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09030226 CITY OF CUPERTINO BdILDING EUVISION PERMIT 7. BUILDING ADDRESS: PERMIT NO. 10310 TULA LN FAST WATER HEATER 09030226 OWNER'S NAME: PERMIT ISSUE DATE KO JE J ANT) CHTTI SHTI H ONE: S A CONTROL NO. (800) 154-8955 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u0c LICENSED CONTRACTOR'S DECLARATION Job Description v I 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 REMV/R SLC GAS WTR HEATER z<y in full force and effect vn Z License Class Lie.8 Dale Contractor tg ARCHITECT'S DECLARATION eE 1 understand my plans shall be used as public records �yU WH Licensed Professional n y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License taw for the p O following reason.(Section 70315,Business and Professions Cate:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure zprior 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 Ysl-- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 113 5 A 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). 3 5 913 0 )9 . 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 oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of Ll 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.). [11.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. ❑1 am exempt under Sec. B&P C for this reason Owner Dare 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 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 am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc 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 ,J Q forthwith comply with such provisions or this permit shall be deemed revoked. zCONSTRUCTION LENDING AGENCY [~—r CA I hereby affirm that there is a construction lending agency for the performance of cal 5 the work for which this permit is issued(Sec.3097,Civ.C.) WCL A Lender's Name a z L.endees Address U Q 1 certify that I have rad this application and state that the above information is LL�^ correct.I agree m 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. a (We)agree to save,indemnify and keep harmless the City of Cupertino against Hliabilities,judgments,toss and expenses which may in any way scenic against said City V Z in consequence of the granting of this permit. Date 0-4 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b'/: SOURCE REGULATIONS. Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of'Zoof 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 roof: shall be inspected prior to any roofing material being installed. ❑Yes ❑No 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 it hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. .Jistrict? ❑Yes ❑No L have read the hazardous materials requirements under Chapter 6.95 of thc 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 mel prior to issuance of a Certificate of Occupancy. Slgnaturt:of Applicant Date All roof coverings to be Class" ''or better Owner or authorized agent Date n Permit No: Oqo 439191 (office use only) City Of Cupertino Building Permit Application E-Mail: Building-Permits@cupertino•org (Address is case sensitive). Jobsite Address:10310 TULA LN Date: 3/30/09 Assessors Parcel Number: �5cr i coq q pct Owners Name: K0, JERRY Phone No: (408)253-5513 Project Valuation: 1/13S>S(V Building Permit Info: Bidg 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 9803,4 State Contractor's Lie. No: 877489 Expiration Date: 5/31/10 Worker's Comp No: A09304455 Expiration Date: 12/1109 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 El American Express [] The Building permit application and a completed & signed contractor/subcontractor form need to be submitted with each permit. Community Development 10300 Two Avenue Cupertino CA 95014 Telephone(408)777-3228 Q Fax(408)777-3333 CUPEkTINO Builffing Department JOS ADDRESS: 10310 TULA LN PERMIT#0. OWNER'S NAME: KO,JERRY PHONE# (408)253-5513 GENERAL CON RACTOPC PAST WATER HEATER COMPAN PAX# 425-636-7085 I am not using any subcontractors: d''` z.'5& w 3/30/09 Signature Date Please check applicable subcontractors and coin feta the following information: SUBCONTRACTOR BUSINESPS NAME BUSINESS LICENSE# Cabinets&Millwork Cement Finishing Electrical Excavation • Fencmg 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