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09050052 FBUILiDINGADDRE-SIS: CUPERTINO � NG DIVISION PERMIT PERMIT NO. 9 MARY AVE FAST WATER HEPERMIT ISSUE DATE ERS NAME: r�nrg(-v nmv>\,r>`_R r A e 9 CONTROL NO. "NE: (800) 4!)4-8955 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 Z p 0 LICENSED CONTRACTOR'S DECLARATION JOU DCSCflptlOn MI hereby affirm that I am licensed under provisions of Chapter 9(commencing y with Section 7000)of Division 3 of the Business and Professions Code,and my license is RMV RPL(; GAS WATER HEATER y in full fora and effect -Z License Class Date Contractor ARCHITECTS DECLARATION CC -� 1 understand my plans shall be used as public records 3 d L O y Licensed Professions OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the mo following reason.(Section 7031.5,Business and Professions Code:Any city or county ,t m 9 which requires a permit to construe alter,improve,demolish,or repair any structure L-rn prior m its issuance,also requires the applicant for such permit to file a signed statement gq,Ft.Floor Area Valuation z< that he is liccnsod pursuant to the provisions of the Contractor's Licerue Law(Chapter 9 Y�$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or8850 y that he is exempt therefrom and Ute basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of APN Number not more than five hundred dollars(S=. 32652032 . 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 sax(Sec.7044,Business Required Inspections and Professions Code:The Contractor's 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 employers,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 Use project(Sec.7044,Business and Professions Code:)The Contracloes Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractor's License fit"' B&P C for this mason ❑I am exempt under Sec 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 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 Workers Compensation Insurance carrier and Policy number am: Cartier. 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 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'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must ,J Z forthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY I hereby alfirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) W ALenders Name 0 z Lenders Address U 0 1 certify that I have read this application and sate that the above information is corccL I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes a (We)agme to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date ►-t 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'loof Will the applicant or future building occupant store or handle hazardous material as defined by Use 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. C]Yes ONO 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 t hazardous air contaminants as defined by the Bay Area Air Quality Management all new Inaterials for inspection. ,strict? ❑Yes ❑No 1 have read the hvardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.I understand that if the building does not currently have a tenant,tat it is my responsibility to notify the occupant of the Date requirements which must be met prior to issuance of a Certificate of Occupancy. S ignatuI-of Applicant All roof coverings to be Class' '`or better Owner or authori7zd agent Date _ 442812 Permit No: D900 _3;-_1, dl�`�-_1, (office use only) City Of Cupertino Building Permit Application E-Mail: Building-Permitsncuper-irlo.or (Address is case sensitive). Jobsite Address: 10379 MARY AVE Date: 5/1/09 Assessor's Parcel Number: S 2c>2 a• Owners Name: BESCH, OTHMAR Phone No: (707)528-8081 Project Valuation: 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 98024 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: 29'00 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 arid a completed & signed contractorisubcontractor form need to be submitted with each permit. Community Development 10300 Torre Avenue j Cupertino CA 95014 Telephone(408)777-3228 OF Fax(408)777-3333 CUPEkTINO Buildi n De artment JOB ADDRESS: 10379 MARY AVE PERMIT# OWNER'S NAME: BESCH, OTHMAR PHONE# (707)528-8081 GENERAL CONTRACTOR:FAST WATER HEATER COMPA FAX# 425-636-7085 G� -AQP I am not using any subcontractors:— 5/1/09 Signature Date Please check applicable subcontractors and complete the followin 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