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09050048 CITY OF CUPERTINO �r �s�. BUILDING DIVISION PERMIT +C�1R4C� � � � r ` BUILDING ADDRESS: PERMIT NO. 7571 ERIN WAY FAST WP.TER HEATER 09090048 OWNER'S NAME: PERMIT ISSUE DATE �N SxMtAkt8.2CONTROL NO. (800) 454-8955 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 apZ LICENSED CONTRACTOR'S DECLARATION Job Description V 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code.and my license is y in full force and effect. REMOVE/REPLC GAS WATER HEATER C ? License Class Lic•# in^ pate Contractor ARCHITECTS DECLARATION < I understand my plans shall be used as public records �yU 4 Q y Licensed Professional y OWNER-BUDER DECLARATION 1 hereby affirm ILthat 1 am exempt from the Contractors License Law for the r p O following mason.(Section 7031.5,Business and Professions Code:Any city or county e m which requires a permit to construct.alter.improve,demolish,or repair any structure n Z} prior to its issuance,also requims 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 Sq.Ft.Floor Area Valuation $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $1545 y 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 APN Number Occupancy Type not more than five hundred dollars(5500). 35920030 . 00 ❑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 Required Inspections and Professions Code:The Conuactoes License Law dors 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.U, 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 Contractors Id- 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 Contractors License Law. C]I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury core of the following declarations: i have and will maintain a Certificate of Consent to self-insure for Workers Compcn- .,ation,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 Polity number are: Cama: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (this section need not be completed if the permit is for one hundred dollars($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 Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z 2 CONSTRUCTION LENDING AGENCY E r 4 I hereby ailuro that there is a construction lending agency for the performance of LY.> the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name Lenders Address U 0 I certify that I have read this application and state that the above information is V. " correct.I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property,for inspection purposes CL (We)agree to save,indemnify and keep harmless the City of Cupertino against c4el liabilities,judgments,toss and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date r4 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Signature of Applicant/Coniractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ❑No If a roof.s installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which L hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. strict? ❑Yes C]No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,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 priors issuance ora Certificate of Occupancy. Signature of Applicant Date Owner or authorized agent Date All roof coverings to be Class'n"or better 440794 Permit No: Q.5 oo Lt (office use only) City Of Cupertino Building Permit Application E-Mail: Building-Permits(aD-cupertino.or (Address is case sensitive). Jobsite Address:7571 ERIN WAY Date: 4/13/09 Assessor's Parcel Number: �6gd,00 10 - ()D Owners Name: COE, ERIC & MICHELLE Phone No: (408)343-0883 Project Valuation: # (-3 4�3• ` 0 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: 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: 877489 Expiration Date: 5/31/10 Worker's Comp No: A09304455 Expiration Date: 12/1/09 Carrier: Truck Insurance Exchange City of Cupertino Business License No: 29100 Credit Card Information Credit Card No: 4417123041349530 Expiration Date: 11/10 Name on Card: Jeff Jordan Visa ❑X MasterCard ❑ American Express ❑ The Building permit application and a completed & signed contractorlsubcontractor form need to be submitted with each permit. Community Development 10300 Torre Avenue IF Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CUPEkTINO Building De artmemt JOB ADDRESS: 7571 ERIN WAY PERMIT# req ()b oaf$ OWNER'S NAME: COE, ERIC & MICHELLE PHONE# (408)343-0883 GENERAL CONTRACTOR FAST WATER HEATE R COMPAM FAX# 425-636-7085 'L4 -AQP I am not using any subcontractors:_ 4/13/09 Signature Date Please check-applicable subcontractors and com Iate the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets&Millwork Cement Finishing Electrical 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