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10100014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10190 S FOOTHILL BLVD CONTRACTOR:JUST WATER HEATERS PERMIT NO: 10100014 INC OWNER'S NAME: SHEU MING-GOEI AND YANG SU-SHI 3400 INVESTMENT BLVD DATE ISSUED: 10/01/2010 .VNER'S PHONE: 4082183218 HAYWARD,CA 94545 PHONE NO:(510)293-9901 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL Lic.# �� 37� INSTALL TANKLESS WATER HEATER License Class T--�-r Contractor, 1 Date r9�ti?{a!��/t' I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declare tions: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the S Ft Floor Area: Valuation:$3500 performance of the work for which this permit is issued. q I have and will maintain Worker's Compensation Insurance,as provided for Iiy Section 3700 of the Labor Code,for the performance of the work for which f►is APN Number:35701084.00 Occupancy Type: permit is issued. 04 j APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws elating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to inter upon the above mentioned property for inspection purposes. (We)agree to s ave 180 DAYS FROM LAST CALLED INSPECTIO indemnify and keep harmless the City of Cupertino against liabilities,judgm:nts, costs,and expenses which may accrue against said City in consequence of tl e Issued b�Tr/ Date: granting of this permit. Additionally,the applicant understands and will con cply with all non-point source regulations per the Cupertino Municipal Code,Sec tion 9.18. RE-ROOFS: natu� Si � Date`8 i7 All roofs shall be inspected prior to any roofing material being installed.If a roof is g installed without first obtaining an inspection,I agree to remove all new materials for inspection. LJ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law fur one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: I,as owner of the property,or my employees with wages as their sole comp:nsation, will do the work,and the structure is not intended or offered for sale(Sec.7 A4, Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will al I hereby affirm under penalty of perjury one of the following three maintain&Safety Code,S ction 25532(a)should Is to reCode, handle thazardouer 9.12 d the Health declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazer ou Compensation,as provided for by Section 3700 of the Labor Code,for the aircontamin is as defined ce bythe Bay Area th the Cupertino it Quality pal Coe,Chapter District enc performance of the work for which this permit is issued. will maintainthe Health&Safety Code,Sections 25505,25533,and 25534. 1 have and will maintain Worker's Compensation Insurance,as provided fi)r by '` Section 3700 of the Labor Code,for the performance of the work for whic i this Owner or authorized agenC 'L�_ Date: i permit is issued. I certify that in the performance of the work for which this permit is issuec.,I shall not employ any person in any manner so as to become subject to the Work er's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I that become subject to the Worker's Compensation provisions of the Labor Cc de,I must work's for a wyhich this shere is a permit is�ssued(Sec!3097,CrveC�for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above informal on is correct.I agree to comply with all city and county ordinances and state la vs relating to building construction,and hereby authorize representatives of this city to enter ARCHITECT'S DECLARATION upon the above mentioned property for inspection purposes.(We)agree t)save •mnify and keep harmless the City of Cupertino against liabilities,judgments, .s,and expenses which may accrue against said City in consequence c f the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will c omply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: 'VALUATION: 1$3,500 —� P*PERMITTYPE: Minor Building Permit 1'LAN CHECK TYPE: Water Heater PRIMARY SFD or Du lex l< r PENTAMATION PRWHEATR USE: P t'LCXJ °.1 f.z PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY BP FEES Water HeaterNent Unit Fee: 1 PRWHEATR 1 $25 1>rortt Plumb.Permit Fee: 1PPERMIT L-lu P,� t t; Of/io '.I, F-1 )n , r l}rn fL1 $42.00 NOTE: Theseees are based on the preliminaryin ormat ion available and are onlyan estimate. Contact the De t or addn'1 in o. FEE ITEMS (Fee Resolution 09-051 Elf.7/1/10) 'FEE QTY/FEE MISC ITEMS Moll /CC' slipp[ PC l"Ce F A I'lrllrlll:a�lec tl.:Ish; P/alt C`ilez:k. Stapp[ I isp Fcc PME Unit Fee: $25.00 PME Permit Fee: $42.00 C misinwfion Ta "Icousli"d Rc iiic';L 1~01. Work Without Permit? 0 Yes E) No $0.00 Plcr�uritr,_7 f'a��.> Travel Documentation Fee: ITRA VDOC $42.00 'il-z,lr 1-Ic>tir�ll 1<><�: Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 == SUBTOTALS: $110.00 $0.00 TOTAL FEE: $110.00 Revised: 9/29/2010 CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: SylviaM 5 ITEMS OF 10 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35701084 . 00 DATE ISSUED. . . . . . . : 10/01/2010 RECEIPT # . . . . . . . . . BS000011618 REFERENCE ID # 10100014 SITE ADDRESS 10190 S FOOTHILL BLVD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SHEU MING-GOEI AND YANG SU-SHI ADDRESS . 10190 S FOOTHILL BLVD CITY/STATE/ZIP CUPERTINO, CA 95014-2602 RECEIVED FROM • " CORNIE: GILROY,GY CONTRACTOR . . . . . . JOHNLIC # 15128 COMPANY JUST WATER HEATERS INC ADDRESS 3400 INVESTMENT BLVD CITY/STATE/ZIP H5Y0A29, CA 94545 TELEPHONE FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL- --------- - ---------- ---------- ---------- ------------- 1. 00 0 . 0 1BCBSC VALUATION 3, 500 .( 0 1 . 00 0 .00 0 . 00 0 .50 0 . 00 1BSEISMICR VALUATION 3, 500 . (10 0 . 50 42 . 00 0 . 00 1PPERMITFE FLAT RATE 1 . 0 42 . 00 0 .00 1PRWHEATR UNITS 1 .x)00 25 . 00 0 .00 25 . 00 0 . 00 1 . x)0 42 . 00 0 .00 42 . 00 0 . 00 1TRAVDOC FLAT RATE ------ ---------- ---------- ---- TOTAL PERMIT 110 .50 0 .00 110 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER CREDIT CARD 246 . 97 MC --------------- TOTAL RECEIPT 246 . 97 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- --------------- 518 WATER HEATER Iran (0 ` S E R V C C E O R D E R 386134 ..1 INPUT : 7/20/10 15 : 54 ZONE : SVCMTV PROMISED : 7/21/10 M8-10AM D PATCHED : MECH: CPLETED : HRS: 1 . 00 JOBS E: 229002 PR: 99 SHEU NG BTBL: 10 10190 FOOTHILL BLVD. TYPE: TE X STEVE CREEK / SFD STAT: 0 (408)218O3 �iA8 95014 ( 408 ) BILL TO: 9a9 99 SHEU MING SHEU MING p� 10190 S . FOOTHI BLVD. a CUPERTINO, CA 95 4 ��/(, C. ( 408 ) 218-3218 ( 408 ) DISPATCHER: PHIL �� O� SEE : ( 408 ) PO: TAX CODE : 4 SU REP BLDG CL SUM: M TERMS : 1 CHECK ` TROUBLE : TA.IKLESS WH EST REF TAG 38610 GO JOB FOR LON TO INSTALL R94LSI 3500 . 00 WEDNESD JOBSITE NOTES : GO JOB FOR LONI INSTALL R94LSI WEDNESDAY 3500 . 00 852A1 / PP 135 . 50 LAST TROUBLE : MECH: 566 SO: ARE ADDRESS & CITY CORRECT??? WHAT IS THE MODEL & SERIAL #?1C WARRANTY WRITTEN ON INVOICE??? Is the manual on the Wa§ham H $ SEPERATED FROM UGRADES??? WAIVER SIGNED IF $750 OR MORE? IS INVOICE SIGNED CORRECTLY? ! ? What is your tag number? ;A !-71 000 �- Dollar amount? Check orCO # on invoice? CDL if paid by check.? 2 invoices on insurance jobs? What is the autho number? What is the water pressure? 75 Are faucets and pilots OK Sticker on the water heater? ),c Customer Tc Obtain Own Permit. Dispatcher: C 1 • � { � --.Y.__rte—¢._ ' 1 � E i — e { y !CP TI•� � � —f fes"` 4--- ----?f—�=j— �'�— a { ! S CITY OF C UPERTINO WATER NEATER CUPEk INO PERMIT APPLICATION FORM APN# v Date: Q-Vi 5. c� Building Address: � 712W. C5—lt;,U Owner's Name: Phone#: Ck p$ Contractor: Phone: License �gl3Z Just Water HeatInc. 5 Fo- 2g 3•zo r2 C (V-- 9 Contact: Phone: Cupertino Business License#: corrt,-Ae,.� G"cb-a�A �:� 3 - zo Z 1 .5r Z-a Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: ��,,w�S t c L l�r 1 t� lew+aY CResidential I' Commercial `J -Cost of Project: - - 3SDo,cx-.> Strapped ❑ On Platform ❑ Bonded ❑ ElNew Location Replacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER W<<ter Heater/Vent BUILDING PPERMITFEE Plt.mbing Permit Issuance PLUMBING BENERGY Ener BUILDING BUSLIC Business License BUILDING