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09020005 CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 22090 WALLA R FAST W1,TER HE OWNER'S NAME: PERMIT ISSUE DATE PHOiWA"GsA*rdA8.2CONTROL NO. (800) 4:54-8955 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u O p LICENSED CONTRACTOR'S DECLARATION Job Description m I hereby affirm that I am licensed under provisions of Chapter 9(commencing V 5 with Section 7000)of Division 3 of the Business and Professions Code,and my license is �y in full form and effect RMV/RPI,C GAS WATER HEATER ? License Class Lle•S Ep Date Contractor ARCHrmcrS DECLARATION 19-, I understand my plans shall be used as public records �aU U.y Licensed Professional n y OWNER-BUILDER DECLARATION I hereby affirm that I 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 f., which requires a permit to construct.alter,improve,demolish,or repair any structure y Z 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 Contractors License Law(Chapter 9 Sq.Ft.Floor Area Valuation y t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $449 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(5500). 326030';8 . 00 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 Required Inspections and Professions Code:The Contractors License Law does not apply to an owner of 9 P 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 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- cense 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. 0 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 Workers Compan- ion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 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 Workers Compensation Insurance carrier and Policy number am: Cartier. Policy NO.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($1110) or less.) I certifv 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'Compcnsadon 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY E~.r 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.) WLL Q L.endces Name r Z Lenders Address V 0 I certify that I have read this application and state that the above information is [L" correct I agree to comply with all city and county ordinances and state laws relating to 0 V building construction.and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. CL (We)agree to save,indemnify and keep harmless the City of Cupertino against „Ey to liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date r t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued bs': SOURCE REGULATIONS. -A�� Re-roofs Signature of Applicant/Comractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 shall be inspected prior to any roofing material being installed. ❑Yes ONO If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection. strict? 0 Yes ONO I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty 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 requirements which must be met prior to issuance of a Certificate of Occupancy. S IgnatuIf:Of Applicant Date Owner or authorized agent Date All roof coverings to be Class" 'or better C)R oa 1920 Permit No: (office use only) City Of Cupertino Building Permit Application E-Mail: Building-Permit cu-ertinc).ora (Address is case sensitive). Jobsits Address:22090 WALLACE DR Date: 2/2/09 Assessor's Parcel Number. (p0 3D 3 O� Owners Name; LIANG,ANTHONY&WU, SCE Phone No: (408)313-8261 Project Valuation: 449.00 Building Permit Info: Bld 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@fastwaterheater.com City, State &zip code: KIRKLAND,WA 98034 State Contractor's Lic. No: 877489 Expiration Date: 5/31/10 Worker's Comp No: A09304455 Expiration Date: 1211/09 Carrier. Truck Insurance Exchange 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. Community Devdopmeat 10300 Torre Avww Cuperimo CA 95014 Telephone(408)7773228 0 CUPE�TI�10 Fax(408)T/73333 Building Department JOB ADDRESS; 22090 WALLACE DR FEUMT# Ir -J O'4NNEWS NAUM: LIANG,ANTHONY&WU, SCE PHONE# 408)313-8261 GENERAL CONTRACTOR:FAST WATER HEATER COMPAN FAX# 425-636-7085 I am not using any subcont maors: ___ '`' � 2/2109 Signature Date Please check applicable subcontractors and co l ,te the f2EEWMn information: 60 SUBCONTRACTOR BUSINI,SS NAME BUSINESS LICENSE# Cabinets&Nliillwork Cement Finishing Electrical Excavation Pencing Flooring:Carpeting Linoleum./Wood Glass/ Glazing Heating Insulation Landscaping Lathing . Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plasbering Pl.---,- Roofing lumRoofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signatvre Date