08020093 CITY OF CUPERTINO
BUILDING DMISION PERNHT CO Rt-1 TQR I1 N'ORMATI' N ''r
BUILDING ADDRESS: PERMIT N0.
7825 LUNAR CT FAST WATER HEATER 08020093
NEWS NAME: PERMIT ISSUE DATE
NARVAEZ PETER D AND ARLENE C 12601 132 AVE NE 02/14/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
RMV/RPLC GAS WTR HTR BLDG J o o o
30o LICFNSEDCONTRACIOR9 DECLARATION Job Description
4 f Fpy 1 hereby affirm that 1 me licensed under provisions of Chapter 9(commencing
n�E with Section 70(110 of Division 3 of the,Business and Pr c 'au ode nd my license is
N in full force and off A
Z�� Dam Cmmcmr
ARCHITECTS DECLARATION
I undcsaunJ my plw Nall W used as public records
igu
b rd� Licensed Professional
OWNER.BUILDER DECLARATION
'f I Wrehy aRrm that 1 am attempt from Ne Contractors License Law for Ute
O O following rtaann.(Sadao IOl 1.5,Runner and Profrmion Cmlc:My city o aunty
22 which toqulres a Permit u construct,alter.Improve,demolish,or repair any Nmclum
zy prior m its issuance,also requires Jan applicant for such Permit to file a signed statement
Nal he is licensed pursuant m the provisions of the Conuxmr's Ucrose law(Clupler 9 Sq.Ft.Floor Area Valuation
(con mentingwith Section70DO)of Division3of the Ousin wdff=iom Code)m
9 Nat he is exempt therefrom and me bull for the alleged mu mption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy e
rem
t ate man five handed dollar(s5w) P Y TYP
❑1,u owner of our property,or my employees with wages as their sole compensation,
will do memolt.and t e nnucmre 4 not intended or offered farad.(Sen.71114,Busiws
and Profession Cade:The Communes License Law does oat apply In me owner of Required Inspections
property,who builds a ire prows IMeon,and who does such work himself orthrough his
own employees,provided that such improvements sin not intended oroQered for sale.11.
however,the Wilding or Improvement is sold within one you of completion.de owner.
Wilder NB haw the burden of proving that he did not Wild or improve(a purpose of
isle.).
❑1,as owner of the Property am exclusively contacting with Iiceved ronlracmre to
concoct the project(Sec.TON,Buineu and Profession Code:)The CO.raoor'a ac-
cents Law dam not apply m an ovmer of propeny who Wilds or Improves moment.and
who consents for such ptojeeu with a contacrot(s)licensed punnnt to W Conmetor's
License Law.
❑lammemptunderSee .Bd PCfomismabn
Poor
Dau
WORKER'S COMPENSATION DECLARATION
I hereby aElrm under penally of perjury aro of the following deelarsumea .... .
❑1 have and will maintain a Centurions of Consent to self-inum for Worker's Compton.
scion,as provided for by Section 37M of the labor Code.for the pesiomance of the
work for which mis permit is iarucl
❑1 have and will maintain Worker's Compensation Instersnce,as required by Section
3700 of m^labor Cade,for me performance of thn wort for which this permit is mused.
My Wo mpeauti sutsmcatrierstd PolicynMoil
mbcr
Carrier. - Paltry No.:
CE IFI A ^OF ATION I N FROM 0 E S
COMPENSATION INSURANCE
(This semlan sued ambacomplewd If the Permit Is foronc hundred dollar(SIM)
or lea)
I anify that in me performaato of the work for which this perm,is blued,l shall net
employ any person in any mannoran as be Wcame abject to me Worker'Comptonudan
Laws of California.Dam
Applicant
NOTICE TO APPLICANT`.If,after making this Certificate of Exemption.you mould
bamme subject to the Worker's Compensation provisions of the Labor Code,you mut
.J,7, forthwith comply who such provision or this Permit shall be domed mvoked. a
,z.t O CONSTRUCTION LENDING AGENCY
I bemh alnrm met mere is a construction lending
F r g agency for the performance of
kY.
the wok for which this permit h issued(Sec.3097,Civ.G)
p[7 A tenders Name
=z Landers Address
U I certify mal 1 have real this application and sum that tW aWve Information Is
Ls. corm I agree m comply with all city and county ordinances and mate laws misting to
.0 Wilding convocation,and hereby atmorim mprewnudws of this city to cnterupon me
W shove-meMoned Properly for inspection punpmes
(We)agree m save,indemnify and trap harmless the City of Caperton against
rn
liabilities,judgements.cane and mpenses which may in my way..against bid City
U,Z in co mmianee of the{manta{of this Permit._ /
^t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �—
so) Ep run 1�
��f Re-roofs
Sgnuu ApplicanUC lar Da/
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding occupant pure or media hamdoes m bcond
u defined by the Cupertino MeettipfiCadc.Chapter 9.11 and the Health and Safety
tie,Section 25532UN
p k'es o All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
em0 Waamdom air commem.nu u deft d by me Bay Ama Air Quality Mmagcment all new materials for Inspection.
District?
❑Yes
Ihavemadmehuarduusma .Ismquimmcnmun@rChapur6.95ofine CAlifor.
mis Halm&Ssfety Cod,k.d.0 25505.25533 anti 25534.1.44 m nd muff the Wilding
dos not curremly low.mans mat lac u my tmpora litY to notify the occupant of the
mqu' ichmnlbe=Ipoor miunnceof.Cortirn of MA
Signature of Applicant Date
ownmmadmannd.gcm r�Yf7D,m' All roof coverings to be Class"B"or better
From: 01/31/2008 18:39 ABBE P.002/004
CITY OF CUPERTINO 392937
.0 WATER HEATER
CUPEZTINO PERWF APPLICATION FORM
APN# 6; � U as v Date:
1/31/08
Building Address:
7825 LUNAR CT
Owner's Name: Phone#:(408)996-0861
NARVAEZ, PETER &ARLENE
Contractor: Phone#: 800454-8955
FAST WATER HEATER COMPANY Fax M. 425-814-9516
Cupertino Business License#: Contractor State License#:
29100 877489
Contact + Phone#: 800-454-8955
Carol Randall
Fax#: 425-814-9516
Building Permit Info:
Bldg Elect El Plumb x Mech
Residential ❑x Commercial ❑
Job Description:
Remove/Replace Gas Water Heater
Strapped E-----On Platform [!3 Bonded [n— New Location ❑ Replacement
Valuation: 449.00
Green Building Check must be completed and attached to this application.
Green Building Points achieved:
From: 01/31/2008 18:38 IM P.003/004
392937
:L
CITY OF CCJPERTINO
WATER HEATER
CUPEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1 PCWHEATR Commercial Wates B PCWF EATR
Heater/Vant
BSEISMICOM Seismic Commercial B
t ]PRWHFATR Residential Water B PRWHEATR
Heater/Veat
BSMSMICRE Seismic Residential B
PPERMFFFEE Plumbing Permit P
TRAVDOC Travel & B
Documentation
BUSLIC Business License B
•
• CITY OF CUPERTINO
4 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36220022 . 00
DATE ISSUED. . . . . . . : 02/14/2008
RECEIPT #. . . . . . . . . : BS000003941
REFERENCE ID # . . . : 08020093
SITE ADDRESS . . . . . : 7825 LUNAR CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : NARVAEZ PETER D AND ARLENE C
ADDRESS . . . . . . . . . . : 7825 LUNAR CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5007
RECEIVED FROM . . . . : FAST WATER HEATER
CONTRACTOR . . . . . . . : JEFF JORDAN LIC # 29100
COMPANY . . . . . . . . . . : FAST WATER HEATER ,
ADDRESS . . . . . . . . . . : 12601 132 AVE NE
CITY/STATE/ZIP . . . : KIRKLAND, WA 98034
TELEPHONE . . . . . . . . : (800)' 454-8955
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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 213 .12 #3500
---------------
TOTAL RECEIPT 213 . 12
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------- ------------------------ -------- ---------------------------
518 WATER HEATER
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEP,TINO
Building De artment
JOB ADDRESS: 7� ""r n y— PERMTT 2� 3
OWNER'S NAME: ` q? � , PHONE #
GENERAL CONTRACTOR: (� FAX#
I am not using any subcontractors: Ll>i� ti ,
Signa a 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
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
% L-
Owner/Contractor Signature Date