07110124 CITY OF CUPERTINO ���,��j��; ,
B�1(LI�itiGBlri�lON PERMIT �����'����
.
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PERMR NO.
Bu � L 2�1810 E ALMADEN AVE FAST WA`['ER HEATER 07110124 .
pERM1T LSSUE DATE
;�WNER'S NAME: • 11 � 2 1� 2 � �']
REZA MORTEZAEI 12601 132 AVE NE
SAMTARY NO. CONTROL NO.
PHONE: � 8OO � 4 �4-8955
BUiLDING PERMIT INFO
ARCHC[ECT/ENGINEER: BLDG ELECi PLUMB MECH
� � 0 �
� p � LICENSED COM'RACTOR'S DECLARATION JOb DCSCI'1pt10il
� m � I heneby afficm �hat I am ►icenscd undcr provisions of Chap�cr 9(commcncing REMOVE / REPLAC E GAS WATER HEATER
_ Z� with SccGon 7000) of Division 3 of thc Busincss and Profcssions Codc. a�d my licensc is
� 7 y in full force an d e C f �
v� Z Licenac Class ' ��• %
n F � Dalc ^ — Conitactor /�"' .
ARCHITECI'S DECLARATION
E � I undcrswnJ my plans sAsll 6e uud as public records
�<
?�U
; u. y Liccnscd Pcufcssional
� O t OWNER-BUILDER DECLARATION
,'� <� 1 hcrcby alTirm ihat I am c�ccmpt Crom ihc Coniractor's Liccnsc Law Car thc
i p o Collowing rcason. (Sccdon 7031.5, Busincss and Profcssions Cafc: Any city or coumy
�_ Pi which rcquires a pertoit to conswct, altcr. improvc• dcmulith, or �epair any urucwre Valuation
prior w ils issuancc, alsu tcquires Ihc applicant for such permit to filc a signcd s�a�ment S Ft. Floor Area $ 4 4 9
- Z< that he is licenseJ pursuant to thc pmvisions a( �hc Comracar's Liccnsc Law (Chapter 9 q•
Y F� (commencing wi�h Scction 7000) of Division 3 at ihc Busincss �nd Profcssions Codc) or
y�� that he is exempt tAcmfrom and ihe buis Cor the al�egcd eumption. My violauon of �CCIl af1C T e
SecGon 7031.5 by siry applicant for a permit subJecu the applicant to a civil penalty of 3 5 715 0= 4!°'�� Number P y yp
not moee ihan fiw hundred dotlars (SS00)•
❑ I, u owncr o[the propaty, a my employces wrth waBa u theu so�� c°mP�"sadon, Required Inspections
will do ihe work �d ihe snucwee is not intended or offered far sale (Sec• 7044. Busines+
and Professiona Code: 11�e Coouxars License l.aw does nai aPP�Y � an�'ner of
propeny who buiids or improves thercon, and who daes such work himself ar through his
awn employees. provided ihat such improvements ue not intended or oRered foc sale. If,
hawaver, the building or improvement ia sold within one yesr of completion. the owneo-
builder will have the barden o[ P�owng Uia� he did not h�ild or improvc tor purpose of
sak.).
0 I. ��,� o[ the proporty. am excluaively conuacting with limnaed rnnuscwrs to
conswct �he project (Sec. 7044. Business and Professions Code:) The Cwnractur's Li-
ccnse Law docs not apply to an owner of property who builds ot improves thmeon, and .
who contrac�s Cor such pmjec�s with a comractor(s) ticensed pursuant to ihe C.anvactors
�� � , B dc P C for �his �cuon
[ am exempt undu Sa.
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hercby aflirm under penalty of peryury one of �he following declarations:
❑ I hsve and will mainuin a Cenifiate ot Conunl to xlf-insurc for Worker's Compen-
sarion, u prm�ided for by Secrion 3700 of �he Labor Code, far ihe performancc o[ Wc
work for which Uus pertnit is issued.
❑ I Aavc and will maintain Workcrs Compensation Insurana, u mquired by Scction ,
3700 of �e Labor Code. Car the pedormance of the worlc for which this pen�it is issued.
My Workers Com ensa�ioa Insunnce cartier sn Policy n� ����
Grtier. uy No.: _,
� p N FROM WORKE1tS' •
COMPENSA170NiNSURANCE
(This scction necd irot bc canplctcd if the pecmit is fw onc hundecd dollars (5100) .
or Icss.)
►�(v that in the performancc of Ihc work (or which �his permi� u iscued. ! shall not
amploy any person in any manncr so u W bcrnmc wbjec� w the Workc�s' Compensation
Laws oC Califomia. Datc
Applicant
N077CE TO APPLICAM: !f, aflcr making this CcrtiCca�c of Excmption, you shoulJ
become subjcct w the Worlcer's Compeasation provisions of �hc Lalwr Cod¢, you muu
, z forthwith camply with such provi�iont or this permit shall be damcd revokcd.
Z � CONSTRUC170N LENDING AGENCY _
(.~.� r�.. 1 hcmby a[tirm dwt thcm is i construction Icnding agcncy (or �hc performance of
p�„� � Ihc work Cor which Utis pemii� is issued (Scc. 3097. Civ. CJ
W A L,endcr's Namc
] z Lcnde�s Address
V � I ceni[y ihat I haw ccad tfus application and siatc ihu Ihc above infortnauun is
w � cortect I agrce w comply wi� all city and comry onfinances aad s�ate laws celadne to
� U building consuuction, and hereby wthorist rcprcsentativcs of this ciry w cnmr upon thc
W alwvc-mentioned propcny for inspenion purposes
� (Wc) agree to save, indcmnify and kaep harm�ess �he C��Y aC Cupertino against
SS
�,,,� � lisbititia, judgmcnts, costs and expenses which may in any way accruc againsl said City �_^ �
(� ' � in consequence o[ thc grandng of this permi� Date 1,
►�+ APPLICANT UNDERS'fANDS AND WILL COMPLY WITH ALL NON-POINT Issued t y:
SOURC ULA170NS.
Re-roof s
of App � uco���o� D81 T of Roof
HAZARDOUS MATERIALS D[SCLOSURE YP
Wip Ihe applicant or futurc building occupant uorc or handlc harardous maicrial
,fefined by Ux Cupertino Municipal Code. Chap�cr 9.12, and the Healih and SaCMy
...�, Scction 25532(a)? All roo''s shall be inspected prior to any roofing material being installed.
� �'° If a rooF is installed without first obtaining an inspection, I agree to remove
Will lhe applicant ot fuwre building occupant use eyuipment or devices w'hich
emi� ha'rardous air conwninan�s as clefincd by tha Bay Arca Air Quality Management all new materials for inspection.
District?
�y� Nu
�-
I havc rcad U�e ha�ardous matcrials requi�cmcnu undcr Chap�cr 6.95 of ihc Califor- � � l ��_� �
nia Fica1N & Safery Cadc. Scctions 25505.25533 and 75534. I undcts�and that �C U�c b���ding
does not curtcndy havc a tenan4 � it ia my responsibiliry w noufy the occupant nf the , Date
�y���� hich must be met �ior w issuance oC a Cenificate of Occupanry. 1 a re of Applieant
- All roof coverings to be Class "B" or better
O n r thorize agcn� ���
From: 10117/2�7 13: Z1 �808 P. 0�/007
• - 381874
CTTY UF CiJPER'I'Il�iO
WATER ]3EATER
cuPE�.�nio PERMIT .A►PP'I�I��ATION FORM � .
APN # Daxe:
� c' �
Building Address:
21810 ALMADEN AVE
Owaer's Name: Phone #
MORTEZAEI REZA 408 446-2534
Contractor. Phone #
FAST WATER HEATER COMPANY 8Q0-454-8955
_ Cupertino Busimess Lioense # State Licensc #
29100 877489 �
Building Permit Info: -
B1 � � -
Job Dcscription: .
Remove/Replace Gas Water He�ter
Residential g] ��� ❑
Cost of Pmject:
449.00
stra,ppea a on Pl�o�n sonaad �
New Location � ���t �
Qty. if
A licable Fee ID - � Fee Descri 'Qn Fee
� PRWHEATR Resid�tial Water Hcaur /Vent BUII D1NG .
p�p'Z'R Comum�er+cial WaterHeat�errNent BIJlLDING
� PPFRMIT'FFE Pl�imbing Permit Issvance PLUMBING
� TRAVDOC T'r3ve1 �t Documantation Fee BUII.DINCi
BUSLIC Hc�siness Licxnsc BiIII.IDNG
TS /,� .
a
CITY OF CUPERTINO
4 ITEMS OF 24 PERMI�' RECEIPT OPERATOR: SylviaM
COPY # : 1
Sec: Twp: Rng: Sub: Bl:c: Lot:
APN ......... 35'715034.00
DATE ISSUED.......: 11/21/2007
RECEIPT #.........: BS)00003298
REFERENCE ID # ...: 07110124
SITE ADDRESS .....: 21810 ALMADEN AVE
SUBDIVISION .......
CITY .............. CUPERTINO
IMPACT AREA .......
OWNER ............: REZA MORTEZAEI
ADDRESS ..........: 21810 ALMADEN AVE
CITY/STATE/ZIP ...: Ci;PERTINO, CA 95014
RECEIVED FROM ....: FPST WATER HEATER C
CONTRACTOR .......: JEFF JORDAN LIC # 29100
COMPANY ..........: F�.ST WATER HEATER
ADDRESS ..........: 1�601 132 AVE NE
CITY/STATE/ZIP ...: K]RKLAND, WA 98034
TELEPHONE ........: (��00) 454-8955
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ----------- -
--------- -----
BSEISMICRE VALUATION 449.00 0.50 0.00 0.50 0.00
PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
PRWHEATR UNITS 1.00 24.48 0.00 24.48 0.00
TR.AVDOC FLAT RATE 1.00 40.79 0. 00 _____40_79 ______0_00
---------- ----------
TOTAL PERMIT : 106.56 0.00 106.56 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
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518 WATER HEATER