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09050053 CITY OF CUPERTINO BUILDING DIVISION PERMIT � � � PERMIT NO. BUILDING ADDRESS: 22588 LAZY A T FAST WAr.' PfTthIIT ISSUE DATE OWNER'S NAME: 34CNI TG R1(9''t4A S*&A CONTROL NO. INE: (800) 4'54-8 )55 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH chi p p 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 ate Business and Professions Code,and my license is RMV/RPL,'- GAS WATER H EATR y in full force and effect c�Z License Class—a Date Contractor ni- ARCHr1ECTS DECLARATION ee I-4t 1 understand my plans shall be used as public records ;yU O in Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the a o following reason.(Section 7031.5.Business and Professions Cork:Any city or county K$Pi which requires a permit to construct.alter,improve.demolish,or repair any structure 4;-- prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq xl- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $1590 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 mom than rive hundred dollars(5500). 34232004 . 00 ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work.and the stiucture is not intended or offered for sale(Sec.7044.Business Required Inspections and Professions Code:The Contractor's 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 We.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.). ❑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. ❑I am exempt under Sec. B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION 1 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- -don,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 for one hundred dollars($100) or less) I cenify 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 Workcrs'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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY F~•t rte., I hereby affirm that there is a construction lending agency for the performance of (1! the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name ] l z endees Address V 0 I certify that I have read this application and state that the above information is LL�' correct I agree to comply with all city and county ordinances and state laws relating to 0 U building construction.and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes W W (We)agree to save,indemnify and keep harmless the City of Cupertino against Clo to liabilities,judgments,costs and expenses which may in any way accnx against said City U Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b): Date SOURCE REGULATIONS. Re-roofs Signature of Applicant/Conuactor 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 Codc.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 Will a roof .s installed without first obtaining an inspection,I agree to remove ll 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 materials for inspection. ,strict? ❑Yes ❑NO I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety 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 ignaturt of Applicant Date All roof coverings to be Class" `'or better Owner or authorized agent Date _ 443079 Permit No: q (office use only) City Of Cupertino Building Permit Application E-Mail: Building-Permitsancupertino orq (Address is case sensitive). Jobsite Address:22588 LAZY OAK*CT Date: 5/4/09 Assessor's Parcel Number:-�14A 3� C>pL+ , r� Owners Name: YOUNG, RICHARD Phone No: (408)255-9437 Project Valuation: I I 5CI a . Do 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: 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: 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 anti a completed & signed contractor/subcontractor form need to be submitted with each permit. Community Development 10300 Torre Avenue 2 : Cupertino CA 95014 Telephone(408)777-3228 C, .OF Fax(408)777-3333 CUPEkTINO Building De�ctnn�n JOB ADDRESS: 22588 LAZY OAKS CT PERMIT# O q o l o U�5 OWNER'S NAME: YOUNG, RICHARD PHONE# (408)255-9437 GENERAL CONTRACTOR:FAST WATER HEATER COMPAM FAX# 425-636-7085 I am not using any subcontractors: _ 5/4/09 Signature Date Please check applicable subcontractors and com le-:e the following information: SUBCONTRACTOR BUSINE'3S NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing IIectrical 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