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07080155MZ 00 m P UU Z as ,ern 'a< yU 0 ti ,pa =a BUILDING DIVISION, PERMIT BUILD] IQ?RR ESS: WY OWNER'S NAME: ,LAWSON CARL D AND MOBLEY—LAW 4E: ARCHITECT/ENGINEER: LICENSED CONTRACfOR's sect-AKAt tutu I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and =L, License Class Lic. q Date — e l -z Contractor ARCHITECTS DECLA AT10N I understand my plans shall be used as public records [ iccnscd Professional OWNER -BUILDER DECLARATION 1 hcrgby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter. improve, demolish• or repair any structure prior to its issuance, also requires the applicant far such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon. and. who contracts for such projects with a contractors) licensed pursuant to the Contractors License Law. 0 I am exempt under Sec. B & P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self -insure for workers compen- sation. as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ] 1 have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Wy Workers Com ensation Insurance arricr d Policy number are: Carrier. olicy No.: CERTIFICA OF EMPTIONFRO WORKERS' C PENSATIONINSURANCE (This section need not be completed if the permit is for one hundred dollars ($ 100) or less.) I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name L.cnder s Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection Purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT vim Sjg[tdldtf o(Applicant/Contractor "w v HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? 0Yes XNo Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? 0 Yes XNo I have read the hazardous materials requirements underChapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant. that it is my responsibility to notify the occupant of the requirem ts ch must be met prior to issuance of a Certificate of occupancy. r ur authorized agent Date FAST VtATER HEATER 12601 132 REMOVE/REPLACE GAS WATER Issued b Re -roof Type of Roof Floor N PERMIT NO. 07080155 PERMIT ISSUE DATE 08/16/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description Required Inspections valuation uccupancy type All roofs shall be inspected prior to any roofing material being installed. If a roofis installed without first obtaining an inspection, I agree to remove all new materials for inspection. e of Applicant Date All roof coverings to be Class "B" or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: // PERMIT #�,--�- D�7uVV PHONE OWNER'S NAME: h GENERAL CONTRACTOR: F FAX # I am not using any subcontractors: Signature Date k 1' bl be ntractors d complete the following information: Please chec 60 1 a ica a su o SUBCONTRACTOR BUSI14ESS 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 3 ITEMS OF 6 CITY OF CUPERTINO PERMI`C RECEIPT Sec: Twp: Rng: Sub: B1:{: Lot: APN ........: 36219026.00 DATE ISSUED.......: 08/16/2007 RECEIPT #......... BS000002401 REFERENCE ID # 07080155 SITE ADDRESS 7898 ROBINDELL WY SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER LAWSON CARL D AND MOBLEY-LAWSO ADDRESS .......... CITY/STATE/ZIP CUPERTINO CA, 95014-5015 RECEIVED FROM FItiH ACQUSTN CO. CONTRACTOR JEFF JORDAN LIC # 29100 COMPANY FAST WATER HEATER ADDRESS 12601 132 AVE NE CITY/STATE/ZIP ...: KIRKLAND, WA 98034 TELEPHONE (E00) 454-8955 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL -- BENERGY PERMIT FEE ---------- 1.00 ---------- 34.86 ----- 0.00 34.86 0.00 BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 ---------- 38.37 ---------- 0.00 ---------- TOTAL PERMIT ---------- 84.02 0.00 84.02 0.00 VOICE ID DESCRIPTION -------- --------------------------- 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING VOICE ID DESCRIPTION -------- ---------------------------- 506 GAS TEST From' 08/08/2007 16:26 CITY OF CUI'ERTINO WATER HEATER CIkE- PERMIT APPLICATION FORM 9188 P.006/008 375309 APN # ,_3/ a/ q Date: I Building Address: 7898 ROBINDELL WAY Owner's Name: Phone 8 (408)255-2074 1AWSON, CRIS Contractor License #: 8774$9 i FAST 1NATER NEATER COMPANY Business License #: } 1 Contact: I Carol Randall 800-454-8955 }Cupertino R X91 elf Building Permit Info: } IPlum 1K1Mecn I Bldg l� Elect �I Er Job Description: I Reeater Residential Commercial I � 1405 of PIojeCt: I 1 1 449.00 j } Scrapped U On Platfonn Bonded INew Location ' replacement � Qt.v. if i eft Isari2t3on Heater 1 Vent ,iniz Permit Issuance Less License Fee