08050151CITY,OF CUPERTINO
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MAT�I0
BUILDING DIVISION PERMIT
Y^f�oL\ iCLiVT 0: INFO L �� g
BUILDING ADDRESS:
PERM" N0.
1.0360 LEOLA CT
FAST WATER HEATER
08050151
FJWS NAME:
PERM" ISSUE DATE
FSSIE LYN
12601 132 AVE NE
05/20/2008
PHONE
SANITARY NO. CONTROL NO.
(800) 454-8955
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONn1ACiOWS DECLARATION
Chapter
Ib Description
OIP
1 Weeby affirm Nat 1 on licensed ¢Mer provisions of 9 (commencing
with Sued.. 7((s)) of Division 3 ofdre Basin. and Proressiom Coda, and my nems is
RMV/RPLC GAS WATER HEATER
in full fame and effect.
License Class Llc. N
Dam. Contractor
ARCHrTECrS DECLARATION
1 uMemund my plana Nall w used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 wmby alTurm that 1 am exempt from the Contractors Wccnse Law for the
following mason. (Section 7031.5. Busimm and Profuuom Code: Any city or county
which rcquima a pmmil to construct, alms improw. dcmuliN. or minor any sutnum
prim W its issuance. atsu mean. the ,Pplica nt fm such permit W frk.signed au cemon
N,theislicensed OfineconmmmarsLicense Law (ChaP=9
Sq. Ft. Floor Area
Valuation
pUMULasNcProvisoes
(commencing with Section 7000)of Division 3 Of the Burrs and Prof.m. Cadet) or
-
$449
than be is exempt tbuefro n and the basis for the almgcd exvnpd. Any violaum Of
Section 7031.5 by.rry.piticantfor a permit ,ubjeetaNeapplicant, toacivil penalty a
Occupancy Type
mmot mora Wnfive huMrod Oolbn (SSoO).
37504025!Number
❑ 1, as owner of ds peoputy, a mY wPloyw with wgu as dc's Lm compensation,
will Pr thewort, and Uc ire Commutesclearownerof
and Pmrmdons code: coaummra License Law dohs aot apply to an
Law
Required Inspections
rough is
who builds w mpr p andww MmrrSf or Wough his
ed that sumh i
Own ore r
awn me far islen,
that suchimproAemuuate nom incnddmpleti
ailxa!ofimpletion,NeaWnar-
ver. se adding n.
builder. Ntbuilding Arden
buildv will have, tics wrdm of proving that w did rot bold on improve for purpose of
of pTNIlahathedid
❑ 1, as owner of the Property. am exclusively contraning with limed conuacmn to
corotruel Ne proj.d (See. 7W. Business and Prorese oro cine:) Th. eomtraemes u.
came Law does non simly so .n awns, or property who builds or improve, ft... and.
who contracts for such projeeu with a contractor(s) licensed Pursuant to time Contractors
Ween Law.
❑ I am exempt under See , B db P C fes this reason
Dam
For WORKERS COMPENSATION DECLARATION
1 hereby Num under pemlly, of perjury arc of Ne fallowing declmuorm
❑ 1 ha+c aM r01 munuin a CeNficateof Current to self -insure fa Wohv'aCwnprn-
wdwm, h(Pe by S )700 a( Nc labor Code. (m the pcuarmanco a( tic
wool, far which this Permit u issued.
❑ 1 have and will maintain Wormers Compensation I., as required by Scedm
37ulof tiro labor Cook. for the mdurmance cftha work for which me, permir is issued.
'
My Wminces Compemauon Infocom¢ mrricr and Policy number sae:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('ITrismalon need not be cwnpleted lithe permit is (maxhundrW dollars ($IbO)
w mu)
1 con fy Not In Ne pvfmor mce of to wont for which Nis Permit is issued, I shall nom
_
employ any person in my manor m as to become mbjmt to ft Wndcn'Compensation
-
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject an the WOrker'. Compensation provision of Iw Lbw Cods you most
fwNwide comply with such provill Or this permit shall is, domed roweled.
CONSTRUCTION LENDING AGENCY
I hereby afEcm that Nem H • consruednn lending agency for do Nerfarmanco of
the wart for which min perms is issued (Sae, win, civ. Q
Lenders None
Landers Aadmas
1 ratify that I have w this application and hum ded rh above infomuvun is
conte I Woo m comply with all City and county remittances and w„• laws rel.ung to
Wilding camaumion, and hereby authmim ropretvrutivetof Nu city to comr upon dm
awwe-menu Property for inspection Puryoses
I%) agnm m save, indemnify and keep harmkss the City of Cupertino agues
ipr may Ntry Way amrye agalml said (.'Ily
in co11m,1ntee .trey and exthis
of xowhleh
of the Permit'
A
APPLICANT SA
UNDERSTANDS
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
-
of Appliuo.
HAZAIData$rgnuuro
HAZARDOUOU S MATERIALS DISCLOSURE
Type of Roof
WIII the Cucant or future building e. Marc or handle
as defined e Chaps Health anmaterial
y the Cupertino Municipal Cade. Chapter 9.13, and res HmIN and Safely
io
Section 25s3za)7
C] Yes ❑Na
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future wilding occupant use cquipmcat or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
�m d, hwamdnair contaminants as dcnmd by the Bay Am. AJ, Quality Managemml
all new materials for inspection.
[:3 yes ON.
I have weal the heramm, treatiseroquvenrns under Chapter 6.95 of the Califw.
era He.]" S.fmyCade, Sees. 25505. 15577 and 35531. I undnwM Nm if do wilding
does ml ewmndy have. RaNI NL II la my rcepamlbility m really dC amapmt Or ft
mgulmmeres which comm In met ria, m immmm or. CwdBmm of amp.ny.
Signature of Applicant Date
- All roof coverings to be Class 1}1' or better
Owner or authmired a gent Dnte
• 4 ITEMS OF 4
Ll
•
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37504025.01
DATE ISSUED.......: 05/20/2008
RECEIPT #.........: BS000004831
REFERENCE ID # ...: 08050151
SITE ADDRESS .....: 10360 LEOLA CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: pdtg
COPY # : 1
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
106.56
---------------
106.56
VOICE ID DESCRIPTION
-------- ----------------------------
518 WATER HEATER
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
------------------------------------
OWNER ............:
JESSIE LYN
ADDRESS ..........:
10360 LEOLA CT
CITY/STATE/ZIP ...:
CUPERTINO, CA 95014
RECEIVED FROM ....:
JEFF JORDAN
CONTRACTOR .......:
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
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
106.56
---------------
106.56
VOICE ID DESCRIPTION
-------- ----------------------------
518 WATER HEATER
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
------------------------------------
L
0
Permit No:
(office use only)
City Of Cupertino Building Permit Application
vuvooa
0 050 /6(
E -Mail: Building-Permits()cupertino.org (Address is case sensitive).
Jobsite Address: 10360 LEOLA CT Date: 5/19/08
Assessor's Parcel Number: 5-7 04 0 �-6, 0/
Owners Name: LYN, JESSIE Phone No: (650)208-6838
Project Valuation: 449.00
Permit Info: Bldg Elect Plumb x
Remove/Replace Gas Water Heater
Contractor Information
Company Name: FAST WATER HEATER COMPANY
Contact Name: Carol Randall
Address: 12601 132ND AVE NE
City, State & zip code: KIRKLAND, WA 98034
State Contractors Lic. No: 877489
Worker's Comp No: 1761660
Carrier: California State Fund
City of Cupertino Business License No: 29100
Phone No:
Fax No: 800-454-8955
E-mail: carolr@fastwaterheater.com
Expiration Date: 5/31/10
Expiration Date: 12/1/08
Credit Card Information
Credit Card No: 4417123041349530 Expiration Date: 11/10
Name on Card: Jeff Jordan
Visa Q MasterCard ❑ American Express ❑
The Building permit application and a completed & signed
contractor/subcontractor form need to be submitted with each permit.
a t
r
CI OF
46UPERTINO
JOB ADDRESS:
Buildin
10360 LEOLA CT
[NAME: LYN, JESSIE
CONTRACTOR: FAST WATER HEATER
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
partment
PERMIT # DvO� O / /
PHONE # (650)208-6838
FAX # 425-814-9516
I am not using any subcontractors: _ � flu 4-,—,ee0 5/19/08
Signature Date
Please check aT)Dlicable subcontractors and complete the following informatinn-
21
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