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09030149 CITY OF CUPERTINO BUILDING DIVISION PERNIIT �1Q � RkT�� r BUILDING ADDRESS: PERMIT NO. 21306 RUMFORD DR FAST WATER nqn-�ni 4q PERMIT ISSUE DATE OWNER'S NAME: S A CONTROL NO. `ONE: (800) 454-8955 BUILDING PERMIT INFO ARCHITEC/F-NGINEER: BLDG ELECT PLUMB MECH 0 � 0 o p a LICENSED CONTRACTOR'S DECLARATION Job Description U f hereby affirm that I am licensed under provisions of Chapter 9(commencing z with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in full force and effect. RMV/RPL C GAS WATR HTR . vM z License Class Lle•N n C-0 Dam Contractor ARCHITECTS DECLARATION 12< 1 understand my plans shall be used as public records D9L 4 G y Licensed Professional y w OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county K m V which requires a permit to construct,alter,improve,demolish•or r pair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation y i p Ft.Floor Area 7._ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq at- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 875 y 9 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 Apra Number Occupancy Type not more than fire hundred dollars(S5W). 32641019 . 00 ❑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 Conuactoes License Law dots 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 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 Contractors 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 workers Compen- ,ation,at 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 Workers Compensation Insurance carrier and Policy number am: Carrier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss) 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 became subject to the Workers'Compersadon 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 Cade,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z 2 CONSTRUCTION LENDING AGENCY (~.t rte.. I hereby affirm that there is a construction lending agency for the performance of �+5 the work for which this permit is issued(Sec.3097,Civ.C.) W 0 Lenders Name aZ Lenders Address V O I certify that I have read this application and state that the above information is (L r-. correct 1 agree to comply with all city and county ordinances and state laws relating to O Vbuilding construction,and hereby authorise representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. W (We)agree to save,indemnify and keep harmless the City of Cupertino against rF-r 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 b): s4t�zw SOURCE REGULATIONS. Re-roofs -- Signature of Applicant/Comractor Dare Type of Roof MATERIALS DISCLOSURE 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 ❑No If a roof .s installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which It hazardous air contaminants as defined by the Bay Area Air Quality Management all new r.iaterials for inspection. .strict? ❑Yes No 1 have mad the hazardous materials requirements under Chapter6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building docs 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 ignatur( of Applicant Date All roof coverings to be Class"rf{"or better Owner or authorized agent Date ��3©` �a 438369 Permit No: ,, -I (office use only) City of Cupertino Building Permit Application E-Mail: BuiWing-Permits @cupertiiio&g (Address is case sensitive). Jobsite Address:21306 RUMFORD DR Date: 3/23/09 Assessorrs Parcel Number: Owners Name: HUANG, TON CHURO Phone No: (408)446-3123 Project Valuation:' <375, C C 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: 12601132ND AVE NE E-mail: caroir@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: 12/1/09 Carrier. Truck Insurance Exchange City of Cupertino Business License No: 29130 Credit Card Information Credit Card No: 4417123041349530 Expiration Date: 11110 Name on Card: Jeff Jordan Visa ® MasterCard ❑ American Express ❑ The Building permit application and a completed & signed contractorlsubcontractor form need to be submitted with each permit. Com Davdopmag 10300 Tome Avww Cop utho CA 95814 ' Tokpbow 2 Fmc 408)777-3333 CUPEkTINO Building De ax-tnlent JOB ADDRffiS; 21306 RUMFORD DR PBRMU# OWNWS NAME HUANG,TON CHURO PHONE# 40S)446-3123 GEMAL CON'IRAC R.-FAST WATER HEATER COMPAN FAX# 425.638-7085 I am riot using any subrontiactors: �0`""� r L� P 3123/09 Sfgrutmre Data Please check a and a the g2ntg infmmati r SUBCONTRACTOR. BUMMSS NAMB BUSDMSS LICENSE# Cabinets&bfflNwozk CemeritPhdddng 8lecbeual ExcaVadm Linoleum/Wood Glass/Glazing Heating Insulation La Ornamental Sheet Metal P WaUpaper Paving Pias Plumbing R Tank Sheet Metal Sheet Rock Tile Over=/Contractor Signature Date