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07090206CITY OF C;UFFKI ENU BUILDING DIVISION PERMIT BUILDIR',Nfga'Tft,IMROSE WAY OWNER'S sNAME: SUSAN YING YNE: ARCHITECTIENGINEER: p Zo LICENSED CONTRACTOR'S DECLARATION VI hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z with Section 7000) of Division 3 oC the Business and Pr fcssions Codc, and my license is i y in full force and eff License asap Lam• 1 � Date— Contractor AR HITECT3DEC i a a 1 understand my plans shall be used as pts is records )0.0 U. ti Licensed Professional OWNER -BUILDER DECLARATION ja 1 hereby affirm that 1 am exempt from the Contractor's License Law for the . n o following reason. (Section 7031.5, Business and Professions Code: Any city or county $ f4C which requires a permit to construct. alter. improve, demolish, or repair any structure a n prior to its issuance, also requires the applicant for such permit to file a signed statement ? < that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 F (commencing with Section 7000) of Division 3 of the Business and Professions Code) or o that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and whodoes such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If. however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Conuaetors Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sec B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: -1 1 have and will maintain a Certificate of Consent to self -insure for WOfkces Compen- ation, at provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ] I have and will maintain Worker's Compensation Insurance, as required by Section 1700 of the Labor Code, for the performance of the work for which this permit is issued. wry Worker�Competion ance ca d �licy number ale: Carrier.J7�i1CJY No.:F PfION FROM WO R COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (S 100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workcrs' Compensation Laws of California. Dale Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Codc, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that I have read this application and slate that the above information is correct. 1 agree to comply with all city and county ordinances and slate laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE �ic—aat/Conu�wtor� r Si a f ApDate S DISCLOSURE Will the applicant or future building Occupant Store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and die Health and Safety Code, Section 25532(a)? ❑ Yes Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management District? ❑ Yeso 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor nia Health & SafetyCmde, Sections 25505, 25533 and 25534.1 understand that if dic building does not currently have a tenant, that it is my responsibility to notify the occupant of tlX rcquircmcW_ytyitjl must be met prior to issuance of a Certificate of Occupancy. Date PERMIT NO. FAST WATER HEATER 1 07090206 PERMIT ISSUE DATE 12601 :_32 AVE NE 09/28/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO REMOVE (REPLACE GAS WATER BLDG ELECT PLUMB Issued by Re -roofs >q. Ft. Floor Area umber Job Description Required Inspections ation Occupancy Type of Loof All roofs shall be inspected prior to any roofing material being installed. If a roof s installed without first obtaining an inspection,.1 agree to remove all new materials for inspection. Signature of Applicant All roof coverings to be Class "B" or better Date 08/19/2013 05:43 FAX 0-709 02-0(o Q37874/40 09 CITY OF CUPERTINO WATER HEATER CUPE fNo PERMIT APPLIC'ATYON FORM APN #/ Date: Building Address: BEN ERGY 1343 PRIMROSE WAY BUILDING Owner's Name: Phone #: YING, SUSAN (408)777'0854 Contractor: License 9: FAST WATER HEATER COMPANY 877489 Contact: Cupertino Business License #: Carol Randall 800-454-8955 29100 Building Permit Info: Sld ❑ Elect 0:�' Plwnb ® Mech Job Description: Remove/Replace Gas Water Heater Residential C& Commercial ❑ Cost of Project: 449.00 Strapped On Platform Bonded 0 Replacement CM New Location Qty. if Fee Inescrintion Fee Group 1 BPWHEATER PPERMITFEE Water Heater / Vent Plumbing Permit Issuance BUILDING PLUMBING BEN ERGY Enew BUILDING BUSLIC Business License BUILDING CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: B1}=: Lot: APN ......... 36017045.00 DATE ISSUED.......: 09/28/2007 RECEIPT #.......... BS(100002817 REFERENCE ID # ...: 07(190206 SITE ADDRESS .....: 1343 PRIMROSE WAY SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............. SUSAN YING ADDRESS ..........: 134:3 PRIMROSE WY CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5229 RECEIVED FROM ....: FAST WATER HEATER CONTRACTOR .......: JEFF JORDAN LIC # 29100 COMPANY ..........: FAST WATER.HEATER ADDRESS ..........: 12001 132 AVE NE CITY/STATE/ZIP ...: KILKLAND, WA 98034 TELEPHONE ........: (800) 454-8955 FEE ID UNIT QUANTITY 1,MOUNT PD -TO -DT THIS REC NEW BAL ----------------------- PPERMITFEE FLAT RATE ---------- 1.00 ---------- 40.79 ---------- 0.00 ---------- 40.79 ---------- 0.00 PRWHEATR UNITS 1.00 24.48 0.00 24.48 0.00 TRAVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00 TOTAL PERMIT ---------- 106.06 ---------- 0.00 ---------- 106.06 ---------- 0.00