07100049 CIT�' OF CUPERTINO " ` ' '
BUILDING DI47510N PERMIT C�.1�T7E�i �:�� Z������'TI(�N ::
,;:. . . ..; _ .
> ;
PERMIT NO.
BUIL �c.�p�R ,�,��IN WAY FAST WA7'ER HEATER 0 710 0 0 4 9 .
PERMIT LSSUE DATE
OWNER'S NAME: ,
BREUNER J OHN Y AN N ANCY L 12601 1�2 AVE NE 10/05/2007
�N�'� r T
SANITqRY NO. CONTROL NO.
( 800 ) 4��4-8955
BUILD[NG PERM(T INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
�� � � �
i p Q LICENSED CONTRACfOR'S DECLARATION JOb DeSCilptlOfl
� V� I hcrcby aCGrm that I am licenscd umlcr provisions aC Chap�cr 9(commencing
;Z� aiUiSec�ion7000)o[Division3ofiheBusincssandPrafcssiunsCode REMOVE/F:EPLACE CiAS WATER HEATER
�= y in full forcc and e C C � � G f
� v� Z Licensc Class L�. X
p Datc Conuad,or
: F ' � A CHITECI'S DECLA
i� a
a I undcrstanJ my pians shall bc useJ as public rccorcls
)qU
' a y Liccnscd Pmfcssional
: a < OWNER-BUILDER DECLARATION
� a� 1 hcrcby alTirm that 1 am cxcmpt from tLc Cantractor's Liccnsc Law far thc
p O Collowing rcazon. (Scctiaa 7Q31.5, Busincss and Profcssions Cafc: Any ciry ar county
�,°, �i which requires a permit to conswct, altcr, improvc, dcmalish, or repair my structurc
�"�+ prior ui ils issuancc, alw requires thc applicant for such permit to filc a signed staicmcnt i, Valuation
- ?< tha� 6e is liccnscd pursuant to thc provisions of thc Contractur's Liccnsc Law (Chaptcr 9 . � q. Ft. Floor Area $ 4 4 9
� t �(commcncing wiih Secdon 7000) of Division 3 0( ihc Businrss nnd Profcssions Codc) ur
y�� that Ae is exempt Ne�efrom and the buu Cor We allegcd exempdon. Any violation o[
Section 7031.5 by a�ry applicant tor a pertnit subjccts ihe applicant to a civil penalty o( 3 5 9 2 0 01: _�(� Number Oceupancy Type
noc more U�an fivc hundrcd dollars (5500).
❑ I, as owncr oC the property. ar my employces with wages az their solc compensation,
will do �hc work, and ihe struMUm is not intended or ofteced for salc (Sec. 7044. Business Required In�pections
and Professions Code: The Conuactor's License Law docc na[ app1Y to an owner o(
propeny who builds or improvu thercon, and wha does such work himulf ar Nrough his
own employces. providcd that such improvements are not imm�ded or oRered for sale. I[,
however, the building or improvement is sold wilhin one year oC complcdon, the ownu-
builder will have the butden of proving Ihat he did no� build or improvc for purpox o(
sak.).
❑ I, as awner of �he property, am esclusively conuacting wiih licensed conuattors a
conswct the project (Sec. 7044. Business and Professions Code:) The Conuactnr's Li-
ccnse Caw does not spply to an owner of propeny w6o builds or improves Ihemon, and .
who contracts fot such projects v+ith a convactor(s) licensed pursuant to the Canvacrors
License I.aw.
❑ I am exempt under Sec. . B dc P C tor this reaton
Owner Date _... _:
WORKER'S COMPENSATfON DECLARATION
I hercby �rm under penalty of pery'ury one of the (ollawing decfaruions:
❑ I hs+e and will mainuin a CertiGam of Conunt to sel(-insme for Workcfs Compen-
satian, as providcd for by Secdon 3700 of the Labor Code. for �he performance o[ thc
woric for which Ihis permi[ is issucd.
❑ I have and will maintain Worker's Compensation Insurance, u requircd 6y Section .
3700 of the Labor Coda Cor the performance of the wort far which this permit is issued.
My Worker mpensauon Insurance carricr d Poliry number are: �
Camer. alicy No.: --�� ��
C RTIFICA OF X PI'ION FROM WORKERS
CO PENSATIONINSURANCE
(ihis section necd not be comple�ed if the pertnit is for onc hundred dollars (S 100)
or Icss.)
I cenify that in thc performancc of ihc work (ar which �his permit is issucd, I shall not
e�ploy any person in any manncr so az m bccomc wbject �o U�e Workcrs' Campensation
Laws of Cali(omia. Datc
Applicant
NOTICE TO APPLICAM: if, aftcr making Wis CcrtiGcatc of Faccmpaon, you should
become subject to lhe Worker's Compensadon provisions oC the Labor Codc, you must
� O farthwi�h comply with such provisions or this pccmit shall bc dccmcd revokcd.
z ""' CONSTRUCPION LENDING AGENCY
(.�.+ .�-� I hereby aRirm ihat there is a consuucti�n tending agency for the perfurtnance oC
pG � �hc wurk fur which ihis permit is issued (Sct. 3097, Civ. C.) ,
W A Lendcr's Narnc
� z Lender's Address
() � 1 cenify �hat I havc rcad this application and siate U�at �he above in(onnauun is
w � cortcci. I agree to comply with all ci�y and county arefinances and swte laws rclating to
� U building conswction, and hemby authori�e rcprcscntativcs of ihis ci�y to cntcr u�n thc
� W abovc-mcntioncd property for inspccuo� purposes.
� (Wc) agree to save, indemni(y and kccp harmless U�e City o( Cupertino against
�� liabiliuu, judgmcnts, costs and expcnscs which may in any way accruc agains� said City
(} ,'� in consequcnce oC tAc granting ot this permit.
� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by Date ���
SOUR LATIONS.
� Re-roofs ��
ppplican�Conuacar "� T of R oof
HAZARDOUS MATERtALS DISCLOSURE YPe
Will ihc applicant or futurc building acupant swrc or handle harardous matcrial
az dcfined by lhe Cupenina Municipal Codc. Chaptc� 9.12, and thc HealUi and SaCety
Codc, Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑ Y� �� -
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use eyuipmenl or dcvices which
cmii harardous air conwninanu az dcfincd Ay ihe Bay Area Air Qualiry Managcment all new rr aterials for inspeciion.
a:u���� �
❑ Ycs �
I havc rca�i the haiardous mamrials requircmcn�s undcr Chap�cr 6.95 of ihc Califor-
nia Hcalth & Safcty Codc, Scctions 25505, 25533 and 25534.1 unckrsund �hat if thc building
docs noi curtently hare a Icnan4 �at il'u my responsibilily to noul'y the occupant nf �hc
reyuiremc ust bc mel prior w issuance oCa Ccnificatc of Occupancy. S jgngtUC2 Of ApPI1CSIlt Date
All roof coverings to be Class "B" or better
authorizcd ag t ���
r
From: 10/04/�07 15:13 �493 P.D04I009
� �/ C� � C� `� ssoaso
CITY 4F CUPERTINO
WATER HEATER
CUPEI�,TINO P�RMIT APPLICA►TION FORM
,�N # �59 0� � C� II. � � �r�: � � d
?
B,�ilaing Add�s:
7577 ERIN WAY
Owaer's Naa�e: Phone #
DRUENER JOHN 408 252-1820
C �� FAST WATER HEATER COMPANY P 80�0-r454-8965
Cupertino Business Licxnse # State License #
29 00 877489
Buildi.ng P�rmit Info:
Bl �t� Ivn ec
Job Descriptian:
RemovelReplace Gas Waber Heater
Residential �] � Commex�cial �
Cost of Projext:
449.00
Strappod On Platfvrm Bonded
New Location � lac�anent �
Qh►• �
A'cable Fee ID Fee Descri 'on Fee Gro
� PR�VI�ATR Resid,�tial Water Heatier Nent BUII.DING
PCR�EA1'R Comtzercial Waber HeaterNent BUIIrDlNG
1 PPE�PS�!`F�E Pl�ml�ing Permit Lssuance PLUMBING
1 TRAVDOC Travel & D�tation Fee BUII,DII�TG
BUSI.IC Busin ess License BUII..IDNC3
CITY OF CUPERTINO
3 ITEMS OF 6_ PERMI7' RECEIPT OPER.ATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Bl}:: Lot:
APN ........ 35�20011.00
DATE ISSUED.......: 10�05/2007
RECEIPT #......... BS(�00002899
REFERENCE ID # ...: 07�.00049
. SITE ADDRESS .....: 75"'7 ERIN WAY
SUBDIVISION .......
CITY .............. CUI'ERTINO
IMPACT AREA .......
OWNER ............: BRI;UNER JOHN Y AND NANCY L TRU
ADDRES5 ........... 75"'7 ERIN WY
CITY/STATE/ZIP ...: CUl'ERTINO CA 95014
RECEIVED FROM ....: FWI� P,CQUISTION CO
CONTR.ACTOR .......: JEI�F JORDAN LIC # 29100
COMPANY ..........: FA:�`I' WATER HEATER
ADDRESS ........... 12�i01 132 AVE NE
CITY/STATE/ZIP ...: KIItKLAND, WA 98034
TELEPHONE ........: (8i)0) 454-8955
FEE ID UNIT QUANTITY ��NlOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
PPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00
PRWHEATR UNITS 1.00 24.48 0.00 24.48 0.00
TRAVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 106.06 0.00 106.06 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME `. `205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
309 EXTERIOR LATH 310 INTERIOR LATH
311 SCR.ATCH COAT 313 ROOF NAIL
Community Development
�` ` � .,� 10300 Torre Avenue
;�,` ,' ; ��, . .
� . Cupertino CA 95014
Telephone (408) ?77-3228
CITY OF Fax (408) 777-3333
';UPEI�TINO
Buildi:n De artment
JOB ADDR S�, � � PERMIT #
-� ��� ��
OWNE 'S NAME: o PHONE # --'`� S'�/,--� S�`
GENERAL CONTRACTOR: �q o. FAX #
I am not using any subcontractors:
Si�;nature Date
Please check a licable subcontractors and com �lete the followin information:
SUBCONTRACTOR BUSIrfESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
IIectrical
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
_ �D�,�'-�T
er/Contractor Signature Date