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08060121
CITY OF CUPERTINO ,+d`aAct;+�;'rx BUILDING DIVISION PERMIT C,ONTRACToR,1NE0RMATION, But PERMIT NO. LDINO.ADDReSIs� N DR FAST WATER HEATER 08060121 OWNERS 3NAlMEE: - PERMIT ISSUE DATE I2AFFETTO, CATHERINE 12601 132 AVE NE 06/17/2008 lipE: (800) 454-8955 SANITARY NO. CONTROL NO. ARCHITECr/ENGINEER; BUILDING PERMIT INFO BLDG EIEC? PLUMB MECH 0 upQ LICENSED CONTRACTOR'S DECLARATION lob Description wF 1 heaR reby am that 1 snn Iicensnd under Provisions of Clwpmr 9(commencing ' �iwith Sadon7").fDivfslon 3efthe Business and Professions Cale.and my Recent is RMV/RPLC GAS WTR HTR In full forte Nd=from nqi Lim.eLia.g � ase Daw Contractor W7 ARCHRECI'S DECLARATION 1 understand atol nd my plans W used as Public recordt U g LL I i..d Professional y03 OWNER-BUILDER DECLARATION iE I berth,.M.that 1 am exempt from the Convectors License Law for site p O fallowing mason.(Section 1W 1.3,Business and Profesefuns Code:Any city or county m which Mum.a permit w condrac4 after.improve.do.-IW.or repair any annual. Zy oar at its issuance.alto requires the applicant foriuch permit an rite a signed statement < that heisEatnadpunuent ft'm,ddmua aaconuaewrtuenseLaw(Chapu,9 Sq.Ft. Floor Area Valuation �$ (commencing with Section]000.f Division 3ofthe Bue.snot Prefessims Cade)m $449 e`2 that he is exempt therefrom and rhe basis for the,alleged exemption.Any violation of Section 10313 by any applicant for a permit subjects the applicant m a civil Penally of not...than Eve hundred dollars ISM 32645002 �Number Occupancy P Y Type 0 L as owner of the property.m my employees with wages as their Sole compenudon, WIII da time Wad4 and dK SWCIYR Y act intended W offered for Lia(Sac.7W,Business and Profesdmas Cade:The Conuacmes Licotwa Law dors not apply m an owner of Required Inspections prapertywno builds mimpsm.dYSeml.and Whooke suclawmich nnoelf.through his own employees.provided that such imPwsements tae not intended.offered forsakes IL however.the building orimpmwmertt is sold within one,year of completion.the owner. builder will hew the burden of proving that Its did cot buM or improve for purpose of LIeJ. 0 1.as Mar a the property,am excfusiwly contracting With licensed contractors or ., consmet the project(Sec.104,1.Business and Professions Code:)The Catracmr's Li- canto Law dao at apply m an owner a pnWeny who(Wilda or Impmwa wenn.and. who contracts for such prejeets with a contractor(s)licensed pu..at at the Consumers License Law. O lamem.ptunder See ,Bk PCrorthis. Owner Data WORKERS COMPENSATION DEC.A TION 1 hereby+(fund under penalty of perjury as of the following declLommse 1 haw and will natural•Cmificateof Conant at self-Imre for Workers Compo. anumn.L provided for by Santa.3100 of time Labor Code,for the puff.. co of the work for Which that permit is issued. O 1 have and will maintain Workers Compewdon I.,L rommed by Session 31Wofam:Labor Cok.fm,the performance of Ne work for whish this permit is issued ' My Workar,Compemadon Insurance arrim and Policy nomber art: Cartier. Policy No.: CERTIFICATE OF EXEMPTION MOM WORKERS' COMPENSATION INSURANCE (Ddssecda need act be completed if Ne permit uforaa hundred doBara(SIM) ) or loss) I certify Out in the performance of Ne work for which Nis Permit is issued.I shall am ..ploy any person i........a m become stancbw the Workers Compensation Laws of California.Data Appficam NOTICE TO APPLICANT:If.aver making this Certificate of Exemption.you should brooms subject be the Workers Compmeidon provision,of the Labm Code yen mud .J O forthwith comply with such ProviSiov or Nd ro is peanit shall Imo doomeoked. z CONSTRUCTION LENDING AGENCY N F I hereby amt.NL them;,is.Wood (See.30 7.CN. away for site perrormsnec of C> the work rm wman this pcm,n ts issmea(sa.3091,sirs e) Leaders Nam= Z) z O z lenders Adartes U O 1 certify that 1 nave mad this application and sem that the show information is CT.H caliC=L 1 agme to comply with all city and county aNindwes and sure laws mlating m 0 building cmnmuction,and hereby LthmiL repnexntadves of this city m enter upon Ne W abow-es j.d ro pmoperty for Inspection pur,pawhich may s . F gy (We)agree w Lw,indemnify and keep harmless the City of Cupertino against Urat incoisequence fh runniatts ng of thsMarrit. mryin any way eccne egalnstsud City Z APPLICANT UNheRSTANDS AND WI Issued by: Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT SOURCE REGULATIONS. Re-roofs BIBnaWR orApplicLUConDate HAZARDOUS MATERIALS occupants.. or Type of Roof Will the apCulan t m fru.Municipal ode.Chantdom m a d the heardoas material L defined a Nc Cupertino Municipal Cate,[hepter 9.12,surd time Hex1th and Safety Code,Schon 255324)? ❑Yca [3 No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove alt hmaNnm air contaminants L delis!by Ne Bay A.Air Quality Maugcmcnt all new materials for inspection. District? OYes ONo 1 hers read the hausedoui materialsreInamecm modc,Chapter6.95otheCalirm- nie Health&SafctyCade.ScNans]S5U5,255]]and 25534.1 understand thvJNc Wilding does not currently bate a bei Wt it u my nespomibilky m ratify site occupant of the reyuirtmcnu which muss he met prior w issuance o(a Cuufwae of Ocapanry. Signature of Applicant Date Owner or authornacd agent r, All roof coverings to be Class'%?."or better CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32645002 . 00 DATE ISSUED. . . . . . . : 06/17/2008 RECEIPT # . . . . . . . . . : BS000005140 REFERENCE ID # . . . : 08060121 SITE ADDRESS . . . . . : 10314 MANN DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : RAFFETTO, CATHERINE ADDRESS . . . . . . . . . . : 10314 MANN DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1141 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 AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 106 . 56 VISA --------------- TOTAL RECEIPT 106 . 56 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER • , Permit No: 080(o 407327 (office use only) City Of Cupertino Building Permit Application E-Mail: Building-Permits(a)cuaertino.org (Address is case sensitive). Jobslte Address:10314 MANN DR Date: 6117108 Assessor's Parcel Number: 500 , Oct Owners Name: RAFFETTO, CATHERME Phone No: (408)446-5329 Project Valuation: 449.00 Building Permit Info: Bldg_ Elect Plumb x Mec; Job Description Remove/Replace Gas Water Heater Contractor Information Company Name: FAST WATER HEATER COMPANY Phone No: Contact Name: Carol Randall Fax No: 800-154-8955 • Address: 12601 132ND AVE NE E-mail: carolr@fastwaterheater.com City, State &Zip code: KIRKLAND,WA 98034 State Contractor's Lic. No: 877489 Expiration Date: 5/31/10 Workers Comp No: 1761650 Expiration Date: 12/1/08 Carrier: California State Fund City of Cupertino Business License No: 29100 Credit Card Information Credit Card No: Expiration Date: 11/10 Name on Card: Jeff Jordan Visa © MasterCard ❑ American Express ❑ The Building permit application and a completed & signed contractor/subcontractor form need to be submitted with each permit. Community Development I, , 03vpertino A 850C14Telephone(408)777-3228 CUFax(408)777-3333 PE�TINO Building Department JOB ADDRESS: 10314 MANN DR PERMIT# OWNER'S NAME: RAFFETTO, CATHERINE PHONE# 408)446-5329 GENERAL CONTRACTOR FAST WATER HEATER CIO�MPAN FAX# 425-814-9516 I am not using any subcontractors: 6117/08 Signature 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 Owner/Contractor Signature Date , •