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08110043 CITY OF CUPERTINO - BUILDING DIVISIrN PERMIT �CmNTRACTt3R.INb'ORMAT,IOIV BUILDING ADDRESS: PERMIT N0, 7652 WEST H FAST WATER HEATED OWNER'S NAME: PERMIT ISSUE DATE NF' A 0. CONTROL NO. (800) 454-8955 ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 !o Zp LICENSED CONTRACTOR'S DECLARATION miI homey affirm that 1 am lianad under Provisions of Chapter 9(commencing Job Description < wide section 7")of Division 3 ofihe Busircss and Professions Code,And my license is i fmOromAanoeffea REMV/REPLC GAS WATER HEATER , vy a Date Class Con p SFO Date - Contractor As shall ECI'S DECLARATION W U 1 understand my plans still M used as public recon4 1.0 Licensed Professional 5 OWNER-BUILDER DECLARATION I 1 Mrtby aRm Nat I em ncmpr an from dee Cmnuofs License Law for tic 0 O following masons.(Sectico 9031.3,Emotions;and Professions Code:Any city or county 4.9 which requires A permit m canurvct.alter,improve.demolish.or repair any ummure °i'n pnW b its issuance also sequin the applicant for such Permit to file a signed suwmem < thnM ulieensed pursuant to Me provisions of Ne Contratewea Lceme Law(Chapter9 Sq.Ft.Floor Area Valuation y�� (commencing wish Section 1000)of Division 3 of tie Business and Professions Code)or y`< Nat he k seempr Norefrom and Mc basis for she alleged eaemption.Any violation of $449 Seed.7031.5 by very applicantfor A permit subjects she applicant m a civil penalty of APN Number Occas TyeP e not more Nan five hundred doll.($500). Occupancy s7 I,asowner of the ro 36227022 . 00 enc ❑ p puty,mmycmonendes w;shwagnu Neuro.compcwtinds will do deew..and the Absolutecrn ts rottmndetl Law do smut(Sec.AnAn Burinw And property h Im Code:The Conhacwh ml Who Law arcs nos apply lf rt ownsr of Required Inspections propertywho builds dedtham Neuron,andwho An,not chw oro lredWosle his own employees.p building or Nu such improvements ase not intendedofcc mpletired for ole,If, howeveWilder Neave Me or improvementg soldwhhinon Mev of mproeforn.theose of Wilder Will have the bumien of proving Nat bo did rot bufltl or Improve for purpose of ' Q 1,u owner of dee property,am exermnvely conlncting with licensed m nmman m consumer Me Pmject(See 1004,Economist and Professions;Cade:)The Connacmrs Li. corse Law does not apply As An owner of property who builds or impmm thereon.and, who contracts for such projects with A contractor(s)licensed purmant to IM Contractor's Lkerta Law. ❑1 Am exempt under Sec ,B k P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under porosity of perjury one of she following decleraumts 41 I have and will maintain a Certificate of Consent to self-insurt for Worker's Compen- on,Af provided fm by Section=of Me Labor Code,for Me performance of Ne work for which this Permit is issued. ❑1 have and will maintain Worse.Compeswtion I.,As required by Senior 3100 offt lsbor Code,for dm penormanee of the work for which Nis permit is Issued. My Wortefs Compensation Ltsurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMP 70N FROM WORKERS COMPENSATION INSURANCE (Nis section reed not be completed If the permit Is focone bottomed dollars($100) or less) 1 certify Net in Ne pesfmsnance of Ibo wort for which this permit u issued.l shall rot employ my person in any manner an As in become subject to the Workers'Compensation Laws of Califomia Due Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subject w Ne Workers Compensation provisions of Ne ISM,Code.You mum rJ z feMwiN comply with such provisions or this permit shall M deemed revoked. Z O CONSTRUCTION LENDING AGENCY r� [—t IMrewhich Mi Upe Vert uacomwc.construction agency for the performance of [Yi Ota work for which Nu permit ts issued(see J097,Civ.C.) aA Lenin's Name Z;) z I<nder's Address t.)p 1 certify that I have mad this application and sum shat the above informadon is [T. F comm I agree in comply with all city and county ordinances and sum laws relating to 0U building construction,and hereby aothonm representatim of this city to cnen upon Ne r W &hove-mentioned property for inspection purposes. f~pry, (We)agree to save,indemnify tad keep harmless the City of Cupertino against liabilities.judgments.costs and expenses which may in any way accred against said City U Z APPL Cn permit. ANT UNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signuurt of APPIicanUCmARDOr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Willy the Cuperor tino Municipal ode.Chaptuomorand M Hmflo ad as da.Sed by the Cupenins MYnleipal Cade.Chapter 9.12,sena tiro Hea1N and Safety Cade,Section 253334)1 0y. ❑No All roofs shall be inspected prior to any roofing material being installed. Aft Will Me applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove Wsvit havardons air emommimas nts defined by Ute Bay Area Air Quality Management all new materials for inspection. ctT ❑Yn ONO 1 have read dee haaatdats materials requiromceds under Clu aw&95 of Ne Califor. mAHealth S9ctyCoM%Smimu 25503.25533 and 25334.1uMrrmarW tMatifde building don not currently hate A Imam that it u my respomibility w miry the occupant of the mquimmenu which mum be met prior m issuuwc of a Ccrdfin of amps . Signature of Applicant Date All roof coverings to be Class' or better OwnermuthoNeO agent Dam' g n CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36227022 . 00 DATE ISSUED. . . . . . . : 11/12/2008 RECEIPT #. . . . . . . . . : BS000006589 REFERENCE ID # . . . : 08110043 SITE ADDRESS . . . . . : 7652 WEST HILL LN SUBDIVISION . . . . . . . CITY .. . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER KIDD LEWIS L AND CAROL A ADDRESS . . . . . . . . . . : 7652 WEST HILL LN CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5057 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 • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CI Fax(408)777-3333 • CUPERTINO BuRding Department JOB ADDRESS: 7652 WEST HILL LN PERMIT# n (�2 OWNER'S NAME: KIDD, LEWIS PHONE# 408)446-0508 ( J GENERAL CONTRACTOR:FAST WATER HEATER COMPAN FAX# 425-814-9516 I am not using any subcontractors:_ "' p 11/11/08 Signature Date Please check applicable subcontractors and coinplebe 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 • Permit No: 09't` V 421922 (office use only) a • City Of Cupertino Building Permit Application E-Mail: Building-Permits(a)cupertino.Org (Address is case sensitive). Jobsite Address:7652 WEST HILL LN Date: 11/11/08 Assessor's Parcel Number:�4,ZZ- O )_2_, 1,(3 Owners Name: KIDD" LEWIS Phone No: (408)446-0508 Project Valuation: 449.00 Building Penult 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: 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: 877489 Expiration Date: 5/31/10 Workers Comp No: 1761660 Expiration Date: 12/1/08 Carrier. California State Fund City of Cupertino Business License No: 29100 Credit Card Information Credit Card No: 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.