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07090207 CITY OF CUPERTINO I�,� BUILDING DIVISION PERNIIT � TRA'..TQ ':� ���N� PERMIT NO. BUILlI!6rJESCOLBY AVE FAST WATER HEATER 07090207 PERMIT ISSUE DATE OWNER'S NAME: JIANG, CHONG 12601 132 AVE NE 09/28/2007 _ SANITARY NO. CONTROL NO. INE: BUILDING PERMIT INFO ARCHITECTIENGINEER: REMOVE/REPLACE GAS WATER BLDG ELECT PLUMB MECH L� D D CI p LICENSED CONTRACTOR'S DECLARATION Job Description V r— I hereby affirm that I am licensed under provisions of Chapter 9(commencing :Z, with Secticn 7000)of Division 3 of the Business and Professions Code,and my license is t�0 y in full fore;and effect, :yZ LicenscSJ C Lic,# y p Date_ — — Contractor l�cARCHITECTS DECLA 1 C4.< I understand my plans shall be used as publi records 3wu U.y Licensed Professional C a OWNER-BUILDER DECLARATION j< 1 hereby affirm that 1 am exempt from the Contractors License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county $ which regaires a permit to construct,alter,improve,demolish,or repair any structure Z} prior to its issuance,also requites the applicant for such permit to rile a signed statementFt.Floor Area Valuation a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q e.t=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 4 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number not more ban five hundred dollars(3500). ❑1,as o+vner 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.70".Business Required Inspections 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-). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- ccnse Law does not apply to an owner of property who builds or improves thereon,and, who contracts for such projects with a cominictor(s)licensed pursuant to the Contractors License law. ❑I am:xempt under Sec. B&P C for this reason Owner_ Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I hart:and will maintain a Certificate of Consent to self-insure for Worker's 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. My Workers Gom easjon Insuranc carri d Policy number are: Cartier. / Policy No.: CER C O EXEMPTION FROM ORKERT OMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I cerifv 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 Workers Compensation provisions of the Labor Code.you must ,J. O forthwi,.h comply with such provisions or this permit shall be deemed revoked. Z. CONSTRUCTION LENDING AGENCY E..c C4 1 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.) W A Lenders Name Lender s Address [certify that I have read this application and state that the above information is LU4 O come t I agree to comply with all city and county ordinances and state laws relating to rJ U building construction,and hereby authorize representatives of this city to cnicrupon 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 U Z in consequence of the granting of this permit. Date 7 O �+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOUR.�E IONS. - Re-roofs si pplicant/Contractor Dat° Type of Roof / HAZARDOUS MATERIALS DISCLOSURE yP v 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)? All roofs ihall be inspected prior to any roofing material being installed. ❑Yes Y�1 No If a roof i;installed without first obtaining an inspection,.1 agree to remove Will the applicant or future building occupant use equipment or devices which --mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505,25533 and 25534.I understand this if the building does not c ave a tenant,that it is my responsibility to notify the occupant of the Date require nost be met prior to issuance of a Certificate of OccupancySignature of Applicant n!7fefa�A All roof coverings to be Class "B"or better authorized agent Dato 08/19/2013 05:43 FAX o�a� �) Z�� R3378973 09 CITY OF CUPERTINO WATER HEATER. CUPE&TINO PERMIT APPLIC kTION FORM Date: Building Address: 10212 COLBY AVE Owner's Name: Phone J1ANG, CHONG (4088 )255-1296 Contractor: License#: FAST WATER HEATER COMPANY 877489 Contact: Cupertino Business License#: Carol Randall 800-454-8955 29100 Building Permit Info: Bldg 0 Elect � Plumb ® Meeh Job Description: Remove/Replace Gas Water Heater Residential (2 Commercial ❑ Cost of Project: 449.00 Strapped On Platform Bonded EY New Location © R lacement Qty. if Applicable Fee ID Fee Description Fee Group 1 BpWHEATER Watcr Heater/Vent BUILDING PPERMITFEE Plum big Permit issuance PLUMBING gE ERGy Energy BUILDING BUSLIC Business License BUILDING I I I i CITY OF CUPERTINO 3 ITEMS OF 6 PERMI`I RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN . . . . . . . . . 31628036 .00 DATE ISSUED. . . . . . . : 09/28/2007 RECEIPT #. . . . . . . . . : BSC00002817 REFERENCE ID # . . . : 07C90207 SITE ADDRESS . . . . . : 10212 COLBY AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JIPNG, CHONG ADDRESS 10212 COLBY AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2420 RECEIVED FROM . . . . : FAET WATER HEATER CONTRACTOR . . . . . . . : JEFF JORDAN LIC # 29100 COMPANY . . . . . . . . . . : FAET WATER HEATER ADDRESS 12E01 132 AVE NE CITY/STATE/ZIP . . . : KIFKLAND, WA 98034 TELEPHONE . . . . . . . . : (8C0) 454-8955 FEE ID UNIT QUANTITY .714OUNT. PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- PPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 PRWHEATR UNITS 1. 00 24 .48 0. 00 24 .48 0. 00 TRAVDOC FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 106. 06 0. 00 106 .06 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 168. 04 #3295 CREDIT CARD 44. 08 VISA --------------- TOTAL RECEIPT 212 .12 a Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 PEI�TIN0 Building Department JOB ADDRESS: PERMIT # Co ©10 o OWNERS AME: _ ,,, PHONE # 9W GENERAL CONTRACTOR. = FAX # I am not using any subcontractors: r �? Si,mature Date Please check applicable subcontractors and com)lete 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 6117 Q�- Owner/Contractor Signature Date