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09030008 CITY OF CUPERTINO BUILDING DIVISION PERIVIIT � � � � BUILDING ADDRESS: PERMIT NO. 21889 RUCKER DR FAST WAFER HEATER 09030008 PERMIT ISSUE DATE NER'S NAME: A A O. CONTROL NO. PHONE: T (800) 4.54-8955 BUILDING PERM(TINFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 � 0 900 ICENSED CONTRACTOR'S DECLARATION Job Description 1"'5 C I hereby affirm that I am licensed under provisions of Chapter 9(commencing -i m with Section 7000)of Division 3 of the Business and Professions Code.and my license is RMU/R P L GAS WTR HTR =H in full force and effect r12 Z License Clan Lie•k n Dam Contractor ARCHITECTS DECLARATION J&d I understand my plans shall be used as public records �,Q 4 Q y Licensed Professional rn OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the O O following reason.(Section 7031.5,Business and Professions Code:Any city or county R Pi which requires a permit to construct alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation C that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq YF- (commencing with Section 7000)of Division 3 of dte Business and Professions Code)or $847 y _ drat 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 APN Number Occupancy Type net more than five hundred dollars(M). 35615012 . 00 ❑1,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 Required Inspections and Professions Code:The Contractors License Law does not apply to an owner of Q p property who builds or improves thereon,and who does 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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves themon,and who contracts for such projects with a contractor(s)licensed pursuant to the contractors License Law. I am exempt under Sec B&P C for this mason -.wner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insum for workers compen- sation,as 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 Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (ibis section need not be completed if the permit is for ono hundred dollars($100) or less) 1 certify that in the performance of the work for which this permit is issued.I shall nm employ any person in any manner so as to become subject to the Workers'Cornpensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you mast Oforthwith comply with such provisions or this permit shall be deemed revoked. Z 0" CONSTRUCTION LENDING AGENCY [~i cm I hereby affirm that there is a construction lending agency for the performance of 5 the work for which this permit is issued(Sec.3097,Civ.C.) WCI.A Lenders Name r1 z !..enders Address U C 1 certify that 1 have mad this application and state that the above information is VL 1-4 cormcL I agree to comply with all city and county ordinances and state laws relating to O Vbuilding construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,costs and expenses which may in any way acme against said City V Z in consequence of the granting of this permit Date t--t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b�: SOURCE REGULATIONS. Re-roof: CIJ — Signature of Applicant/Contractor Date T of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety .odc.Section 25532(x)? All roof;shall be inspected prior to any roofing material being installed. ❑Yes ❑No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new 1 naterials for inspection. District? C]Yes C]No I have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant that it is my responsibility to notify the Occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy. Slgnatur:of Applicant Date All roof coverings to be Class" 'or better Owner or authorized agent Date r\ft ,�� 435865 Permit No: 01 (office use only) City of Cupertino Building Permit Application E-Mail: Building-Permits a@cupertino.or (Address is case sensitive). Jobsite Address:21889 RUCKER DR Date: 3/3/09 Assessor's Parcel Number. �S 01 A Owners Name: SU,CHARLES Phone No: (408)858-7331 ProJect Valuation: j�{�p,Irl Building Permit Info: Bldg_ Elect Plumb ? Mech Job Description Remove/Replace Gas Water Heater Contractor information Company Name: FAST WATER HEATER COMFANY Phone No: Contact Name: Julie Caskey Fax No: 425-636-7084 Address: 12601 132ND AVE NE E-mail:carolr@fastwaterheater.com City, State &zip code: KIRKLAND,WA 98034 State Contractor's Lic. No: 877469 Expiration Date: 5/31/10 Worker's Comp No: A09304455 Expiration Date: 1211/09 Carrier: Truck Insurance Exchange City of Cupertino Business License No: 29100 Credit Card information Credit Card No: 4417123041349530 Explration 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. Commm2ity Development 10300 Torre Mum Cuper6 no CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: 21889 RUCKER DR PST# OWNER'S NAlM: SU,CHARLES PHONE# 408)858-7331 GENERAL CONTRACTOR FAST WATER HEATER COMPAN FAX# 425-636-7085 I am not using any subcontractors: 3/3/09 Sign►tare Date Please check applicable subcontractors and c le t the f22 information SUBCON"1'I.tACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets&Nfillwork Cement Finishing IIectrical 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