08050064 (2) CITY OF CUPERTINO sib at�c �^�-: �°•"" 777777
BUILDING DIVISION PERMIT `CC11�I'pRA.CT'OR�INk'Ulil�'IA'pION
BUILDING ADDRESS: PERMITNO.
61.40 WILLOWGROVE LN FAST WATER HEATER 08050064
OWNER'S NAME: PERMIT ISSUE DATE
RUPE MICHAEL W AND ALTIERI JUN 12601 132 AVE NE 05/06/2008
NE: SANITARY NO. CONTROL N0.
ARCH=/ENGINEER:
BUIIDINO PERMITINFO
RMV/RPLC GAS WATER HEATER BLDG ELF-Cf PLUMB MEcx
O O O O
uGp LICENSED CONTRACIDR'S DECLARATION Job Description
ZC 1 wrdy otand Inas 1 am limed under proaisioru of CTapicr 9(rnmmcncial P
<t� with Sationl0(10)of Dividon 3.fft Business and Pmfessmad Code.W my liccmeu
In full forte and affect.
j Z Lice=Class Lk.0
n F es DareContractor .
I ARCHMICTS DECLARATION
y
` 1 ucroand my plans shall w useas
d Public retards
; U rld
s u. LiccmeJ Prof cssional
y03 OWNER-BUILDER DECLARATION
.� 0 I hereby... alarm Nat 1 1mo. .Buss from the Convector's license law for the
O O following mason.Permit
t 71D 1.3. 4 M�n,. and Professionsmli Code:Any city m county
$t4i which requires.pumit m comwc.allec.improve,, wmrnit Oar caput any modem
tat heitsisawnte,alwnt of to deapplic of forme such Pctmit Lia a,LacdstsNmce,
F < (commecingwidPurcamtlrNcofDiviomofofowBuazmfsnianrelsonsOcmr9 Sq.Ft. Floor Area Valuation
y L`$
(commencing exempt onfrd,oection nto bases Division Business andexampt PmfMyvi Coda)of
Nu w u exempt terefrom and the baso for Ne ulegrA e.mpdm.My violauan of
Section 7031.5 by airy applicant for a permit subjects to applicant to a civil penalty of APN Number Occupancy Type
not mat Nan film hundred dollars ISMP Y YP
1,as owner of Use Property.or my employs with wades as their case compensation,
will do Newark.and Neswcture I...tinanded aronened for sale(Sm.70".Bounce
and Profesuom Cade:The Conuactr's Liceme Law doe Out apply t an owner of Required Inspections
property who Wil&orintpro Ms thereon,and me doesaud work nimseNor Nmagh his
awn employees,provided drat such improvements AM notimended oroffared for We.If.
however,the building or improvement is sold witin oro year of cemplenon.Ne owner-
builder will have to harden of proving that Im did Our could Or improve for Impose of
sale.).
❑1.as mater of the property.and,aGudmly centuries wit Keened co eran ars to
construct to project(Sec.7W.Business and Profesuom Code:)Tim Contractor's Li- .
deme law does not apply N an owner of property who builds or improves detest,and.
who comsacu for such projece wit a rontacmr(s)Iirmaed percent,w the Conuw.noea
Liceme Law.
❑IomeamnInumsSea .B&PCf.'dd:; amt
Owner Dae
WORKER'S COMPENSATION DECLARATION
I hescby,affirm muter Pemltr of perjury,ane of de fallowing declarations:
1 haw and will munukt a CardfnsasafConsanl to self-insure for Worker's Camper,
recon,as provided for by Section 3700 of the labor Code.for to performae.of the
work for which this Permit is Wood.
❑I have scud will mum.Wafte.Compcmadon Imuran.,As required by Section
3700 ofte labs Cow,for she performance ofte wog for which Nu Permit tissued. '
My Workers Compamauon ntsusmce cannot and Policy number An
Career. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thr accuoa reed notbcccmpleed if to Permit is foram:hundred dallart(SIM)
or lee.)
I county,to in to perfsmatee of use work In,which this permit is Issued,l shin am
employ anyperson in any mannered as m become subject to the Workers'Compensation
Laws of California Dat
Applicant
NOTICE TO APPLICANT.If,after making Nis Certifiaa of Exemption,you should
w ome subject m the Wmlrces Compensation pmvisists of de labor Cade,you mut
Oz fad,wit comply witheach provisam s Nu pe.I,shall he d.med.1,od.
z 0 CONSTRUCTION LENDING AGENCY
F4 Nc wort wodyi.MN'u�tomI..cstswcnsn lendingaseney for to Perfomaseof
pi permit is issued(See.3097,Civ,C.)
QLaMer's Name
a z Under's Address
U 0 L cenify tal 1 have mad this application and some to to above itfamadun t
{I.Ecdrrecl.1 alma m edut wit all city and county ordinances and scale tors relating t 1
-0 Wilding construction.soul hereby auNrdm mptetatsnves of Nis city do enter upon use
4L7 aMve-menuaned propertysr'fariand epccuon pugexs
gy (We)agree m save,indemnify and keep harmless the City of Cupertino against
N incmiva,Judgmfhegranting.(erpeorthth may in any way scone against said City
V,'� A cPLICANTe of to panting of tis D WILL
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signazum al Appli. DataDa
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant no fousareni building e,Chapter
vee ad handle da h eaNam mattes
As dnM by the 32(a)?nil Municipal Cade.Chaper 9.11.and Ne HaIN and Safety
coda. 11ronY.ss3x+n All roofs shall be inspected prior to any roofing material being installed.
11 Y. ❑Nr
Will to applicant or future building a.upant um do,inam or devices which If a roof is installed without first obtaining an inspection,I agree to remove
7dWA
t havaNnns or contaminants a wfacd by the Bay Area Air Quality Management all new materials for inspection.
PGYm ❑Nr
i have read de haasrdrass maerude requimmemsunderChaper6.95oftc CuifdryHmll&SafctyCmw.3ccddns 25505,25533 and25534.1tandemed tsifte buildins m,curmedy ham a term.to it t my raponsihilitm wdry de ad u ose,or de
uirements which maser he mel prior m lanced.of.cerdReate or Oop.nry. Signature of Applicant Date
ncror.uNaN<dagent Dam All roof coverings to be Class') or better
CITY OF CUPERTINO
• 4 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37538014 . 00
DATE ISSUED. . . . . . . : 05/06/2008
RECEIPT # . . . . . . . . . : BS000004682
REFERENCE ID # . . . : 08050064
SITE ADDRESS . . . . . : 6140 WILLOWGROVE LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . . .-
OWNER . . . . . . . . . . . . : RUPE MICHAEL W AND ALTIERI JUN
ADDRESS . . . . . . . . . . : 6140 WILLOWGROVE IN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4649
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
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
•
Permit No:o3 1 4 Q ory()o� 402774
(office use only)
City Of Cupertino Building Permit Application
E-Mail: Building-Permits((D-cupertino.org (Address is case sensitive).
Jobsite Address:6140 WILLOWGROVE LN Date: 5/2108
Assessor's Parcel Number: 3�53 �U `f U O
Owners Name: RUPE, MIKE Phone No: (408)255-1229
Project Valuation: 449.00
Building Permit Info: Bldg Elect _ Plumb X Mech
Job Description
Remove/Replace Gas Water Heater
Contractor Information
Company Name: FAST WATER HEATER COMPANY Phone No:
• Contact Name: Carol Randall Fax No: 800-454-6955
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
Worker's Comp No: 1761660 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
a •i _ 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
O F
Fax(408)777-3333
CUPEkTINO
Building Ike ' cutment
JOB ADDRESS: 6140 WILLOWGROVE LN PERMIT# OB �� ( l
OWNER'S NAME: RUPE, MIKE PHONE # (408)255-1229
GENERAL CONTRACTOR:FAST WATER HEATER COMPAN FAX# 425-814-9516
I am not using any subcontractors:_ �'`a" / " 5/2/08
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/ GIazing
• Heating
Insulation
Landscaping
Lathing ' 4
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
•