08030076 (2)CITY OF CUPERTINO
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BUIL'DINO DIVISION PERMIT
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BUILQI[{GlTT'skED FIR CT
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FAST WATER HEATER
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P`RnT30076 ,
WNER'S NAME:
PERMIT ISSUE DATE
YUAN, ZHENGYU(KEVEN)
12601 132 AVE NE
03/14/2008
TR ONE:
SANITARY NO. COmROL NO.
ARCHITECT/ENGINEFA:
RMV/RPLC GAS WTR HEATER
BUILDING PERMIT INFO
BLDG EI.ECf PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Descri hOn
1 honey aM m thin 1 am limned under pmvisiaos of Chapter 9 (uom ummin{
P
with Section 7l111U)of Division 7 ofthe Banner and prolamines Code dmylle mala
-
in full forte esti IfI.Icenm
C IY.I
Dau Canumwr
ARCHITECPSDECLAR ON
1 untletwnd my plana WII M used u public mcnrds
Licensed Professional
OWNER-BUILDER DECLARATION
I Mreby aRrm that I am exempt from the Contsacurs License Law for the,
following wan. (Section 7131.5. Business and Profesaiom Cale: Any city or =only
,
whish requires a permit to eomweL slur. impmw, dvmaltsh, or =put, my structure
prim It its issuance. amu mquires the applicant for such permit in file a signed uamment
is licensed to the of the Concurs Licm,x law tamp= 9
Sq. Ft. Floor Area
Valuation
thin M puetant provisions
(commencing with Stttim 7000) of Division 3 of he Busiess and Pmlasians Code) 0r
that he ts exempt therefrom and Ne buts for the alleged eamnption. Any violation of
APN Number
Occupancy Type
Section 7071.5 by any applicants for a permit subjects the applicant to a civil penalty of
vel mese Nm five hundred dollars (Iwo).
❑ 1, u awrcr of Ota property, m my anpl%ees used xgex u Netr role c0mpuuadm,
Required Inspections
dothexrk esti the
taw dam est apply lo rt renes of
otoluuntledm ave dor act
he Connector,
and Cade: Conbmurs "ply.70N.B mer of
stat Ao,
who ep =who chxhbimxel(m through his
gopenywho Wiprovidd mrove who
but
owes employes, provided dins such improvements art not intended mortared rmmle If.
that ammo
however, Ne Wilding m improwmmt ts mitl within one year or empletion, the owner.
Wilder will haw du buNrn of poWn{ that M did ros build or Mprow for purpose of
ala).
❑ 1, as owner of the property am exclusively conumUng with licensed entncmra m
mmlrocl the project (Sec. 70". Butlnem and Prolusions Cade) The Cmtamur's LL
ounce law does not apply to an owner of property who Wilds or improves thereon. and,
who conmcta for such pmjccts with a ronuawrtal licensed purmant to tM Cmuacmra
1.'cenm Law.
❑ Ioenuemptundersed ,BAPCfxrNiswan
nu Data
WORKER'S COMPENSATION DECLAMI10N
1 hereby arcirm under penalty or perjury mad of the following declaratione
1 haw and will maintain aCWOnta of Camera m self-Imam (or Workers Compen-
sstlon, 3700 of Ne IaWr Cade, for tin performanou of ted
fpoerr
wale For mi tSeddon
watch this is Issued.
1 have anti will maintain Wmtrra Compewtion Insurance, u requited by Section
3700of Wracluj dcper(ame.aa(the work for whim thin pennittsime4
My Wor a rope as Brim and Policy number e•
,
Cattkr. Polpcy No.:
ER FI PITON FROM W R f � S'
OMPENSATION INSURANCE
(Thtssecdm cad rot W completed if the permit la Intone hundred dollars (5100)
or leaq
1 unify But in the performane, of the work for which this parent is used, i mall not
employ any person in my manmrm m to become subject to the Wortrn' Camp• een on
Lax of California. Data
Applicant
NOTICE TO APPLICANT: IL afar making this CeNOcau of Exemption. you should
become subject to the Workers Compensation previsions of the lahm Code, you most
forthwith comply with such provivtm or this permit mall W deemed evaded.
CONSfRUCf10NLENDINGiAOENCY
1 Mr that team is s lending7.Cs. agency for Um performance of
ed (See, 30
the work for whleh th4 permit ts issued (sap, 7097, Cis. CI
which
leaders Nurse
ad e: Add=
1 I mniry that 1 Mw mad this application sed sam thin the aWve information Is
e coerce. I agree to empty with all city and county Winaecea and sum laws relating in
Wilding construction. and hereby mthorim representatives of this city to enur upon he
1 me ve-mcndoned property for inspection purposes.
(We) agtxe to saw, indemnify and soup harmless tae Cly of Cupertino aria= t
j liabilities, judgments, cow and expenses which may In my way aroma apiest aid City
in consequence of the {ranting of this permit.
till,
AP DEMANDS AND WILL COMPLY WITH AL NON- OINT
Issued by:9 Date s. /
SOUNS.
/
Re-roofs J
Type Of Roof
TI
-�z%r- D
�-�
a�ywum ofA I F1x`mm"OU SATERIAISDISCLDsURE U
Will the mPliunt m rutun building o=upant uom orhandle hamrdous maurial
as dented by do Cupertino Municipal Code. Chapter 9.13, and the Hnldt and Safety
lat 3557x(07
. sectWIII
All roofs shall be inspected prior to any roofing material being installed.
❑Yu No
If a roof is installed without first obtaining an inspection,agree to remove
the applicant or u m Wilding occupant not equipment or deHces which
emit hamroma air contaminants as dellned by the Bay Area Air Quality Management
.1
all new materials for inspection.
District?
❑ Yu u
Lis
I haw real the hu nequiremenuundcr Chmour6.95 a(the Califor.
nu H=IthB Safety Cade. Sections 75505.35577 aa135534.1 understood thatif the Wilding
des. c n W a anm1. au is 4 my rexpamlbility m ratify tip. occupant or the
regai h mel prior mIssuance of, CW f O
Signature of Applicant Date
All roof coverings to be Class'A:s' or better
Oxer or authors gcnl am'
M
0
•
CITY OF CUPERTINO
4 ITEMS OF 8 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35905043.00
DATE ISSUED.......: 03/14/2008
RECEIPT #.........: BS000004161
REFERENCE ID # ...: 08030076
SITE ADDRESS .....: 21113 RED FIR CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
OWNER ............:
YUAN; ZHENGYU(KEVEN)
ADDRESS ..........:
21113 RED FIR CT
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-4254
RECEIVED FROM ....:
FWH ACQUISITION CO
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
1TRAVD0C
FLAT RATE 1.00
40.79 0.00
40.79
0.00
TOTAL PERMIT
---------- ----------
106.56 0.00
----------
106.56
----------
0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
From: 03/06/2008 13:43 #677 P.004/007
4
CITY OF CUPERTINO U 0 U 3 co -7 (p 395950
WATER HEATER
PERMIT APPLICATION FORM
APN #2 5 O 5b o U o
JJ
Date.
318!08
Building Address:
21113 RED FIR CT
Owner's Name:
Phone #: (408)627-9858
YUAN, ZHENGYU (KEVEN)
Contractor:
Phone #: 800-454-8955
FAST WATER HEATER COMPANY
FAX 425-814-9516.
Cupertino Business License #:
Contractor State License #:
29100
877489
Contact:
I
Phone #: 600-454-8955
Carol Randall
Fax #: 425.814-9516
Building Permit Info:
laldg El meet Plumb x Mech
Residential
Commercial ❑
Job Description:
Remove/Replace Gas Water Heater
Strapped ❑ C+n Platform ❑ Bonded ❑
New Location ❑ Replacement
Valuation:
449.00
Green Building Cheek mast be completed and attached to this application.
Green Building Points achieved: �--
n
From: 03/06/2006 13:43 #677 P.005/007
0
CUPEft,_
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
395950
Quantity
Fee M
Fee Description
Fee Permit Type
Group
IPCWHEATR
Commercial Water
Heater/Vent
B PCWHEATR
BSEISMICOM
Seismio Commercial
B
I
IPRWTWATR
Residential Water
Heatedvent
B PRWHEATR
BSEISMICRE
Seismic Residential
B
PPERIvIITFEE
Plumbing Perrmt
P
TRAVDOC
, Travel &
Documentation
B
BUSLIC
Business License
B
0
CITY OF
°*UPEkTINO
0
JOB ADDRESS:
OWNER'S
GENERAL
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
I am not using any subcontractors: X&"&j
Si ture Date
Please check applicable subcontractors and complete the following information:
"OwnifiContractor Signature
03 l w
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
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
"OwnifiContractor Signature
03 l w
Date