08080136 CITY OF CUPERTINO
BUILDING DIVISION P]-,i' IT kl� t� l�[1T' R # j? �YIJ. FJ7 :
BUILDING ADDRESS: PERMIT NO.
10403 SOMERSET CT FAST WATER HEATER 08080136
OWNER'S NAME: PERbffI IS5UEDATE
KAI. PENG 12601 132 AVE NE 08/19/2008
NE: SANITARY NO. CONTROL NO.
(800) 454-8955
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGO ELECTO PLUMB MECHUM
�oo LICENSED CONTRACTORS DECLARATION
I thereby W
reby affirm 1 am licensed under previsions of Chapter 9(commencing Job Description
JiB ec
wiNSdon7ODMofDiN on3afthrBusim udPmfessil"Cndeanamylicensris RMV/RPLC GAS WTR HTR
n�8; in full force and enact.
jR4 License Clan Lie.#
m Dem Conuaner
ARCHITECTS DECLARATION
S U 1 undersand my pima shall be reed as public records
k C Licensed Pmfcssional
5 OWNER-BUILDER m the Contractor's
Z I hereby a1Srm on I am exempt from me Gam mns Code:
my Law for Ne
❑o hollowing meson.(Section t ]o alis Business and improve.
dom li Code:Any rm or county
$tui which requires nissuance.
Permit re cowtrat almc. forsu de ermit ni repair ed strenuro
zs thimbia ensed pursuant
W the sin applicantofor suhprmitm fit Law
€g (co W e licensed Puruanl m this previsions of ao Camncmrs Liam 6w(Chadha 9 Sq.Ft.Floor Area Valuation
5 B (cat he is ing exempt Section and
theof Division r then egad Business;and Mrsoon.An Taw Cade)or $449
S u he ts campy therefrom ant the aper it the antigen exemption,Any it Penalty of
Sudan tom by wanyredkanlra•positubjecaNeapplicanttoacivilpndtyof Number Occupancy Type
hat m.ran Rwe hundred amlm(sSBo). 3 6 9 2 9 0 31 .�1N
❑L ot ownsk,ere p were err I.our
imumned or mffmges pe Heir eek compnwarms
will aotrework,and Nebo commnoss nmam awns Faruk(Ser.n a,Busineu
and Pro(essiobu Caac improves
Conarrmfa and
who Law d.not apply in an a ash of Required Inspections
man ern who builds mimpmvsa oimpr improvements
who ante urhwork h roffror edWvugh his
1.
owneer.the
uiding or nutechimprevem within am
net IneanndmtUema furthe saide.Own IL
however,Ne biking m rnpovernanl Is halt a did
aro Weld of completion,fr p e owner-
Wilder NE have the buten of pouring that k did ret Wild o improve fm puryate of
aleJ.
❑1,as Dare of the proprty,are exclusively connecting cling with licensed rontaanma to
eenstu7 the project(Sec.7044,Bwkea and Professions Cml The Commences t.4
cense law does not apply in an owner of property who Guilds or impmm themon,and,
-he comncts far such frrejacts with aeanuacmRq licensed punwm to do Convenors
Lleose Law.
❑I am exempt under Sec. .B&P C for this maxon
0. Dam
WORKERS COMPENSATION DECLARATION
I hereby afRm under penally of perjury ane of Use following declarations,
I have and will maintun a Cerdficateof Consent in self-Ware fm Wmkers Compan-
suion,as provided for by Section 3700 of the Labor Code.for the performance of W
work for which this Parrett r intend.
❑1 have and will maintain Waftes Compensation Iwunmes,as required by Section
3700o(sn labor Code for the asfoms.nce offt work farwhwh this permit is issued. '
My Worker.CampenWlon Insurance carrier and Policy number am:
Cartier: Poliry No,:
CERTIFICATE OF U MP 70N FROM WORKERS'
COMPENSATION INSURANCE ,
(Thr season exam msbecomplend irthe permit fmone hundred do0an(5100)
less.)
1 certify that In the Performance of the mark for which this permis is ruin,l"I not
employ any pcmn In any manncrm as m became subject to the Workera'Comperadde
Laws of Caliromr.Dan
Applicant
NOTICE TO APPLICANT.If,afmr making this CcniBnn of Exemption,you should
become subject n tba Workers Compensation previsions of the Labor Cone,you mum
.J 0 forthwith comply with men Provisions or this Permit 0.11 be dermad revoked.
,z.t 55 CONSTRUCTION LENDING AGENCY
[r I hemhy afflm that inert is a commas..kndingagrncy fm the perfurmanm of
Cli i
the wart fm which this permit Is wood(Sec.3097,Cl,C.) .
W�Q Lenders Num
7 z Lenders Addma
UO I certify that I luve red afiu
this appdan sish
on and sum thn ave km
fowwr
n
Uy carrces.l agree to comply with all city and county ordinances and sale Is"mining in
C)T' building comuuction.and hereby authorize tepseseeasves of this city to enter upon that
W above-mensaned property for inspection purpura
(We)agree to UK.indemnity and 4sp humlea Use City of cuperdno agunm
cn Iiabillses,judgments,coin and expanses which may in any way mane against mid City
in Comermancen Of'be 1.11.2 of this
U?
APPLICANT UNDERSTANDS AND WILL AND WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
HAZARDOUS Signuum of AppliceHAZARDOU Den
S MATERIALS DISCLOSURE - Type Of ROOF
WIII the applicant or Enure Wilding aupant uore or handl haysMons material
u dented isin Cupertino Municipal Code.Chapter 9.1;and en Hulth tea Safety
Code.semeo n 25537(+)7
❑Yee ONO All roofs shall be inspected prior to any roofing material being installed.
0ser ct
W1,11 the applicant or future building occupant erequipment m device,which If a roof is installed without first obtaining an inspection,I agree to remove
t c.. aw air contaminants a deflated by the Bay Area Air Quality Management all new materials for inspection.
7
❑Yes ON.
I have real the hnardons materials requirements under Chapter 6.95 ofthe Cslifor- -
naHealth&SafctyCons.Sas.75505.25533 and 25534.I undcxmand Nu if sin Wilding
dos an,curransy base a seu•ak that It r my rupowaiilly to mairy One nexam aof also '
requirements which mum W met pd.,to hal-ace ref.Culafeeo of Decamme,. Signature of Applicant Date
Ownc,or aNari>=d span Den' All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 36929031: 01
DATE ISSUED. . . . . . . : 08/19/2008
RECEIPT # . . . . . . . . . : BS000005822
REFERENCE ID # . . . : 08080136
SITE ADDRESS . . . . . : 10403 SOMERSET CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . ... : KAI PENG
ADDRESS . . . . . . . . . . : 10403 SOMERSET CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
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 106 . 56 VISA
---------------
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
•
Permit No: Mo p 0 3 b 412958
(office use only)
City Of Cupertino Building Permit Application
E-Mair' Building-Permits(cDcupertino.org (Address Is case sensitive).
Jobsite Address:10403 SOMERSET CT Date: 8/18/08
Assessors Parcel Number: 3(09 29 03 1• 061
OwnersName:.PENG, KAI Phone No: (408)886-8817
Project Valuation: 449.00
Building Permit Infd:l 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: 12801 132ND AVE NE E-mail:carolr(dfasWaterheater.com
i.
City, State & zip code: KIRKLAND, WA 98034
State Contractors Lic, No: 877489 Explratton Date: 5/31/10
Workers Comp No: 1761660 Expiration Date: 12/1/08
Carrier: California State Fund
City of Cieertino Business License No: 29100
Credit Card Information
Credit Cera No: Expiration Date: 11/10
,
Name on Card: Jeff Jordan
Visa 01, MasterCard ❑ American Express ❑
The Building permit application and a completed &signed
contractor/subcontractor form need to be submitted with each permit.
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)Tn-3228
400 Fax(408)777-3333
•CUPEkTINO:'
Building Department
JOB ADDRESS: 10403 SOMERSET CT PERMIT#
OWNER'S NAME: PEND, KAI PHONE# 408)886-8817 lP
GENERAL CONTRACTOR:FAST WATER
HEATER COMPA FAX# 425-814-9516
m
I anot usingeny subcontractors:_ �° � 8/18/08
Signature Date
Please check a ' licable subcontractors and complete the following information:-
SUBCONTRACTOR
nformation:SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets&Millwork
Cement Fuushing
Electrical
Excavation
Pencing
Flooring:Carpeting
Linoleum/Wood
Glass f Glazing
• Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental ShM Metal
Paint ipg/Wallpaper
Paving
Plastering
Plumbing
Roofing `
Septic Tank
Sheet Metal
Sheet gock
Tile
Owner/Contractor Signature Date