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09050049 CITY OF CUPERTINO BUILDING DIVISION PERMIT � R�� ZNF6777--�7777777� � + : PERMIT NO. BUILDING ADDRESS: 18463 FARMINGHAM WAY FAST PER 4EATEE nqn,�on4q PERMIT ISSUE DATE OWNER'S NAME: A CONTROL NO. 1 : 800) 4D-4-8955 BUILDING PERMIT INFO ARCHr=/ENGINEER: BLDG ELECT PLUMB MECH app ' LICENSED CONTRACTORS DECLARATION Job DCSCnpt10D U 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 RMV/R P L-- GAS WATER HEATER =y in full fora and effeCL s n? License Class Dam Contractor t- ARCHITECTS DECLARATION U I understand my plans shall be used as public records i C I- Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the in O following reason.(Section 7031.5,Business and Professions Code:Any city or county K.1 ff which requires a permit to construct alter,improve,demolish,or repair any structure y'fin prior m its issuance,also requires the applicant for such permit to file a signed statement Sq.Ft.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 xG (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 81177 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). 37522078 . 01 ❑1,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 Cade:The Contractors License Law does 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 m 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-insum for Worker's Compcn- -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 Workers 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: Carries Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('Ibis section need not be completed if the permit is for one hundred dollars($100) or less.) 1 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'Compensadon 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY F~,►�. 1 hereby affirm that there is a construction lending agency for the performance of a✓ the work for which this permit is issued(Sec.3097,Civ.C.) W ALender's Nama, z L.cndees Address (�C I certify that I have read this application and state that the above information is 4L Fcorrect I agree to comply with all city and county ordinances and state laws relating to V building construction,and hereby authorise representatives of this city m enter upon the W above-mentioned property for inspection purposes C>w (We)agree to save,indemnify and keep harmless the City of Cupertino against „Hy coi 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 b3: SOURCE REGULATIONS. Re-roofs Signature of Applicant/Contractor Date T of Roof HAZARDOUS MATERIALS DISCLOSURE Type 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(x)? All roofs 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 Area Air Quality Management all new r Iaterials for inspection. .strict? ❑Yes 0 N 1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SaretyCode,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 or a certificate of occupancy. Signature of Applicant Date All roof coverings to be Class'A"or better Owner or authari7ed agent Dam _ ,�,.,� I Permit No: 00,0 9 440918 (office use only) City of Cupertino Building Permit Application E-Mail: Building-Permits(pD-cupertirlo.org (Address is case sensitive). Jobsite Address:18463 FARMINGHAM WAY Date: 4/14/09 Assessor's Parcel Number: �J Ok Owners Name: YAN, PAUL Phone No: (408)644-4489 Project Valuation: J' Building Permit Info: Bldg Elect Plumb X Mech Job Desi+ri tion 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 98031 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: 29100 Credit Card Information Credit Card No: 4417123041349530 Expiration Date: 11/10 Name on Card: Jeff Jordan Visa ❑X MasterCard ❑ American Express ❑ The Building permit application and a completed & signed contractor/subcontractor form need to be submitted with each permit. Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 OF Fax(408)777-3333 CUPS TINO Building Department JOB ADDRESS: 18463 FARMINGHAM WAY PERMIT# ociDf:�-) O04 OWNER'S NAME: YAN, PAUL PHONE# (408)644-4489 GENERAL CONTRACTOR:FAST WATER HEATER COMPA FAX# 425-636-7085 I am not using any subcontractors: _ 4/14/09 Signature Date Please check a plicable subcontractors and com If,te the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing 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