08040061 CTTY OF CUPERTINO .+, sAt 'd
BUIL ole brvlslor7 PERMIT CONTRA T',QRINFORMAT-19N
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BUI I G1�DORESS: PERMIT NO.
NOVEMBER DR FAST WATER HEATER 08040061
OWNER'S NAME: PERMIT ISSUE DATE
ERNEST HUA 12601 132 AVE NE 04/09/2008
ONE: SANITARY NO. CONTROL NO.
RCHIIEC(ENGINEER: BURRING PERMIT INFO
RMV/RPLC GAS WATR HEATER BLDG 0
900 LICENSED CONTRACTOR'S DECLARATION lb Description
0F 1 bmcby Anne UWm Revd under aeunder Provis (commencingo0SCr1P of Chapter 9(commencing
with Section 70111)of Division 3 of the Baines And Profession+Codo.and.,icanais
^ in full force AM effect
i Lice.Class Lk.I
C Dem Contractor,
3 k'
ARCHITECT'S DECLARATION
tl S I understand my Plans Mall be used as public rtceirds
An. LicensedProfessional
Professil
D OWNER-BUILDER DECLARATION
N
MI I hereby.nim that 1am.Bump from the Canuno
af+Licence law for tic
EMO N O following moan.(Section 701.5.Butlimu and Pofasians Cade:Any city or county
$f<u which requlma•petit recnres the siter,nt fusu,mermiti ores siganyamocn,
Z
prior mslieuaaealw s M the the fusuch
that hcmlke with
puramt retie of Division
of the Contractor's Llanulso(ChapterCode)or Sq.Ft.Floor Area Valuation
9 that heis.'wWSecUon ID0 it of buts
afr mthecgcd Business and Pretensions Any
Cam)or
Nat he LL aumpt therefrom and Un bun for tie Wegcd exemption.Any vlolaJone(
Section 7071.5 by airy applicant far a pemit abjeeu the applicant to a civil penalty of APN Number Occupancy Type
not mom Nan five hundred dollars(SSW),
O 1,As owner of th pmpe,Y,a my employees with nage,As their Glee hop sada,
will m the work,and Ne+mcture u not Intended or aRemd far tale(Sec.70th,Basirca
and Pmfesaions Cade:The Coauacloes License Law das set apply in an en ar of Required Inspections
property who huhldsairepoles Nveon.aha who daa+uchwork himselfe duough his
awn ctnployuee,provided Nat such improwmenLL an,not Installed oroQemd for Bale R.
howem,Ne building or improvement I,old within one year of completion.One,awar-
Wilder MB naw the bumen of proving that Ire did not build or impmw for purpo m of
u c.).
❑1,as mover of the property am excloaiwly contracting with licensed anvaiora In
coMmet the project(Sec.7094.Baines,aha Professional Code:)Tan ConmacmYs U.
cons:law dote not apply in an owner of property who builds or improm themm,ad,
who comacLL for suck pmjecm with a conuacmrU),Eeensed punnant in can Contractor's
Lim.Law.
❑1 Am exempt under See .B&PC for Ni,mum
Owm Dau
WORKERS COMPENSATION DECLARATION
1 hereby AfRm unlet patty of perjury ons of tha(closing deelaradonc
ON haw and will maintain.CemBea sof Consent in air-insure for WarkefaCompn-
dM.as provided far by Section 7700 of du labor Code,for the prfomana of Ne
for which this petit is head.
❑1 haw and will maintain Workces Compensation Insurma,As required by Section
37M of the,labor Com,fa We perfommce of the work for which Nu petit Is Island
My Worker's Compensation Insurance carrier and Policy number am:
Cartier. Policy No.: -
CERTIFICATE OFEXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This aortia reed at bccomplemd Hills,Permit is for.husband AMR.(31M)
or lnsq
1 canify that In the perfamauca of W work for which this Permit is What,I shall trot
employ anyper es,in my remora As An become subject o Un Workeri Compensatia
laws of California.Data
Applicant
NOTICE TO APPLICANP.IL after nasion{this Cenifiam or Escom an,you shtmw
become subject n dee Workcls Compeesatia provisions of the labor CMB you most
O forthwith comply with mh Provisions or Nu petit Nall M damcd romkcd
,Z„^ CONSIRUCnON LENDING AGENCY
'(•v 1hereby AM.that Unna is a c^Mrucdnn kMingagemy for Ne perfomame of
C4> site work for which this petit LL wood(Sec.3097,CIv.C.)
W�Q Lenmfs Name
D z Landers Address
U Q 1 comfy Nat 1 have mW this application and sum that Ne show Information is
D,!-'. conecL I agree in comply with all city and county eminences and Amu laws musing u
.O rU^ Wilding conauetion,and hereby allotlm mpmmadws of Nis city to enmr upon Ne
ahem-mentiond Property for iapcd.Pupates.
y (We)agree to am indemnify ad keep hamlee the City of Cupe te.against
rA liabMunt,judgmenu.case and expenses which may in my way oma against aid City
U Z in comeqaree of the panting of this petit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Sig nature of APPlicaHAZA DO Data
HAZARDOUS MATFATAIS DISCLOSURE Type of Roof
Will Un id Cupertino
no forum building e,Chapter
m handle hatamou metrial
As mend by Ne Cupertino Municipl Coo.Chapter 9.I2.and dm Health mJ Safety
Com.Suction 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
Oyes 0N
Will tin applicant or future building omens ase equipment a mriees which If a roof is installed without first obtaining an inspection,.I agree to remove
L huardoa car comerinsrtu u canoed by Na Bay Amo Air Guilty Management all new materials for inspection.
cl7
❑Yes ON.
1 have mad the hazardous materials require==under Chapter 6.95 of Ne Califor-
MIA HCulth&SafetyCode,Secdoa 25505,25533 and 25534.1 Moderated Nstlfft building
does not currently have a UmlML Net It it my no onnhility to notify the aenupant of the
requirements which mat d mel prior to Waseca orf.Cenirtcam or Ocmpacy. Signature of Applicant Date
Owner or m0oriad agent Dam All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 4 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36213029 .00
DATE ISSUED. . . . . . . : 04/09/2008
RECEIPT # . . . . . . . . . : BS000004429
REFERENCE ID # . . . : 08040061
SITE ADDRESS . . . . . : 946 NOVEMBER DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ERNEST HUA
ADDRESS . . . . . . . . . . : 946 NOVEMBER DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4121
RECEIVED FROM . . . . : JEFF JORDAN
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
----------------- --------------- --------------------
CREDIT CARD 639 . 36 VISA
---------------
TOTAL RECEIPT 639 . 36
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-- ---------------------------- -------- -------------------- -
518 WATER HEATER
Permit No:
080JI 0()W / 400313
(office use only)
City Of Cupertino Building Permit Application
E-Mail: Buildinq-Permits(dcupertino.org (Address is case sensitive).
Jobslte Address:946 NOVEMBER DR Date: 4/8/08
Assessor's Parcel Number:
Owners Name: HUA, ERNEST Phone No: (408)446-5176
Project Valuation: 449.00
Building Permit Info: Bldg Elect Plumb X Mach
Job Description
Remove/Replace Gas Water Heater
Contractor'Information
Company Name: FAST WATER HEATER COMPANY 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: 677469 Expiration Date: 5/31/08
Worker's Comp No: 1761660 Expiration Date: 12/1/06
Carrier: California State Fund
City of Cupertino Business License No: 29100.
Credit Card information
Credit Card No: 4417123041349530 Expiration 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.
aCI0F'
Community Development
10300 Tone Avemte
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
CUPERTINO
B�.�.d:a.n De a.g't�.ent
JOB ADDRESS: 946 NOVEMBER DR PERMIT#O ( / ) U(p I
OWNER'S NAME: HUA, ERNEST PHONE# (408)446-"15176
GENERAL CONTRACTOR:FAST WATER HEATER COMPA FAX# 425-814-9516
I am not using any subcontractors:_ �'`� ' 4/8/08
Signature Date
Please check a licable subcontractors and complete the followinginformation:
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