09050055 CITY OF CUPERTINO `
BUILDING DIVISION PERMIT �������������������
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PERMIT NO.
BUILDMG ADDRESS:
10510 BAYWO D T FAST WA'
pE[ZZMTT ISSUE DATE
OWNER'S NAME: ,
` S A . CONTROL NO.
�NE:
(800) 4�4-8955
BUII.DING PERMIT INFO
ARCHTi'ECT/ENGINEER: � E� PLU�MH �
u p p LICENSED CONTRACI'OR'S DECLARATION fOU DeSCiIpLlOi1
�w� �q�yy�rm�hat I am licenscd unAcr provisions aC Chaptcr 9(rnmmencing
y W wiih Secdon 701x))ot Division 3 of u�c Business and Profcssions Codc.and my liccnsc is RMV�RE P LC GA S WATER H EAT ER
��y in tull Coree and effect
��? Licenac Clau ContracWr
±F,p Datc
�� ARCHITECCS DECLARATION
I undcrstanJ my plans shall bc u�cd u puAlic rccorda
ac
�yU
L O y Lx:ensed Pnifessianai
OWNER-BUILDER DECI.ARATION
�<� 1 hereby at7rm�hat t am exempt Gom�hc Conuactor's Liccnae Law for thc
i O O Collowing icuon.(Scction 7031.5,Busincss and Profcssions Codc:Any city or county
k m� which requires a pem�it to conuruct,alicr.improvc.dcmolish.tu mpair any swcturc
��y prior 4i i�s iuuancc.also rcquires�hc applicant Cor such permit to filc a signcd stn�emcm Valuation
_z,. �s Ft.Floor Area
< Uut t�e is liccnscJ pursuant to the pmvisions of�hc Conuactor's Liccnsc I�w(Chaptcr 9 Sq•
xts-�� (commcncing wiU�Scction 7000)of Division S of�hc Busincss and Profcssiona Cadc)or 9 2�
i�� ihat he is wcempt thuefrom and ihe basis Cor�6e aileged exempdon.Any viotuion of
Section 7031.3 by ury applicant fw s permit subjecu ihe applicant to a civi]pcnaity af ApN Number Oecupancy Type
not mae�han five dund�ed dollars(SSOU)• 316 3 0 0 6 5 . 0 0
❑1.u owner o[the property.or my employces with wages az ihe'v sok compenastlon,
willdo�hewodc.andihes�ucw�eunotintendedoraReeedforsale(Sec.7044,Businesa Required Inspeetions
and Rofessiona Code:'ll�e Conuactors License I.aw docx not apply iu an ow�r of
propeny who�ilda a improves thercun,and who does such work himaelf or Uwugh his
own employces,providcd that such improvemen�s ue not in�ended or oQered for sale.It.
however,the building or impmvement ic sold within om year o(compleGon,t6e owner
builder will have�he bu�den o[proving that he did not build or improve[or purycue of
sak.).
0 I.as owner oC the propeny.am aectusively coNracting wi�h licensed conwctors to
conswct the p�ojett(Sec.7044.Business and Profcuions Code:)7Le Contracmrs Li-
cenu I�w docs aot appty a an m�mu of propeny who builds or improves U+ereon,and,
who convacu[or such p�ojects with a conuactor(s)licensed pursusnt w ide Convactors
License Law.
�I am exempt under See. .B 8 P C for ihis rcason
Ownu Date
WORKER'S COMPENSATION DECLARATION
1 hereby�rm under penalty ot pery'ury one o[the following declaralians:
i hsve und will maintein a CutiGcate of Conaent lo self-insure f�Worker's Campen-
sation,as providcd for by Sectiun 3700 of the[abor Code,for�he pedormance of ihe
woric for which Ihis permit is issued.
❑I havc and will maimain Worker's Compensation Insurana,u requircd by Sccdon ,
3700 oC the Labor Codc,Cw the pcR'ormancc of the work for which�his pecmit is issued•
My Worke�s Compensation Insurance carticr and Policy number are:
Cartier. Poliry No.:
CER1'IFICATE OF EXEMPTION FROM WORKERS'
COMPENSATIONINSURANCE
(('hit sectian nad rrot bc completcd i(ihe permit is for anc hunNcd dollars(5100)
or Icss.)
I cenify thnt in thc performaxe of ihc woric for which ihis permit is�ssued.�shs1�not
amploy any person in any man�rcr w u w become subject to the Worlcers'Compensauon
Laws oC Ca►ifomia Datc
Applicant
NOT7CE TO APPLICAM:if,atYcr making U�is Ccrtificatc of ExemMion,you should
become subject to thc Worker's Compensation provisiona of Ihc Labor Code,yau must
�,� forthwith comply with such provisioas or this permit shall bc dccmcd�evokcd.
Z O CONSfRUCf10N LENDING AGENCY
H.�-� I hereby amrm�hat ihere ia a consuuction Iending agency for the perCormance o! -
py� Uu work fur which this permit is iuucd(Scc.3097,Civ.CJ ,
W Q Lendcr's Namc
]z L.cnders Address
(�� 1 eertify Ihat 1 have cead Wis applicuion and siate�hu ihc above infortnatiun is
w F cortect 1 a�ce to comply with all ciry and councy onfinances and sute laws relaung�o
0 U building consuuction,and hereby authorin mprescntativcs of ihis ciiy to cntcr upon thc
�w ahovamcnGoncd propenyforinspenion purposes
a (We)agree to uve,indcmnify and kecp harmless U�e City of Cupertino against
�� liabilities,judgmcnu,costa and expenscs which may in any way accruc againsl said City
(,)z in consequence aC thc granting of Ihis permit. DSCC
►" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
Re-roofs
Signuurc of ApplicanUConuacWr Da�c
HAZARDOUS MA'fERIALS D[SCLOSURE Type of�:OOf
�Il lhc applicant or futwc building occupant storc or handlc haratdous ma�crisl
as dcfincd by U�c Cupenino Municipal Codc.Chapicr 9.12,md the Hea1W and Safcry
c«�,Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ycs ❑No
Will thc applicant or fuwrc building accupant usc eyuipmcnt or dcviccs which
If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air coniaminan�s u Jcfincd by the Bay Arca Air Quality Managcmcnt all nevv riaterials for inspecrion.
:�s�;���
❑Yes p Rlo
1 havc rcad the hvard<ws matcrials requiremenLc undcr Chaptcr 6.95 af Ihc Califor-
nis Hcalih&Safe�y Codc,Sccdons 25505.25533 aru125534.1 undcfs�and�hat if ihc building
docs noi curten�y have a tenant,ihat it is my responsibiliry w noufy ihe occupant of ihe
�cquiremen�s which mus�be met prior�o issuaricc o[a Ccnificaic of Occupanry. SIgi13tUIf;Of APp11C1T1L Date
All roof coverings to be Class"�''or better
Owncr or authori�cd agcni Da�c
443318
Permit No: �p-����
_' , toffice use only)
City Of Cuperfiino Buildir�g Permit Application
E-Maii: Buildinq-Permits a„�,_cupertin��.orq {Address is case sensitive).
Jobsite Address:10510 BAYWOOD CT Date: 5/6/09
Assesso�'s Parcel Number: 31 '�3 c��lfl�. u �
Owners Name: WAGNER, ED Phone No: (408)725-8020
Project Valuation:���� ° �"'�
Building Permit lnfo: Bldg Efect _ Plumb X Mech
Job Desc ri tion
Remove/Replace Gas Water Heater
Contractor t��formation
Company Name: FAST WATER HEATER COMf�ANY P�one 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 Camp No: A09304455 Expiration Date: 12/1/09
Carrier: Truck insurance Exchange
City o#Cupertino Business License No: 291C'�
Credi# Card Information
Credit Card No: 4417123041349530 Expiration Date: 11/10
Name on Card: Jeff Jordan
Visa [.]X MasterCard ❑ American Ex�ress ❑
The Buitding permit app[ication ancf a compieted & signed
contractor/subcontractor form nee�� to be submitted with each permit.
Community Developmen#
10300 Torre Avenue
r: ; � �+� : Cupertino CA 95014
:� ' Telephone(408)777-3228
� �� Fax(408)777-3333
euP��.T�No
�1111�111 De �7C'tl�.��ll.�
jOB ADDRESS: 10510 BAYWOOD CT PERMIT# _
D�O'� ��� �
QWNER'S NAN�: WAGNER, ED PHONE# (408)725-8020
GENERAL CONTRACTOR:FAST WATER HEATER COMPA FAX# 425-636-7085
..���� Y�QP
I am not using any subcontractors:._ � ._ 5/6/09
Sigru�tvre Date
Please check a licable subcontractors and com lete the followin information:
SUBCONTRACTOR BUSINESS NAME BUSLNESS LICENSE #
Cabinets &MiIl.work
Cement Finzshing
IIectri.cal
Excavation
Fencing
: Flooring:Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insvlation
Landscaping
La�hing
Masonry
Chrnamental Sheet Metal.
Pain.ting/ Wallpapex
Paving
Plastering
Plumbing
Roofing
Septic Tar�c
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signatvre Date