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08060074 (2)g2 kw� 0z z C Lac � oz V FC_ of F4 �z CITY OF CUPERTINO.�-n.,k?ti+suq..a',r IATFORMATION, Bu1'DINGa DIVISION PERMIT „CONTRACTOR s,.xe:<,!: "LlO ST?'EfflLLER AVE 7NAME: FAST WATER HEATER 08060074 OWNERS PERMIT ISSUE DATE ISHAN WU 12601 132 AVE NE 06/10/2008 E: SANITARY NO. CONTROL N0. (800) 454-8955 7AICHITECT'ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Chimer Job Description 1 bercby affirm Nat 1 an licensed under psaviski of 9 (ammencing with Section 7") ofDivision 3 ofthe Businessand Profaamus Code,aed my licensc us REMV/REALC GAS WTR HEATER in full forte and effm Lt.... Class Lie.N Dale Conlrutor ARCHITECTS DECLARATION 1 und,aaznd my plans Nall he used u public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby aRr Nu I am exempt from the Contractor's License Law for the following reason. (Section 1031.3. Businrss and Profesdom Code: Any city car manly which requires a permit to construct. alter. arf mere, dcmNLsh, or repair any swclma prior to its issuance, also Rquiru the applican, far such permit to file a signal summons he is licensed to the of the Contractors Licame, law Sq.Ft.Floor Area$449 Valuation that purevanl provisions chapter (commencing with Scotism 7000) of Division 3 of the Business and Professions Code) or Nu he is central, therefrom and de buts for the alleged exemption. My violation of 36916022.9 Occas Occupancy Type Sec ton 7031.5 by any applicant for a Permit mbjcm the applicant to • civil penally OfNumber rml more than A. hundred dollars ISM I,uownv of de Property, car my ertploycas with wage uthevsole compewdon, Required Inspections da NCalts. and N- Iceunt's LndCdorawdosn otCplyina n owmara'e YW he Cmu Law lags not apply lf owMr and COdc Conllanda, property Nerrmn, and who daesmd mpr ndwho is walk imselrar through his bas rt c�y wyces. pdserimprovu Own semenu ase cossud malfered fm sale If, Own such nt won. WeeWiprog or i paan marm�our ofo the owner. h.wewr. We building or improvement, is within one nest of coprown far builder wire base Ik burden of poring Nat he did not bonded m improv Ins Ptiryote of east umJ. ❑ 1. as owner of the property am exclusively canning with licensed contraction to Wnstaml Ik project (Sec 1066. Business and Professions Code:) M codas Imes Li. . cense law does not apply to an owncr of properly who Wilde or Impmses thmmum. and, wh.aontrinf for such projens with a cammctur(s) lived pursued m ban Conuane's License law. 0 I am exempt under, Sec , B d P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION 10 l hereby a im uM r pe Ly of perjury one of the folbwing tr landoo , ❑ 1 haw and will maintain a Canifiate ofCouenuo self--mouseforWorkmSComan- sstion, as Provided for by Section 3700 of the labor Cade. for the peRamance of the wart for which this permit is issmd. ❑ I have and will maimsin Worker's Compensation Insurance, u raquired by Section _ 3700.(Ne labor Cade, for the perfaranee of 0 e work for which one peri, is issued. ' My Worker's Composition. Luse. carrier and Poliey Rumba are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Thu section need not be completed if Ne permit btforone hundred dollars ($100) or las) 1 unify las, In the Performance of the work for which Nis permit is Waxed. I shall no, employ any person in any manncr so u b baame mbjmt R the Workers' Compensation laws of Califomia. Dare Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should became subject N the Worker's CamPcaution provisions of the lahnr Cade you mus, . foMwith comply with such pno isinu m has perit shall be deemed rewked. CONSTRUCTION LENDING AGENCY 1 hereby afrirm thu Nese at a c.nextmctino lending agency for the padom once of be wart for which Nis .it is untied (Sec. 3097. Civ, C.) LandusName L mi Address 1 coldly Net 1 have Rad this application and sale Out the chose in(omadun in ca eacL I agree In comply with all ally and aunty mdinaMTe and Start laws relating un building construction, and hereby autharizn rcpresenutivu of this city in toter upon de algYe-mejudgm pmpcn Ins inspection (We) agree to saw. indemnify and ni nameless the City of Cupertino against which may costa and expenses which may In anyway aurae against said City iuequor I. con of dre of thegrammeof this Leri, A APPLICANT APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. Re -roofs Dale Stgnuurt ofApplic aAZARDOUS H MATERIALS DISCLOSURE Type of Roof Will the applicant car future building no -Prim more at handle hazardous material as defined by tax Cuper irm Municipal Cade. Chapter 9.13, and the Health and Safety 35533(a)? Cade, Section t] N. ec Ya All roofs shall be inspected prior to any roofing material being installed. WiII the applimo car furore building anvpanl use equipment m Jcvica which If a roof is installed without first obtaining an inspection, I agree to remove Pima menus allcontaminsu nu defim•d by the Bay Area Air Quality Managcmcm all new materials for inspection. . . ❑Ya ❑No 1 haw real the huasNur maari d, RquiRmantaunAer Chapter 6.95 ofdre Calif.,. .is Health Safety Code• Suuons 35505, 25533 and 25534.1 uRlec and the ifdxe Wilding data tet currently haw a urian, but it is my Rsposou ity m mdry the occupant of Nc requirements which mull bane, Priarle tssaamc.raeenireale car OcaPamy. Signature of Applicant Date All roof coverings to be Class 'W' or better Owner or anthatiaed agent D,le • 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: - APN ........: 36916022.00 DATE ISSUED.......: 06/10/2008 RECEIPT #.........: BS000005061 REFERENCE ID # ...: 08060074 SITE ADDRESS .....: 10537 MILLER AVE SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 106.56 --------------- 106.56 VOICE ID DESCRIPTION -------- ---------------------------- 1 518 WATER HEATER • REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION ------------------------------------ OWNER ............: PEISHAN WU ADDRESS ..........: 10537 MILLER 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 ........: (8010) 454-8955 FEE ID ---------- UNIT QUANTITY ----------------------- AMOUNT PD -TO -DT THIS REC NEW BAL IBSEISMICR 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 ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 106.56 --------------- 106.56 VOICE ID DESCRIPTION -------- ---------------------------- 1 518 WATER HEATER • REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION ------------------------------------ 0 I� L-A 0 Permit No: 06 Co 00-7 4Ub6ZZ (office use only) City Of Cupertino Building Permit Application E -Mail: Building-Permits(a-)cupertino.org (Address is case sensitive). Jobsite Address: 10537 MILLER AVE Date: 6/10108 Assessor's Parcel Number: 3 (n Q I tQo DO Owners Name: WU, PEISHAN Phone No: (408)507-1189 Project Valuation: 449.00 Building Permit Info: Bldg Elect Plu 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 City 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: 1211108 Credit Card Information Credit Card No: Expiration Date 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. CI OF :U PEI,TINO r L Buil JOB ADDRESS: 10537 MILLER AVE 'S NAME: Wtl, PEISHAN iL CONTRACTOR: FAST WATER HEATER COM Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 �artment PERMIT # ofo60 007 PHONE # (408)507-1189 FAX # 425-814-9516 1 am not using any subcontractors: _ �'` �� " 6/10/06 Signature Date Please check annlirahlP svhrnnirartnrc an11 rmm�lc+o +I,e 0 Owner/ Contractor Signature Date 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 Pltunbing Roofing EM Septic Tank Sheet Metal Sheet Rock Tile 0 Owner/ Contractor Signature Date