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08110031 CITY OF CUPERTINO BUILDING DIVISION PERMIT 9CONTRACTOR�INF()RMATION oa j.+F� n:wn^!e; r»I ro, g ^s,��E,.°•n5 4� .,a^rkxv,,l,�. BUILDING ADDRESS: PERMIT N0. 10243 ALPINE DR APT 3 FAST WATER HEATER 08110011 OWNER'S NAME: PERMin ISSUE DATE T�FTI (`TT 12601 132 AOIT� NE rNE - CONTROL NO. (800) 454-8955 ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Sao LICENSED CONTRACTORS DECLARATION �w I hereby aflime Nat 1 m Ikess under pmAi os of CMpmr 9(cemmcncin{ Job Description ma wiNSection701y.fDi hm.3ofdsltumrauaand Pmlcssi...Code,andmylicesasei, =N in full farce and effect. REMV/RPLC GAS WATER HEATER , Ll License ChCa Lie.R t- Dam Ci ntramw ARCHITECTS DECLARATION u I understand my pkns shall bo used as public record, s GLicensed Pmfestiomai 3 OWNER-BUILDER DECLARATION F I bcmby affirm Nn I am escmpl from the Canaan e's License law for Om cc (.]lowing moon.(Soction 7031.5,Bueinss and Pmfesi.ns Cade:Any city or county $ which mqulm a Permit to cansruct.alcor,improve,demoHm.or repair any structure that he I. iutoredp..t1.to Nc applicant far such pctmitmfilcasigneJ slat.mcnl < NatMi,IlccseJ purswntmOW proosims of Nc Commutes Uaense Law(Chapter9 Sq.Ft. Floor Area Valuation z5 (commencing with Section 70M)of Division 3 of NC Bear.and Profess;os Cade)or $449 e5— Nat he u eacmpt therefrom and Ne hums for the alkgs ewnPmma My violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy e rot m.m then live hundred dollars(ZOO). 32615035 . 03 P yTyP ❑I,u awrmr of Us popery,a mY eroPloyw with wags ss dm's sok compensation, and da feesiort.and The, Conammtkknmde Law dos act apply to Buvrmof Required Inspections and Professional Code TM Camm�of,Dana law dos set apply lf't Corr of 9 P Property who Wilds o improves thereon,and who does such work himulf ed through his Own employes,provided that such improvements are not intended aro@sed We Own r, hadder.Nebuildingea improvementisChat within aneyesofcompletion,Neowmer- buo.). will have dm dsnderr of proving Nat bo did not build m impove far Purpse of rati ❑I.as Comer of the property am exclusively...Watling with licensed cam actors an commset Ne project(Sec.7016,Business and Professions Code:)The Conuazwr's Li. cause law dos not apply N an Owner of property who builds or impmm Ncceon,and who contacts for such pgens with a contractor(s)licensed pursuant to also Commames Licmarc law. Con❑l exempt under See ,B h P C for this won OwnerDam WORKERS COMPENSATION DECLARATION 1 hereby alfum under penalty of perjmy one of OW falbwini declarWonc . I have and will maintain a Certificate of Consent to,elf-insum forWCskelCompen- -�• cation,a provided far by Section 3700 of the Labor Code,for the performance of the wart for which this permit is issued. ❑I have and will maintain Workers Compensation Imuana,as required by Seeman 37M.f We Tabor Code,for the penrosmace of th.work for which this permit u leaned. ' My Warker's Compensation Inaame Cartier and Policy number art: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This=am nerd ambe completed If de permit is forone hundred dolts(SIM) car lits) 1«nify Net in Ne performance of than work for which this Permit is issued.l shall not employ any person in any marcra.as W bccomc subject to the Warted Compensation Laws of California.Das Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become sabjact to the Workcr',Compensation provisions of We Labor Cade.you must .JO forthwith comply with such provisions,or Nu permit mall M doemed matd e z'-v CONSTRUCTION LENDING AGENCY [-v .�., I hereby&M m Nat them is a construction kadini aFncy for NC Performance of �iNe work fur which Nu Permit is wood(Sec.3097,Civ.C.) Ga Lcndel's Name , 7 z Lasers Address U O 1 certify that I have mad Nis application as sum than tls above Woman.is [f. corett I agree Or empty with all city and county on inancea and sum law,missing to ' .0 building mmrm.tion,and bomb,AU006M mpmsenutim of Nu city to enter upon We N{Z1 above-mentioned Property for inspection Purposes gy (We)agree to ave,indemnify and keep hanalea the City of Cupertino against fry limilids judgments.cam Waspss cwhich may In my way amue againr said City U'•z in consequence of the{ranting of this permia ^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of AWIiCmhCoWImW s Dale HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII due applicant or future building occupant stem or handle haaNuus materia] u maned by dm Cupertino Municipal Cade.Chapter 9.13.and the Health and Safety Cam.Section 25532h)! All roofs shall be inspected prior to any roofing material being installed. OYa ON. Will Ne applicant or future building occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove I hammous air contaminants as defined by We Bay Area Air Quality Managemcm all new materials for inspection. muict7 ❑Ys El No 1 haw mad the haankrus materials requimments under&pmr 6.95 of We Cdifor. riaHoul"Salay Cola.Sm.25505.35533 and 25534.1undersund Nuif dW Wilding dos rent contend,haw a Whorl that it u my responsibility to notify,the occupant of Ne regairemenu which mlut W met prior toism m of.Carinate of Oaupancy. Signature Of Applicant Date Owner err mthamcd:gem Dow All roof coverings to be Class'%q."or better CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT. OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32615035 . 03 DATE ISSUED. . . . . . . : 11/07/2008 RECEIPT # . . . . . . . . . : BS000006571 REFERENCE ID # . . . : 08110031 SITE ADDRESS . . . . . : 10243 ALPINE DR APT 3 SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LEW, GIL ' ADDRESS . . . . . . . . . . : 10243 ALPINE DR APT 3 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 eFEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEV-SAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 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 IPRWHEATR 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 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CUPEt�TINO Building Department JOB ADDRESS: 10243 ALPINE DR#3 L' T# Og/ O D,� / OWNER'S NAME: LEW, GIL PHONE# 916)218-5830 GENERAL CONTRACTOR:FAST WATER HEATER COMPAN FAX# 425-814-9516 I am not using any subcontractors:_ �'" / 11/7/08 Signature Date Please check applicable subcontractors and con let,the follmdng information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets&Millwork Cement Finishing Electrical Excavation Fencing Flooring:Carpeting Undleum/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 0 Permit No: 091 i 00.3 I 421206 (office use only) City Of Cupertino Building Permit Application • E-Mail: Building-PermitsCc�cu -ertino.org (Address is case sensitive). Jobsite Address:10243 ALPINE DR 93 Date: 1117/08 Assessors Parcel Number. 15 O 35 Owners Name: LEW, GIL Phone No: (916)218-5830 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: eContact Name: Carol Randall Fax No: 800454-8955 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 Worker's Comp No: 1761680 Expiration Date: 12/1/08 Carrier California State Fund City of Cupertino Business License No: 29100 Credit Card Information Credit Card No: j ,onjoillilillillisomw Expiration Date: 11/10 Name on Card: Jeff Jordan Visa ® MasterCard ❑ American Express ❑ The Building permit application and a completed & signed . contractorisubcontractor form need to be submitted with each permit.