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08110091 CITY OF CUPERTINO BU�'.DINC�v3s3oN PERMIT �, CONTRAC4QRINF,ORMr1 '_N� -_-` BUILDING ADDRESS: PERMIT NO. 1574 PRIMROSE WAY FAST WATER HEATER OW NEWS NAME: PERMIT ISSUE DATE VE: ACONTROL NO. (800) 454-8955 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 4400 LICENSED CONTRACTOR'S DECLARATION Job Description 4 u� 1 hereby afOrm that 1 am licensed under previsions of Chapmr 9(commencing with Section 7")of Division 3.1'the Bummus and Profauiom Code.ami my licenset- in eisin fullfmaanaefrect. REMV/RPLC GAS WATER HEATER L7 z 1lceme am tx. — Dam Can - ntram ARCHITECT'S DECLARATION U 1 underund my plans MAB m used As public records g Licensed PrOe.i...I OWNER-BUILDER DECLARATION I hey aNat I am exempt(sere dm n Conbaots License law for the z no limit,ebffirm following won.(Sada.7011.5,Business and Professions Cade:My city ce county 3$ which requires•permit on m.mme4 alcor.impmsa.demolish,on open any structure MAE heiUiuuancc.asunt In the pmc silica of for Contractor's Law(Cha mcnl � Nat he is licensed pursuant In the proviaiow of the Conmacmr's lame law(Chapter Sq.Ft.Floor Area Valuation (commencing with Section 700(j)of Division Sof the Business and Professions Cock)or r3 u exemptm and th449 $ that he MEAmfroe basis for the AllegedemMO.Any violation of Senior 7031.5 by soy applicant for a permit subjects the applicant In A civil penalty of APN Number Occupancy Type Mt mom man fire handmd dollars ISSOo). 36615011 . 00 0 I,as owner of th property.or my employees with urges ss they sok compemton, will do Mework,and immuctam Is not intended orofined fon.k(See 71344.Buaineas Required Inspections and Professions Code:The CartraatuYa U.Law does not apply m e an owner of q p pmpersy who builds or imleeMs Mercer,and who does such work himself or through his own employe..provided that much impmMsncen art oat inrendM wagered fw sale.If. hrswerer.the building or WproMmcet is sold within Mm year of emap"On.Me owrcl- budm writ rove the burden of pming that W did not Wild Or motmsa Ire pulp.of Ask.). 0 1,as owner a Me property,Am comm ivcly counseling with licensed centraelms in cemsmct the project(Sec.7004.Business and Pmfessiom Code)The Contrzones U. cane taw dots not Apply m An owner of proper,who builds.1impmvu Merron.and, wbuconmcmfwsuchprojewwithaeanwwLoT(s)li,,n tipursuantunMe ContanMs License Law. ❑Iamocmptunder See .B&PCfwthin. owner Dm WORKERS COMPENSATION DECLARATION 1 mods,affirm under penalty of parjury oro of the following dalmuars hart and Will maintain•Ceel him of Consent in xlf-iasme for W~.Camp on, - tion,as pM,,idW for by Section 3700 of the labor Code,fire Me perforce.of Me work for which this permit is issued. 0 I hart and will maintain Wmire's Compensation Insurer cc.As tequpmd by Section 3700 of the labor Code,for Me performance of the work for which this permit Is issued. My WeWds Compensation Witham carrier and Policy number art: Cartier Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (17tlaseetion need ret be eomplim d ifthe permit Is foranehun trod dollar($100) or less) 1 entry Met in Me Wfmmance of Me work for which MIs permit Is issued.I shell not employ any person in my manner an As w become subject to Me Workers'CompemWoa laws of Caliromia.Dam Appho it NOTICE TO APPLICANT.If. net making this certifrcam of Exemption,you mmu become subject in the Wortmes Compensation previsions of Me IaWr Code.you mail �z foMwiM comply with such provisions or this Permit shall he dcemW remised. 'Z O CONSTRUCTION LENDING AGENCY [-... I hereby anism that Marc is a cmmucton bending agency for Me PMormana of p:> Me work for which this permit is hued(Sec.1097•Civ.C.) ALender's Name z Lenders Address _ U O 1 certify Mat 1 have mad this application And sum Mu Mc abuts info muton u U. - carry 1 Agree in comply withall City and county aNi.andtate Tawe nelatng W .O building construction,and hereby mtoon.represmutMA ofibisaly m UiWulm the tL1 abort-me.tim ed property for inspection purposes y (We)agree to rare.indemnify and loop harmless the City of Cupertino against fA liabilities,judgmemn.costs and Expenses which may in any way accrue Against said City U Z in consequence of Me granting of this Permit. '—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Silmmum of AppliantlCanuacrar Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicmtw forum building occupant mom or handle haysNous mamrial as defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety GAIE.Section W324)7 All roofs shall be inspected prior to any roofing material being installed. Oyer 0 N will Mc"]I.,or future Wilding occupant use ego mcnt or&,I.which If a roof is installed without first obtaining an inspection,I agree to remove It hwaNnw air conrmininr As defined by Me Bay Arta Air Quality Management all new materials for inspection. rtriel7 CYu C3 No 1 hers mad the hanrdous mamriais rtquimmenu umber Chm+mr Q95 ofthe Caiifw- nWHcalM&SafetyCode.Sxd=M5W.B533aw 534.IwWov WMaifthe Wilding tom ret Cumntly has A mmol Not it AS MY tesponaibilitY to rmrifY Me occupant of the ochimmennwhich most WMet prior tomaaneeofaCertificate ofoccupancy, Signature of Applicant Date Ownm onuthamnd egem Dam All roof coverings to be Class'ns'or better CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36615011 . 00 DATE ISSUED. . . . . . . : 11/24/2008 RECEIPT # . . . . . . . . . : BS000006685 REFERENCE ID # . . . : 08110091 SITE ADDRESS . . . . . : 1574 PRIMROSE WAY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : RIZK, TAMER ADDRESS . . . . . . . . . . : 1574 PRIMROSE WAY CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5230 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 . . . . . . . . : (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 IPRWHEATR 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 ---------- --------------- -------------------- CREDIT CARD 106 . 56 VISA --------------- TOTAL RECEIPT 106 . 56 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- -- ------ -------- -------- ----------- ---- 518 WATER HEATER • Community Development 10300 Torre Avenue Cupertillo CA 95014 Telephone(408)777-3228 O Fax(408)777-3333 �CUPEkTINO Building Department JOB ADDRESS: 1574 PRIMEROSE WAY PERMIT# v, I 009 ' OWNER'S NAME: RIZK, TAMER PHONE# 408)393-4943 GENERAL CONTRACTOR:FAST WATER�HEATER COMPAN FAX# 425-814-9516 I am not using any subcontractors:_ - " / 11/24/08 Signature Date Please check applicable subcontractors and con Tete 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 Owner/Contractor Signature Date • Permit No: V Q I I Q oq 1423425 (office use only) City Of Cupertino Building Permit Application • E-Mail: Buildinq-Permits cDcupertino.org (Address is case sensitive). Jobsite Address:1574 PRIMROSE WAY Date: 11/24/08 Assessor's Parcel Number: I 0l l •Ofl Owners Name: RIZK, TAMER Phone No: (408)393-4943 Project Valuation: 449.00 Building Permit Info: Bldg Elect Plumb X Mach Job Description Remove/Replace Gas Water Heater Contractor Information Company Name: FAST WATER HEATER COMPANY Phone No: • Contact Name: Carol Randall Fax No: 800-454-8955 Address: 12601 132ND AVE NE E-mail: carolr@fastwaterheater.com City, State &zip code: KIRKLAND,WA 98034 State Contractor's Lic. No: 877489 Expiration Date: 5/31/10 Worker's Comp No: 1761660 Expiration Date: 12/1/08 Carrier: California State Fund City of Cupertino Business License No: 29100 Credit Card Information Credit Card No: Expiration Date: 11/10 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.