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09010078 CITY OF CUPERTINO BUILDING DIVISION PERMIT # ? BUILDING ADDRESS: PERMIT NO. 22087 SAN FEERNANDO CT FAST WATER HEATER 09010078 OWNER'S NAME: PERMIT ISSUE DATE i0 SAWr,ktyCONTROL NO. ARCHITEGTIENGiNEER: BUILDING PERMIT INFO RMV/RPLC GAS WATER HEATER BLDG ELECT PLUMB MEcx O p LICENSED CONTRACTOR'S DECLARATION O v I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description z with Section 7000)of Division 3 of the Business and Professions Code,and my license is "=y in full force and effect. DjgZ License Class Lic.N E t-p Dale Contractor ARCHITECTS DECLARATION 4 U I understand my plans shall be used as public records 4 O y Licensed Professional y 3 OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the p o following mason.(Section 7031.5,Business and Professions Code:Any city or county 4$V which requires a permit to construct,alter,improve,demolish,or repair any structure y`y prior to its issuance,also requires the applicant for such permit to file a signed statement _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation 20 yt— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y .. 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 APN Number Occupancy Type not more than five hundred dollars($500). ❑1,as owner of the property,or my employees with wages as their sok 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 Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements arc not intended or offered for Sade.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 ConuwWes Li. cense Law does not apply W an owner of property who builds or improves themon,and. who contracts for such projects with a contra tors)licensed pursuant W the Contractor's License Law. C]I 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: 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- -tion,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 Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued My Worker's Compensation Insurance carrier and Policy number arc: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (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 W the Worker's Compensation provisions of the labor Code,you must 0 forthwith comply with such provisions or this permit shall be deemed revoked. z m--r CONSTRUCTION LENDING AGENCY [~i►rA-� I hereby affirm that there is a construction lending agency for the performance of {Si the work for which this permit is issued(Sec.3097,Civ.C.) a0 Lender's Name z Lender's Address V Q 1 certify that I have read this application and state that the above information is LL,►r correct.I agree W comply with all city and county ordinances and state laws relating W O V building construction,and hereby authorize representatives of this city W enter upon Ore W 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 V Z in consequence of the granting of this permit. F" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of Applicant/Contractor Dale HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hanrdous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yu ❑No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. .strict? ❑Yes ❑No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,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 requirements which must be met prier W issuance of Certificate of Occupancy. Signature of Applicant Date Owner or authorized agent Date All roof coverings to be Class". "or better CITY OF CUPERTINO 5 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35712061 . 00 DATE ISSUED. . . . . . . : 01/20/2009 RECEIPT #. . . . . . . . . : BS000006994 REFERENCE ID # • . . : 09010078 SITE ADDRESS . . . . . : 22087 SAN FEERNANDO CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : DANIEL CHEN ADDRESS . . . . . . . . . . : 22087 SAN FEERNANDO CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 449. 00 1 .00 0 . 00 1 . 00 0 . 00 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 1TRAVDOC FLAT RATE 1. 00 40 .79 0 . 00 40. 79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 107.56 0 . 00 107. 56 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER O p 429758 Permit No: 0 (office use only) City Of Cupertino Building Permit Application E-Mail: Building-PermitsCa�,tk rtino.org Address is case sensitive). Jobsite Address:22087 SAN FERNANDO CT Date: 1/19/09 Assessor's Parcel Number:� 7 / o(,I , r Owners Name: CHEN, DANIEL Phone No: (408)390-4818 Project Valuation: 449.00 Building Permit Info: Bldg Elect Plumb X Mech Job Description Remove/Replace Gas Water Heater Contractor Information Company Name: FAST WATER HEATER COMPANY Phone No: Contact Name: Julie Caskey Fax No: 425-636-7084 Address: 12601 132ND AVE NE E-mail:carolr c@fastwaterheater.cdm -_ City, State &zip node: KIRKLAND,WA-98034 State Contractor's Llc. No: 877489 Expiration Date: 5/31/10 Worker's Comp No: A09304455 Expiration Date: 12/1/09 Carrier: Truck Insurance Exchange C ity of Cupertino Business License No: 29100 Credit Card Information Credit Card No: P Expiration Date: 11/10 Name on Card: Jeff Jordan Visa ® MasterCard ❑ American Express ❑ The Building permit application and a completed & signed contractorisubcontractor form need to be submitted with each permit.. CO3=Unity Devel Tm=t 10300 Tomo Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CUINO Buncting Department JOB ADDRESS. 22087 SAN FERNANDO CT PERMTI`# o d ze OWNER'S NAME: CHEN, DANIEL PHONE# 408)390-4818 GENERAL CONTRACTOR:FAST WATER HEATER COMPAN FAX# 425-636-7085 I am not using any subcontractors: 1/19/09 Signature Date Please check applicable subcontractors and com fete the followmg information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets&Millwork Cement Fuvshing Electrical Excavation Fencing Flooring:Carpeting Linoleum/Wood Glass/Glazing Heating Insulation - .. Landscaping Lathing Masonry Ornamental Sheet Metal Painti=ng/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date