 mlecmmpcnsadon, will do Rework.and dm he C m 4 not Intended mamertd Imam(Sec.W sem Budseu and property wh ons carie:film CavamtM.License Lass don tet apply t an owrce of Required Inspections Own cro was Wilds"improves tumrovement amnoacnwrk him.elr"t= ns own employ building that ver improvements in not ear dedefc"am i m.forest,I- Wilder,In bom th g he Mprovemant m said whin one you of mproe for to ownu- sala I. will have Olt When of pmHng dot a did ver build m improve for purpose of ❑1.as Owner of am property.am exclusively concreting with licensed mnuactn to convect the project(Sec.70".Business so Professions Ckdc)The Cpnuactoes U. cense law does not apply or an owner of property who builds or Improves tamer,and, who contracts for such projects whin a mnnacmK.)licensed pursuant m Re Cso m data License Law. ❑Iamuemptmder Sm. ,BAPCfortumuon nv Dam WORKER'S COMPENSATION DECLARATION 1 Wrathy affmn under pevlly of perjury ons of me fallowing declarations: _ I haw and will maintain.Certificate of COnsentto self-iname for Workcei Camper. uaon,u Provided for by Section 3700 or the lab"Code.for s o performance of to ' work for which to permit is issued. . ❑1 have and will maintain Worker'.Compensation Insumem,as required by Somion 3700 of to labor Code,for tk pcRormmce of to work for which this Permit is leaned My Warkfs site on steno. umrr anal Policy n�u Cartitr:---lEt �r�PoOry No, I C F PION FROM 0 ER COMPENSATION INSURANCE (This do.mW not W camplcmd KIM Permit 1.fora..hunRaddollan(SIM) lir leu) 1 certify tat in to performama N to work for which this Permit Is luted,I shall not employ any person in any mannerso u in become subject to to Workers'Compensation Law,of California.Dam Appllcant NOTICE TO APPLICANT:If,after malting this Certificate of Exemption.y=should become subjmt in to Worker's CamPenudon provisions of the Lsb"Code,you noun �O forthwith comply wins each Provisions"to permit Mall be decreeo d roked. ZCONSTRUCTION LENDING AGENCY y F I kmby affirm tat Rem is a cotuuuctinn lending agemy for to performance of a> to work for which this Permit Is issued(Sec.3097,Civ.C.) Q Lender's Name z Lendn's Address fJ Q 1 certify that 1 haw read tb application seed sum Rai the be.Information 1, iL^. eortest I agree m=reply with all city and county ordinances and mute laws relating m .0 rU^ Wilding construction,and hereby mmorim representatives of tb city to enter upon to ul aWw-mentioned property for insPection puryasea 0y (We)agree to ave,indemnify and keep hsrmleu the City of Cupertino against „y rA INtolides.Iudgmcnt,cam and expcuu which may in my way amue agalul said City t)7 in consequence of me goosing of to fermis. ^7 APPLICAIJT UNDERSTANDS AND WILL COMPLY WITH AL NO -POINT Issued by: Date SOU TIONS. e( / 6I A4 Re-roofs SI{nuts O p :teat on xnznRCOUS MATERIALS DISCLOSURE Type of Roof Will to applicam or Imam Wllding occupmumm or handle huWom material defined by to Capentm Mu Na pal Code.Chapter 9.13,and to Healt and Safety ve.Section,25532(a)7 All roofs shall be inspected prior to any roofing material being installed. CYns Will to aPoll cant Or Powis ilding tsnnpam tax am,.pmmt or devices which If a roof is installed without first obtaining an inspection,.I agree to remove emit hauNnns air cmtaminsnu delved by to Bay Ama Air Quality Management all new materials for inspection. - DimicR Over, No I have matt the hausRsns mamriab nquiremcr s took,Chapter 6.95 of the C.lifor. nu Healdt&Safety Code,Section 03115,25533 and 25534.1 understood Ruif to Wilding does tet currently have a tanlK Rat It 4 my reaponsihiltry m mdfY the"caput Of tie re n Inch moss kmet Poor soisaumecofaConti fmateof r. Signature of Applicant Date Owner a sensed ase ate. . All roof coverings to be Class"B"or better From: 01/23/2008 14:15 #398 P.007/010 CITY OF CUPERTINO 3913b' WATER HEATER CUP T�No PERMIT APPLICATION FORM APN# 3),(V3 I Date. 1173/06 Building Addreas: 10365 CRESTON DR Owner's Name; Phone#:(408)739-5352 SKIBBINS, GLENN Contractor: Phone#: 800-454-8955 FAST WATER HEATER COMPANY Fax#: 425-814-9516 Cupertino Business License#: Contractor State License#: 29100 877489 Contact Phone#: 800454-8955 Carol Rendall Fax#: 425-814-9516 ilding Permit Info: Bldg Blest M Plumb x Mech Residential ❑x Conunarcial ❑ Job Description: Remove/Replace Gas Water Heater Strapped ® 'On platfor [Bonded ❑ New Location ❑ Replacement Valuation: 449.00 Green Building Check mnst be completed and attached to this application. Green Building Points achieved: -Z3— • From: 01/23/2008 14:15 #39B P.008/010 391351 CIW OF CUPERTINO WATER HEATER CUP No PERMIT APPLICATION FORM Quantity Fie ID Foe Description Fee Permit Type Group IPCWHBATR Commercial Wates B PCWFLEATR Heater/Vant BSEISMICOM Seismic Commercial B 1 l PRWT ATR Residential Wates B PRWSEATR Heater/Vent BSEISMICRL Seismic Residential B PPERMTI'FBE Plumbing Permit P :RAVD0C Travel & B Documentation SLIC Business License B • CITY OF CUPERTINO 4 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32637009 . 00 DATE ISSUED. . . . . . . : 02/01/2008 RECEIPT # . . . . . . . . . : BS000003827 REFERENCE ID # . 08020003 SITE ADDRESS . . . . . : 10365 CRESTON DR SUBDIVISION . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SKIBBINS EUGENE F AND GENEVIEV ADDRESS . . . . . . . . . . : 10365 CRESTON DR CITY/STATE/ZIP . . . : CUPERTINO_ CA, 95014-1015 RECEIVED FROM . . . . : FAST WATER HEATER 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 ----------------- --------------- -------------------- CHECK 213 . 12 #3482 --------------- TOTAL RECEIPT 213 . 12 VOICE ID DESCRIPTION -VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: patg Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32637009 .00 INVOICE DATE. . . . . . : 02/01/2008 REFERENCE ID # . . . : 08020003 SITE ADDRESS . . . ... : 10365 .CREST0N DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SKIBBINS EUGENE F AND GENEVIEV ADDRESS 10365 CRESTON DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1015 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 DESCRIPTION-- ------ DUE FOR ----- AMOUNT DUE _ - _PAID BALANCE ----- ------- ------ --- ---------- SEISMIC RESIDENTIAL PRINTING PERMIT 0. 50 0. 00 0.50 PLUMBNG PERMIT ISSUE PRINTING PERMIT 40.79 0. 00 40 .79 RESIDENTIAL WATER HEATER/VE PRINTING PERMIT 24 .48 0. 00 24 .48 TRAVEL & DOCUMENTATION FEE PRINTING PERMIT 40.79 0. 00 40 .79 ---------- ---------- ---------- 106 .56 0. 00 106 .56 VOICE ID DESCRIPTION _ VOICE ID DESCRIPTION -------- ---------------------------- ------ ---------------------------- 518 WATER HEATER Community Development 10300 Torre Avenue V � - Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building Department JOB ADD EShS: S PERMIT# ©O D 3 OWNER'S'NAME: PHONE # GENERAL CONTRACTOR FAX # I am not using any subcontractors: Q D Si a Daie 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 Owne ontractor Signature Date