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08020092 CITY OF CUPERTINO •s} w.+ N BUILDING DIVISION PERMIT C40WRA—e A .IFORMA'i�TO m"l•mss..t.a,�. T.rz"� °. dfi .. _ m'._v E s !. "'TVARAN AVE FAST WATER HEATER PERMIT08020092 ER's NAME: PERM T ISSUE DATE KL ARE WHITMAN 12601 132 AVE NE 02/14/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: REMV/REPLC GAS W HTR BLDG BUILDING PLUMBG MECH 300 LICENSED CONTRACTOR'S DECLARATION Job DCSCrI DOD U 1 Mreby eflirm Nal l em lk.d under p.vision of Chapmr 9(mmmencing P wish Section]IXXB orDivhionlaf the BusinmaM f)uiou Cede,andmylicenso la ^ in roll fade and off W $Z_ Lice.so CI Lk.IT Da¢ ConlDECL ARCHr1ECT1 DELLA ATI N 1 understand my plans shall he used u public renrN ]yU g Ord Licensed professional h^ OWNER-BUILDER DECLARATION 9 0 Z I hereby.(firm that 11. exempt from dm Commnah e:Any c Law for the O O fallowing moon.permit t ]031.5.Business and Pmfauinu Code:Any eM m runty $ which mqulma n permit m ernes the alum improve,demolish.u or mash ed uRecatUre mmeni ptiemits Issuance,shot requires the applicant farauch permitm 0leasigmtl wrement g�o (c a. .l.g it pursuant to the of Dialonsof thethe an Pus Law(Chaptm9 Sq.Ft. Floor Area Valuation 44 e$ (eom a is licensed pursuant to the of vivuian 3 the Contractor's ants and License iw( hapten r .� that he is exempt therefore and the barns for Ne alleged m emp Jon.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant t0 a civil penalty of APN Number Occupancy not ore Nan five hundred dollars(550'J). •T1 7 Pe m ❑I.ae owner of Ne pmpeny,m my employm wish wages u Nair mle mmpc=dw. will do the wart,and testmclure is notinlended.(offered forsale(See.7014,Business and Professin0u Cade:The Conbacmra License Law dm not apply m an owner or Required Inspections property who Wlldserimp rmathereon,andwho daessuchw^hhimself or Through his own employm,prodded thrones improvemmts rte not intended aroRemd foruls.if, however.the Wilding or improvement is sold within one yen of completion.to cameo- Wilder will have W Wmen of proving that he did oat build or Improve for purpose of aleJ. 0 1,a awns of the property am esclmivmy contracting with licensed mnuacrors to consumer The project(Sec.7044,Business am Prefessiau Cade:)The Cmdemars U. more law dm not apply in an owner of property who Wilda or improve,ther000.and who co nn cts for such projects wit a contmcmr(s)licensed pound m to Contractors License law, 0 l am uempt under See ,B At P C for this ream. 40-1 Do, WORKER'S COMPENSATION DECLARATION 1 hereby efnrm under penalty of pmjury,one of the fallowing declarations: ❑Than am will maintain a Certificate of Content to self-Innn,furworkefrcornwa- a er.u provided for by Section 37W of the labor Code,for W performance of the work for which Nis permit is issued. ❑1 have and will maintain Worker's Compensation luusnca,as required by Section 3700 of Ne labor Code,for to Muformanm ofte work for which utis permit is issued. ' My We ompenati 1. cos carrier and Polity um cr a Carrie) Policy No.: CE IFICATE 0•^XEMPTION FROM WORKERS' COMPENSATION INSURANCE md,recdon recd oatbo completed ifde permit isfaramc hundred dollars($100) carless.) - I certify that in Ne performaee of the work for which This Permit is issued.l shall not employ any person in any m umcrm as N become subject m the Workeri Compenutinn Laws of California.Data - Applic ret NOTICE TO APPLICANT.If,aper making Nis Conifieale of Exemption,you should become subject N the Wwker's Compensation provisions of The Labor Code,you must z0 forthwith comply wit such Provisions or This permit shall bo deemrA revoked. rN. CONmL;cnON LENDING AGENCY F Ihereby a(for)that them ts a construction lending agency for the performance of lie work fur which This permit is issued(Sec.3097,Civ,C.) W Lend.e.Name z Lenders Address U I mNfy Net 1 haw road this application and sum Nu The above information is W F correct.1 agree 0o comply with W city and county onfinarm and sure laws mating To O V Wilding construction,and hereby autodm representatives of Nis city to enter upon the W above-mentioned property fur iupection purposes. gy (We)agree to save,indemnity and kmp hart.the City of Cupertino ageiut h Ilsbilitiu,judgment.casts and espensu which may in any way urn)against aid City t.)Z in consequence of the gmmung of this permil. �+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -\ S ULATIONS, ' [ '9 1 — Re-roofs SignetuonVAppliart/ccmii16 OUS � MATERIALS DISCLOSURE Type of Roof Will the applicant or forum building ompammom or handle haeu mu,masctial defied by the Cupertino Munici Code.Chapter 9.11,and the Health and Safety Section 25532(x)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yu o Will the applicantor 11 1 build' mit g occupant use equipment or devices which If a roof is installed without first obtaining an inspection,.I agree to remove ehaumnus air costumes..u nod by the Bay Area Air Quslity Management all new materials for inspection. Diane,? ❑Yns o 1 have mad the harudon,materiels requirements under ChmW6.95 of Nc CAifor- niaHcalt&Safaty Codc,Sccdou 25505.25533 and 75534.1 mrdorsund OWiftic Wilding dm amt currently haw a moa s,Nat it W my oMmuibilb,m ondry the suupsot of the req cat w 00wnmar w ormnsmaucco , cutcatsaropmpMq./� Signature of Applicant Date owns or ariam agent� Q f fiddle All roof coverings to be Class"B" or better From: 02/08/2008 14:50 0987 P.004/013 CITY OF CUPERTINO 393581 WATER HEATER /J�� U CUP R-T1NO PERMU APPLICATION FORM APN# / ` _ v (� Date: 2/8108 Building Address: w 21842 GRANADA AVE Owner's Name: Phone#:(408)881-0130 WHITMAN, KLARE Contractor: Phone#: 800-454-8955 FAST WATER HEATER COMPANY Fax 425-814-9518 #: Cupertino Business License#: Contractor State License#: 29100 877489 contact I Phone t 800-454-8955 Carol Randall FaX#: 425-814-9516 wilding Permit Info: Bld Elect Plumb x Mech Residential ❑x Commercial ❑ Job Description- Remove/Replace Gas Water Heater Strapped [!I—on Platform Bonded New Location ❑ Replacement Valuation: 449.00 Green Building Cbeck must be completed and attached to this application. Green Building Polars achieved: 0 From: M/M/208 14:51 =7 P.GM/018 393581 • CITY OF CUPERTINO WATER HEATER CUPEkTwO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1PCWHEATR Commercial Water B PCWHEATR Heater/Vent BSEISMICOM Seisrnia Commercial B 1 J PRWHFA.TR Residential Water B PRVVBFATR Heater/Vent BSEISMICRE Seismic Residential B PPERIvMEE Plumbing Peraut P TRAVDOC Travel& B Documentation BUSLIC Business License B • • CITY OF CUPERTINO 4 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35716026. 00 DATE ISSUED. . . . . . . : 02/14/2008 RECEIPT # . . . . . . . . . : BS000003941 REFERENCE ID # . . . : 08020092 SITE ADDRESS . . . . . : 21842 GRANADA AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : KLARE WHITMAN ADDRESS . . . . . . . . . . : 21842 GRANADA AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : FAST WATER HEATER CONTRACTOR . . . . . . . t JEFF JORDAN LIC # 29100 COMPANY . . . . . . . . . . : FAST WATER HEATER ADDRESS . . . . . . . . . . : 12601 132 AVE NE CITY/STATE/ZIP . . . : KIRKLAND, WA 98034 • TELEPHONE . . . . . . . . : (800) 454-8955 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- - - ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 449 . 00 0. 50 0. 00 0. 50 0. 00 1PPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 1PRWHEATR UNITS 1. 00 24 .48 0. 00 24 .48 0 . 00 1TRAVDOC 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 • - Community Development 10300 Torre Avenue ' ✓` Cupertino CA 95014 Telephone(408)777-3228 It CITY OF Fax(408)777-3333 UPEkTINO Building Department JOB ADDRESS: �S: PE dC�o e-2-- OWNER'S OWNER'S N `L PHONE # GENERAL CONTRACTOR: Y FAX # I am not using any subcontractors: 7l d(174�L�� 66 Signa a Date Please check applicable subcontractors and complete the following 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 er/Contractor Signature Date