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08120053
CITY OF CUPERTINO �AN, BUILDINfO D:tISION PERMIT kCO,,NTRAGTQ;R INFO„Ii1VIATON •- BUILDING ADDRESS: PERMIT NO. 10290 WESTACRES DR HOME DEPOT OWNER'S NAME: PERMIT ISSUE DATE NE: A CONTBOL NO. (425) 636-7054 ARCHITEC.ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED COWMAI=R'S DECLARATION lob Description v�abs C 1 hcreby alErm BuI lam lived under provisions of CMpier 9(commercing t� wbb 5eclion]IXXI)of Divblon3afJU Budneu and Profcuium Code.and mylicevc is nth inmllroaeananitxl. REPLACE GAS WATER HEATER . $z Licauscratax-Lie-fDate CoS tr ARCHIECTnDECLARATION Sv 1 undersand my plan"I he used as public records �1U g o I MusedProfcstlonal a 5 OWNER-BUILDERexemptDE DECLARATION 1 hereby aRrm Nn 1 1. exempt from the Contractors Cos Lieeue law for the my o o following mason.(Section]811.5.Business and ove.dO iuu Cale:Any city as Caunre 5$ which requires n permit ne croswcL alcor.improve,d Permit,ri repair any structure Z), pdOrmlB lSeuaMC.also 1C90 RS the applicant o forthe Ndlpmmilmrim icanum aw(Chmmenl < Nu hculicenxd pursumuo de provisions of me Conuuar'a Licensa law(CNpur9 Sq.Ft. Floor Area Valuation y� (commencing With Section 7000)of Division 3 of de Business arta pmfessm.cock)or 449 e5@ does be is exempt therefrom and the bus for the alleged mompli er.My violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of APN Number Occupancy Type not mart the five hundred dollars WOOL 35911031 . 00 ❑Lax mwrmr of die property,ormy employes with wagesas sheer sox compensation, will do the work.and the smmmmle ant intended oralfered for ask,(Sec.70W.Bu news Required Inspections and Profossioon Code The ConmeroYs License Law dam nut apply m N owner of q P property who builds w improves theme.andwho doessuchwarkhinumf orthrough his awn employers,provided Oat uch improvements arc not intended oraBerW for We.If. ' however,the building or improvement issold within one year of completion.the owns- builder will have the Maden of proving Nat he did cot build or improve for purpose of sale.). ❑L as.weer of tie property am asemovely cunoacrimS vith licensed cenummra m comsroct the projem(Sec.7044,Business and Profusions Code:)The Conuaetm's Li. taus law dors not apply te an owner of property Who builds or improves thereon,and who comate for such projects with a comvacuard licensed Personal as the Conuamoh License lar. ❑I mm eumpt under Set .B&PC fw this name Owner Data WORKER'S COMPENSATION DECLARATION I hereby aRurn under Fancily of perjury arc of the following declanuions - 1 ham and will commain a CertiEcaa ofUment to wif-imam forwarkefs Comprn- tion.u provided for by Section 3700 of the lobo,Code,for Ne performance of the work for which this permit is issued. 1 have and Will maintain Wankel.Compensation I..az required by$anion 3700 of the Labor Com,for the performance of the work for which this permit is issued. My Warkce.Compeuatiom Inmrmce canner and Polity numhcr me: Cartier Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Ihissectioe teed Out he wmplctW if We permit is formic hundred dollar($1013) or less) 1 certify Oat I.thc performance of the work Ion which this permit is issued.l shall not amplay any Pelson in any nu merso a m hecemm subjcct to the Worker'Compuuation laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exception,you should become subject to the WorheYs Campnssumn provisions or the labor Coda you mm z forthwith comply With such ponvisioru or this permit shall be&zoned mmked. z O CONSrRUCnON LENDING AGENCY f•” I hereby affirm this them is a construction lendingagcocy for the performance or LYime work for which mu permit u issued(Set 71197,Cih,C.) GQ Lum mss Name =z landoes Address U 0 1 cosily that I ham read this application and sum this the above information is IT.E cmotet I agae to comply with all city and county oodisunces and state laws mladng to .0 building conswcdon,and hereby aumwim representatives or this city m enter upon me �[Il above-mandioned property for isspudim purposes C (We)agree to save.indemnify card keep harmless the City of Cupertino agalut F I/1 Iiabilidesjudgments.cosU eM expenses which may manyway acsncagainatmid City V z APPL CANTeOf the UNDERSfANDS ANDOf WILLWILL COMPLY WITH ALL NON-POINT Issued by: 66 HAZARDOUS Date SOURCE REGULATIONS. Re-roofs Signature o(ApplinDO Disc HAZARDOUS MAT73UALS DISCLOSURE Type of Roof Will the applicantarfuture buildingoccupant store or handlehansdours and az deRnetl by the Cupertino Municipal Code.Chapter 9.12.and the Health mJ Safely Cos,Sermon M532p7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes ONO Will the applicant or future building oauWut use equipment or devices Mich If a roof is installed without first obtaining an inspection,I agree to remove t harardnus air comaminaos a dehncd by me Bay Area Air Quality Managemcnl all new materials for inspection. cl7 Oyes ONO 1 have mad the hansdmu..data m pormounts mrder Chapter 6.95 of Oa:Caliro' ria Health&Safety Cade,Socuou 25505,25533 andl M534.I understand that if the Wilding does mol currently bow a mnme mut it is my responsibility m notify the occupant of the mquimmcns watch eras be mel Prior to sentence of a Cerulicam of Occupaszy. Signature of Applicant Date owneror..'W redact., Dam All roof coverings to be Class'}"or better • CITY OF CUPERTINO 4 ITEMS OF 28 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35911031 . 00 DATE ISSUED. . . . . . . : 12/04/2008 RECEIPT # . . . . . . . . . : BS000006760 REFERENCE ID # . . . : 08120053 SITE ADDRESS . . . . . : 10290 WESTACRES DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : NATHAN YEE ADDRESS . . . . . . . . . . : 10290 WESTACRES DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JEFF JORDAN CONTRACTOR . . . . . . . : FRANK BLAKE LIC # 30610 COMPANY . . . . . . . . . . : HOME DEPOT ADDRESS . . . . . . . . . . : 12601 132ND AVE NE CITY/STATE/ZIP . . . : KIRKLAND, WA 98034 TELEPHONE . . . . . . . . : (425) 636-7054 • 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 s �k Community Development 10300 Torre Avenue Cupertino CA 95014 Telepbone(408)777-3228 C OF Fax(408)777-3333 9CUPEkTINO Building Department JOB ADDRESS: 10290 WESTACRES DR PER 41T#o 8/al>vs3 OWNER'S NAME: YEE,NATHAN PHONE # (408)777-8986 GENERAL CONTRACTOR:HOME DEPOT FAX# 425-814-9516 I am not using any subcontractors:_ �" - __/� `" �P 11/4/08 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 O Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile • Ovorter/Contractor Signature Date Permit No:!J 5rPr53 000000 (office use only) 0 City Of Cupertino Building Permit Application E-Mail: Building-Permits(C cupertino.Org (Address is case sensitive). Jobsite Address: 10290 WESTACRES DR Date: 11/4/08 Assessor's Parcel Number: 33� // b ,3 Owners Name: YEE,NATHAN Phone No: (408)777-8986 Project Valuation: 449.00 Building Permit Info: Bldg Elect Plumb X Mech Job Description Remove/Replace Gas Water Heater Contractor Information Company Name: HOME DEPOT Phone No: • Contact Name: Carol Randall Fax No: 800-454-8955 Address: 12601 132ND AVE NE E-mail: carolr@fastwaterheater.com City, State & zip code: KIRKLAND, WA 98034 State Contractor's Lic. No: 602331 Expiration Date: 9/3o/lo Worker's Comp No: 1928756 Expiration Date: 3/1/09 Carrier: AMERICAN HOME ASSURA City of Cupertino Business License No: I�ecl Credit Card Information Credit Card No: a Expiration Date: 11/10 Name on Card: Jeff Jordan Visa © MasterCard ❑ American Express ❑ S The Building permit application and acompleted & signed contractor/subcontractor form need to be submitted with each permit.