07100091 CITY OF CUPERTINO '
BUILDiNG D7VIS10tV PERMIT ���� ���� ���������� `
:>. ,.>, _ ........
_.. ..
,:
PERMIT NO.
BUILDING ADDRESS:
7484 DE FOE DR FAST W��TER HEATER 07100091 .
P6RMIT ISSUE DATE
OWNER'S NAME: ,
MUNOZ JOSEPH M AND ANITA M 12601 :.32 AVE NE 1 1 2 7
- SANITARY NO. CONTROL NO.
NE:
BU(LDING PERMIT INFO
ARCHITECf'/ENGiNEER:
REMOVE,'REPLACE GAS WATER B►-�c ELECT PLUMB MECH
0 0 � 0
i p p LICENSED CONTRACTOR'S DECLARAT[ON IOb D2SCrlpt101]
� V� I hcrcby aCficm ihat I am liccnscd undcr provisions oC Chap�cr 9(commencing
; Z� wiih SccGon 7001)) o( Division 3 of thc Busincss and Profcssians Code, a� my licensc is
�� y in fu0 Corce and cCtec �
� v� z[,icenic CI �s '^ � Lic. iF
: F � Datc — Con�raciur �"
� ^ ARCHITECI'S DECLARATIO
i o�c a I undcrstanJ my plans shall bc uscd as public records
)yU
' a y Liccnsed Pn�fcssional
; � < OWNER-BUILDER DECI.ARATION
'}� I hcrcby �lTirm �hat 1 am cxcmpt trom ihc Coniraaor's Liccnsc Law for �t�c
� p o following rcuon. (Scction 7Q31.5, Busincss and Profcssians Calc: Any city or coumy
< � Which requires a pcimit w conswct, al�cr, improvc, dcmalish, or repair any svucture
° z� prior ui i�s issuance, also requircs the applicant for such permit to file a signed sta�men� , FC. FlOOT Are3 Valuation
�= a� that 6c is liccnscd pursuant lo Uu provisions of Utc Conuactur's Liccnsc Law (Chaptcr 9 �>q
r F- (commencing wi�h Sation 7000) of Division 3 of ihc Busincss and Profcssions Codc) or
��� that he is e�cempt the+efrpm and the basis Cor �e allegcd exemptioa Any violation o(
Section 703I.5 by arry applicant for a permit subjecu ihe applicant to a civil penalty o( ApN Number Oeeupaney Type
not more ihan five dundmd dollars (5500�
❑ I. u owncr oC ttie pcoperty. or my cmployces with wages u the'v solc compensation,
willdothcworkandtheswaureisnotintendedoraRe�Aforsak(Sec. Required Inspections
and Prokssians Code: The Conuacwrs License Law docs iat apply to an owner of
propeny wha builds or imptoves U�emon, and who does such work himself or Uuough 6is
own employces, providcd that such improvements are not in� ar ollered for sala If.
however, the building or improvement is sold within one year of compledon, the owner-
builder will have �he burden of proving that he did not build ar improve for purpose af
salc.).
❑ I. as owner of the property. am ezclusively conlracting with Gcensed rnnvactors w
conswct Ne projea (Sec. 7044. Business and Professioas Code:) 7Le Contracw�s Li-
cense Law dacs aot apply to an owncr of property who builds or imp�oves �hemon. and ,
who conuacts Cor such pmjects with a contractor(s) licensed purwant w �he Conuxtafs
License Law.
❑ I am ezempt undu See . B� P C for �his rcuan
Owner Dale _ .
WORKIItS COMPENSA'tTON DECLARATION
1 hereby aftirtn under penalty of perjury one af �he fallowin6 declaratianx
�] [ have and will maintain a Cenificate of Conscm to ulf-insu�e for Worlrc�s Compen-
sation, u provided for by Secuon 3700 of the Labor Code. for tde pedormancc o[ the
work for whicd this pertni[ is issucd.
❑ I have and will maintain Workefs Compensation Insurana, as �equired by Scction .
3700 of �Ac Labor Code. Cor 1he performance of �he work for which this permit is issued.
My Worker's Cam ensa 'on Insurance carticr d Policy number a¢:
Cartier. olicy No.: � 7����
CERTIFICA O EXEMPf[ON FROM WORKERS'
COMPENSATION INSURANCE
(This section necd not Ae comple�ed i( the permit is !ar anc hundred dollus (5100)
or Icss.)
I cenify ih�t in thc perfannancc of �hc work for which this pertnit is issucd. 1 slwll not
employ any person in any manncr so as to bccomc subject to ihe WorYCrs' CompcnsaGon
Laws of CaliComia. Datc
Applicam
NOTICE TO APPLICAM: [f, aftcr making ihis CeniGcaic of Excmption, you should
become subject �o ihe Worker's Compensation provisions of the Lahor Code, you must
, O forthwith comply with such provisions or this pccmil sha0 6c dccmcd icvoked.
� ""' CONSfRUCI'lON LENDING AGENCY
(.~-� � 1 hcccby altirm �hat thcre is a conswction Icnding agcnry for thc pedormancc oC
(� .� thc wurk far which ihis permit is issucd (Scc. 3097, Civ. C.) ,
W Q Lendcr's Narnc
� z Lender's Address
V � � certitY thai 1 have rcad ihis applicuion and sia�c that t!rc a6ovc informauun is
�►" corrcct. 1 ag�ce to comply with all city and county orttinances and sUte laws rclating w
� U building conswction, and hcreby authori�e rcprcscnutivcs of this ciiy to cmcr upon lhc
� W abovc-mcntioncd propcny for inspccuon purposes.
a (Wc) agree lo save, indcmnify and kecp harmless the Ci�y af Cupertino agtinst
H � liabiliuu, judgmcn�s, costs end expcnscs which may in any way ucrue against stid City /
U z in conxquencc oC thc granung of Ihis permit. D1LC �( G�
►'� APPLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
SOU TIONS.
— — Re-roofs /�1/
o ApplicandConuactor �� T of R oof
HAZARDOUS MATERIALS DISCLOSURE }��
Will Ihc applicant or futurc building accupant storc or handle harardous ma�crial
az defincd by thc Cupenino Municipal Codc. Chaplcr 9.12. and the Hql�h and SaCety
c«k SecGon 25532(a)? .�/ All roofs shall be inspected prior to any roofing material being installed.
� Ycs ��p No ,
�` If a roof is installed without first obtaining an inspection, I agree to remove
Will thc applicant or fuwre building occupant utc cquipmcat w dcvices which
cmit harardaus air conuminams u ticfincd hy the Bay Area Air Qualiry Managcment all new cr aterials for inspecr_ion.
Disvict?
� yes Nu
I havc ccad the ha�ard<ws ma�crials requiremcnt� undcrChaprcr6.95 of �hc Cali[or
nia Hcalth & Satcty Codc, Scctions Z5505, 25533 and 25534. I undcrsund �hat iCthc building
docs no� curten�ly h�vc a tcnant, Ihat it is my responsiAility to notiCy thc occupant nf �hc
ccyuiremcn m�uxme� SignatureofApplicant Date
All roof coverings to be Class "B" or better
au�horizcd agcnt Datc
From: 10/10/i�7 07:50 �619 P.003/008
� saoszs
� ����vo���r
CITY OF CIJPERZ'I�U
WATER ��ATER
cuPF�,r�r�o P�RMIT APPLII�ATIQN FURM
�rr # � � 9� �� .3.5 � � v n�►o�: . � � r ,�
l
B,�aun� ��:
7484 DE FOE DR
Ovmer's Name: Phone #
MUNOZ JOE 408 252-1373
Contractor. Phone #
FAST WATER HEATER COMPANY 8Q0-�45�4-8955
Cuperttno Busivaess Laoeasc # State License #
29100 sn4as
Building Permit Info:
Bld ��e� li�zn �
7ob Uescription:
Remove/Replace Gas Water Heate�
�tesidantial �] Commercial ❑
Cost of Project:
419.00
Strapped On Platform Banded
Now Location � lacement �
QtY• �
A licablc Fee ID F�ee Descri 'on I�ee Crre
� PRWHEATR Resideatia�l Wat� Hoater Nant BUIIDiNG
PCWT�ATR Coa�merciai Water HeaterNent BUILDING
1 PPfiRMTI'FETs Pluinbiag Pennit Issuance PLUMBING
1 'IRAVDQC . Tra�►�1 & Docume�atadon Fee $iJII.DING
BUSLIC Bus:iness License �UII.IDNG
.
CITY OF �UPERTINO
4 ITEMS OF 12 PERMIT RECEIPT OPER.ATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 35924035.00
DATE ISSUED.......: 10/11/2007
RECEIPT #.......... BS000002962
REFERENCE ID # ...: 07100091
SITE ADDRESS .....: 7484 DE FOE DR
SUBDIVISION .......
CITY .............. CUFERTINO
IMPACT AREA .......
OWNER ............: M[T�OZ JOSEPH M AND ANITA M
ADDRESS ..........: 7484 DE FOE DR
CITY/STATE/ZIP ...: CUFERTINO CA, 95014-4307
RECEIVED FROM ....: FWf: ACQUISITION CO
CONTRACTOR .......: JEFF JORDAN LIC # 29100
COMPANY ..........: FA�T WATER HEATER
ADDRESS ........... 12E01 132 AVE NE
CITY/STATE/ZIP ...: KIFKLAND, WA 98034
TELEPHONE ........: (8C0) 454-8955
FEE ID UNIT QUANTITY �MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BSEISMICRE VALUATION 449.00 0.50 0.00 0.50 0.00
PPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00
PRWHEATR UNITS 1.00 24.48 0.00 24.48 0.00
TRAVDOC 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
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER