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07060065 CITY OF CUPERTINO .oil - BUILDING DIVISION PERMIT PERMIT NO. Bu1L�olc..,a§P' kI VERS IDE DR FAST WA'P=:R HEATER 07060065 G S tS S PERMIT ISSUE DATE OWNER'S NAME: PON, MICHAEL 12601 132 AVE NE 06/08/2007 SANITARY NO. CONTROL NO. NE: (800) 451-8955 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB ME�CH p z0 LICENSED CONTRACTOR'S DECLARATION Job Description u I hereby affirm that I am licensed under provisions of Chapter 9(commencing REMOVE A STD REPLACE WATER HEATER ;z aj with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in full fora and v�z License Cl, L•g ❑ Datc — Contractor L4 ARCHITECTS DECLA ATl N �a i C4< l understand my plans shall be used as public records >yU W y Licensed Professional OWNER -BUILDERDECLARATION 1 he affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct.alter,improve,demolish,or repair any structure — prior tai its issuance,also requires the applicant for such permit to file a signed statementS a Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $449 t I=❑ (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 Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3560303 4 not more than five hundred dollars($500). ❑1,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 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's L- eone Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License law. ❑1 am exempt 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 have 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. I have and will maintain Workers Compensation Insurance,as required by Section 700 of the Labor Code.for the performance of the work for which this permit is issued. My Worker's Compensation lnsurance ca . and Policy number are: Cartier: Policy No.: CERTIFIC O EXEMPTION FROM ORKERS' COMPENSATION INSURANCE (This section need not he 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,1 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 O forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of p:> the work for which this permit is issued(See.3097,Civ.C.) W Q Lendces Name 2 Lender's Address U O 1 certify that 1 have read this application and state that the above information is Lt: F correct.1 agree to comply with all city and county ordinances and state laws relating to CU building construction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. O. (We)agree to save,indemnify and keep harmless the City oC Cupertino against ,Hy t4 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 ►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOUR LATIONS. l7 Re-roofs I of Applican✓Contractor Dare Type of R sof HAZARDOUS MATERIALS DISCLOSURE yp 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:;hall be inspected prior to any roofing material being installed. ❑Yes J<No If a roof i:;installed without first obtaining an inspection,I agree to remove 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 all new m for inspection. District? ❑Yes CKNo I have read the hazardous materials requirements under Chapter 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 m notify the occupant of the „Date requircmen tell must be met prior to issuance of a Certificate of Occupancy. re of Applicant 067.05 All roof coverings to be Class"B or better authorixcd agent Date CITY OF C'UPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35603034 . 00 DATE ISSUED. . . . . . . : 06/08/2007 RECEIPT # . . . . . . . . . BSOO0001593 REFERENCE ID # . . . : 07060065 SITE ADDRESS 22383 RIVERSIDE DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PON MICHAEL ADDRESS 223:33 RIVERSIDE DR CITY/STATE/ZIP . . . : CUP"sRTINO, CA 95014-3960 RECEIVED FROM FAST WATER HEATER CONTRACTOR JEF? JORDAN LIC # 29100 COMPANY FAST WATER HEATER ADDRESS 126 )1 132 AVE NE CITY/STATE/ZIP . . . : KIRCLAND, WA 98034 TELEPHONE (80)) 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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------- CHECK 84 . 02 3163 --------------- TOTAL RECEIPT 84 . 02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING From: 06/04/2007 14:20 1502 P.004/008 368842 CITY OF CUPIERTINO WA'D'ER HEATER CE tti�IO PERMIT APPLICATION FORM Ip - AM# v5( v:5 -03Y" o� Building Address: 3 RIVERSIDE DR Owner's Name: - Phone M PON, MICHAEL (408)257-3635 . Contractor: License M. FAST WATER HEATER COMPANY 877489 Contact: Cupertino Business License M Cara RandaQ 800-454-8955 �29l oto Building Permit Info: BMJ ❑ Elect ❑ Plumb ® Mech ❑ Job Description: RernoYelR Gas WaW Heater Residential [$ Commercial Q Cost of Project: 449.00 Strapped U On Platform U Bonded New Location ❑ Ralgacemot M Applicable Fee ID Fee Desai 'don Fee Group BPWHEATER Water heater/Vent BUILDING PPS Plumbbg Permit Issuance PLUMBING BENERGY BUILDING BUSLIC Busirwo Liewn BUILDING