07110122 CITY OF C[JPERTINO �� ' ` °
BUIL37NG DIVi�S�ON PE1�1v11T �������� ���������' `
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BUILDING ADDRESS: PERMTf NO.
10575 GLENVIEW AVE FAST WA��ER HEATER 07110122 .
v�VNER'S NAME: ����
KIM YOUNG 1260 1: 32 AVE NE � 11/21/2007
PHONE: SANITARY NO. CON7ROL NO.
( 800 ) 4!i4-8955
ARCHI'IECT/ENGINEER: BUiLDING PERMIT INFO
BLDG ELECf PLUMB MECH
� � � 0
u O p LICENSED CONT[tACI'OR'S DECLARATION JOU DeSCflpUOfl
;� �� I hcrcby affirm �hat I am liccnsed undcr provisions of Chap�cr 9(commencing
_ z W wi�h Scction 7IX10) of Division 3 of thc Busincss and Rotcssions Code, and my licensc is REMO VE /] tE P LAC E CiA S WAT E R H EAT ER
'� y in full farce and e
� Z Licenac Ca�s �' L�. K
n F- 0 DaIC !� — Conlracmr �� �,�
� ARCHiTECI'S DECLARATI
I underslanJ my plans shall be uscd as public rccords
W
4
U
`Q y Liccnsed Rufessional
n y 3 OWNER-BUILDER DECLARA170N
� <� I hcrcby affirtn that 1 am excmpt from thc Con�ractors Liccnsc Law for thc
L O O Collowing reason. (Sxtion 7031.5, Busincss and Profcssions Ca1c: Any ci�y ar county
K m Pi which �cquirct s permic to conswc4 al�cr, impmvc, dcmolixh, or repair any swcwic
y Z� prior io i�s issuancc, alsu rcquircs ihc applicant for such permit �o filc a signcd statcmcnt
�= 0 �hat he is liccnscd pursuant lo �hc provisions oC ihc Conuactor's License law (Chaptcr 9 iq. Ft. Floor Area $ 4 4 9 Valuation
� I— $ (commencing wiih Section 7000) of Division 3 of �he Business and Professions Code) or
y �'. Nat he is exempt theccfrom and t6e basis for the allcged eumption. Any violadon o(
Section 7031.3 by a�ry applicant fw a pertnit subjecu �he applicant to a civil penalty of Number Occupancy Type
not mme �aa fiw hund�ed dollars (SS00). 3 6 9 2 6 0 2�).`
❑ I. u owncr oCtl�e propecty. or my employcea with wsges at du'v solc compensadon,
will do the wodc, snd �he stmcwrc is not intendcd or ollered for sale (Sec. 7044, Husiness Re uired Ins ections
and Protessions Code: The Conuactor's License Law do�t not apply ta an owner of 9 P
property who builds a improves �l�ercon, and wAo does such work himut[ or through his
own employces, provided tha� such improvemrn�s ue not imended ar olCered for sala ff.
however, the building or improvement ia sold within one yeu o( compledon, the owner-
builder witl have the burden oC proving �a� he did not build or improvc for purpoae of
sakJ.
❑ 1, as owner of the property, am �acclusively conuacting wi�h Rcensed rnnuscturs to
consuuct the pmject (Sec. 7044. Business and Professions Code:) The Contruwr's Li-
cense Law dacs not apply to an owner of propeny who builds or improves thereon, and ,
who conuac�s for such pmjec�s with a convactor(s) Iicensed purswnt w �he Convacwr's
" '^.ense Law.
1 am exempt under Sec. . B dc P C for ihis rcason
Owner Date
WORKER'S COMPENSAT[ON DECLARATION
1 hereby afficm under penalty of peryury one o[ the following decianlions:
❑ I hsve and will mainuin s CeniGnte oC Content to ul(-insurc Cor Worker's Compen-
sarion, as providcd for by Secdan 3700 af the Labor Code, for �he performancc oC �he
work for which this pertnit is issued.
❑ I havc and will mumain Workcrs Compensation Insurana, u rcquired by Scction
3700 of �e Labor Codc, Cor thc performancc of �he wort for which this permit is is�ued.
My Worke�s om ensa�ion Insunnce rticr Poliry numbcr am:
�u; � licy No.:
CERTIFICAT OF CEMPI'!ON FROM ORKE S'
CO PENSATIONINSURANCE •
(This scction necd not be canpleted if the permit is for anc hundred dollara (S 100)
or Icss.) '
I cenify that in thc pertorma�rcc of thc work for which this pertnit is issued. 1 shall not
employ any person in my manner so az to become subject to the Workers' Compensauon
Laws of Calitomia. Date
Applicant
NOTICE T'O APPLICANT: lf, aficr making �his Ccrti�ca�e of Excmption, you should
become subject �o the Worlcer's Compensation provisions of We Labor Code, you muu
� O fortAwith comply wi�h such provisions or this permil sha�l bc dccmcd revokcd.
z ""' CONSTRUCTION LENDING AGENCY
F r ►�—� I hercby sflirm Uut there is a consuuction lending agcncy (or �hc performance uf
(Y, � ihe wurk for which ihis pertnit is iuucd (Scc. )097, Civ. C.)
W Q Lendcr's Namc ^
? z Lcnde�s Address
V � t cenify �hat I have read this application and siatc �AU �hc a6ove intormadun is
w� cortec� I agree w comply with all city and counry ordinances and suie laws reiaung to
0 U building consuuction, and hereby authori�t representauvcs of this city w cntcr upon the
� w abovc-mcntioned property for inspccUon purpoxs
a (Wc) agra to save, indcmnify and keep harmless �he City of Cupenino against
�� liabiliuu, Judgmcnls, costs and expcnsea which may in any way accruc against said City
U'",� in consequencc oC the granung of �his permit. Date r� '�
� APPLIC UNDERSTANDS AND W1LL COMPLY WITH ALL NON-POINT Issued by: �'
SOUR GULAT(ONS.
- Re-roofs �
o ApplicanVConuactor Da�
HAZARDOUS MATERIALS DISCLOSURE Ty� Of R� )Of
Wil1 Ihe appliant or futurc building accupant storc or handlc ha•rardous ma�criil
dcfincd by the Cupertino Mmricipal Code. Chaptcr 9.12, and �he Health and Safcty
�� Section 25532(a)? / All roofs.: hall be inspected prior to any roofing material being installed.
❑ Ycs (�No
Will We a�licant or futum Duilding occupant use equipmcnl or devices ahich If a roof i: installed without first obtaining an inspection, I agree to remove
emii harardous uir conwninants dcfined by the Bay Area Air Quality Managemcnt all new m; iterials for inspection.
Disuic�?
� Ycs �Nu
1 havc road the ha�ardous maicrials requi�emcnts undcr Chap�cr 6.95 of drc Cali[or-
nia Flcalth & SafctyCodc, Scctians 25505.25533 and 25534.1 undcrs�and �hat if �he 6uilding
docs not cwren�y havc a mnan4 Nat it is my responsibility m notify thc occupant of the
rcyu�re n which must be met prior to issuarice of a Ccnificate of Occupancy. S 1gI18tUCe )f APpI1CZf1� Date
�r C All roof coverings to be Class "B" or better
cr or au�horized agcn� ���
CITY OF CUPERTINO
4 ITEMS OF 24 PERMI7' RECEIPT OPERATOR: SylviaM
COPY # : 3
Sec: Twp: Rng: Sub: Bl}�:: Lot:
APN ......... 36�26020.00
DATE ISSUED.......: 11/21/2007
RECEIPT #.........: BSC00003298
REFERENCE ID # ...: 07]10122
SITE ADDRESS .....: 10_`75 GLENVIEW AVE
SUBDIVISION .......
CITY .............. CUYERTINO
IMPACT AREA .......
OWNER ............. KID[ YOUNG
ADDRESS ..........: 10`_75 GLENVIEW AVE
CITY/STATE/ZIP ...: CUF'ERTINO CA, 95014-4567
RECEIVED FROM ....: FA;�T WATER HEATER C
CONTRACTOR .......: JEF'F JORDAN LIC # 29100
COMPANY ..........: FA:�T WATER HEATER
ADDRESS ..........: 12E�01 132 AVE NE
CITY/STATE/ZIP ...: KIF:KLAND, WA 98034
TELEPHONE ........: (8(i0) 454
FEE ID UNIT QUANTITY �LMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --�-------- ---------- ---------- ----------
BSEISMICRE VALUATION 449.00 0.50 0.00 0.50 0.00
PPERMITFEE FLAT RATE 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 : 106.56 0.00 106.56 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
From: 10/11/2007 10:Z7 �647 P.002J0�
380407
�� oF cLr�ERZ�o
WATER F��iTER
CUPEI�TiNO PERMIT A►P'PLI(;ATION F4RM �, b ��
APN#� l�v2C�C1��•� Date:_ !�-�
.��i' • �- I
Building Address:
10575 G1..ENVIEW AVE
�w�'s Name: Phonc #
KIM YOUNG 951 201-8$94
����r Phone #
FAST WATER HEATER COMPANY 500-�454-8955
Cupertino Business Lioease # State License #
29100 877489
Building Permit Info:
Bl file�t lu m Mech _
Job Dcscripdoa:
RemovelReplace Gas Water Heater
Residential gJ Comm�ercial ❑
Cost of Projoct:
4a8.00
Stiapped �uu Platfota► Bonde�d
New Location � t �
A�� 'cable Fee ID Fae Descri tion Fee
� PRWI�ATR Residentiel Watcr Hea�er Nent BUII.DING
pCWHEATR Coa�mercial Water HesterNent BUlLUING
1 PP�RIVIITFFE Plurabing Pemnit Issuance PLUIV�INCi
1 1RAyi)OC 7Ya��e1 �t Documentatioa Fee BiTbDING
BUSLIC Bu�ness Licensa BiT�IDNt3
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