04030188 ` CITY OF CUPERTINO
BUILDING DIVISION PERMIT e ONTRATZU'WC-,T�,ORINFsORMATION ,
BOILDING ADDRESS: HOT WATER INC PERMIT NO04030188
7519 BARNHART PT,
OWNER'S NAME: PERMrr ISSUE DATE
GADDE VIJAY 9531 GRACE-LANT) AITT7. 112 /24 /911104
ONE: SANITARY NO. CONTROL NO,
(650) 298-8494
ARCHIIECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION _ y� O O O O
u 1wmby M.that I am Iiavcd under pmvWaruof Chapter 9(commencing �` bDescfl tW
With Section 7")of Division 3oftho Budneu IF Code.and my lkcue is r
In mu come a ad aRtn' _ REPLACE W TE HEA
z
Lk , G.3(� Lice
Conduct., o
yyy+++ ! -` AR CHITECTS DECLARATION
�i I undcrsusnJ my plw Mall w usul u puhlic rtcorda '` 'r
7
o Licensed ProRuleast
OWNER-BUILDER DECLARATION
m 0 I hereby affirm Thal 1 I. exempt from dr Contrarao License Law for the
iOO following wan. cerin ID3LSBusiness
mpr Profession Code:My city or county .
$ilii whichitsissuance.
requires a permit re cares the pier.improve,demolish.t m e a sig ed structure
pdunoitsissuance,rsu requires the inion of forthe such panni'tofilem Law(Chmmnnt
=�< that Ine("roma caused Section
In the provisions of the the
Liccnsc lsw(C Code)or Sq. Ft. Floor Area Valuation
�$
("romancing Is axe pt Sermon andl00M be Division r of the al eged Business And Proficulon.mynas CMc)of
Nat he b exempt therefrom arM the buts for de alleged exemption.My violation of
Section 7031.5 by any applicant for a permit nbjcots the applicant to a civil penalty of 3 @&N6QMer0 0 Occupancy Type
not mom Nan five hundred dollars(5.500).
❑1,a owner of the pmpeny,ser my employm with wges u Their sole eompenudon.
wUldotheworkendthewnvrtisnolinsendedoroRerttlfonatn(Sa.70N,Budmss
And Professions Code:;Ta C.Ame mes Lt..Law dm Required Inse not apply to an owner a( q p
property w ho wildsor imp roves demon,and who does such work himsel f or through his
own employers,provided that such improvements art not intended oroRemd for sale.If.
haweva.the building or Improvement Is sold within On,year ofcompledon.the owner- t "'
builder will have the burden of proving dust N did rot build or improve for purpose of
uie.).
1,u owam of the property,am exclusively contracting with licensed contractars to
convect the project(See,]014,Buinass and Profusions Code:)The Conaactor's Li.
cause Lew does not apply m an owns of property who builds or improves themon.and, .
who contracts for such projects with a eonuatar(s)liceued pursuant w the Convector's
License Law.
XP
ri 1 am exempt under Ser. .B As P C for this won
Owner Dose
WORKERS COMPENSATION DECLARATION
I hemby alTitm under penalty of pujury arc of the following declarations:
1 hew and will maintain aCeniOcase of Consent to self-inaum for WorkeriCompen-
ICIA"U'r
tian,u provided for by Sadon 7700 of the Iswr Code,for the Performance of tht
rk for which this permit is iesuM.
eve and will maintain Worker's Compensation Insurance,u required by Section
of
mal
Cade.for the pofmmua of the wok for which thin permit is is.sued,
y Worker's Cnm��ll melon Inunna canis rd Policy numberf�fti i"U" policyNo,;
CERTIFICATE OF EXEMPTION FROM WORKER
COMPENSATION INSURANCE
('Dib action need not hecompleted Ifthe Permit Is forone hundred dollan($100)
ser kat.)
1 unify that In the perfarmance of the work for which this permit is issued.I shall not
employ any person in any meaner an As to become subjut to the WorkersCompensation
Lew of Celifmnia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenificale of Exemption,you should
become subject a the WOrkCe3 Compmealion provision of the Labor CadC,you must
0z foMwidb comply with such provisions a this ream t shall In,deemed revoked.
Z " CONSTRUCTION LENDING AGENCY
[r 14 I bemhy arum Not there 4a conuuatinn lending agency for the performance of
!Yi 7 de work for which thin Permit 4 Island!(Sec.3097,Civ.C.)
WM Q Lender's Name
D z Lenders Addw
U2 1 artily that I have read this application and sea that the above information is
f' comet.1 Agra to comply with all city and county on inrm and atse law relating At
tJ V building comtrucuan,aml heroby ootbarise repruentstive5 o(this city to enter upon the
W awvnmentiuned popeny
for inspection puryotu.
d (We)agree m ave,indemnify and kap harmless the City of Cupertino against
.r rA Ilabilldn,Judgmcnu.cmu and expenses which may in any Way ensue Against said City
C)',Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU O
(� l r D Qj Z4_l/6Lj Re-roofs
Signature of ApplianVConusewrI Gad
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building acc.puuurt Or handle hussdous materiel
As defined by Inc Cupertino Municipal Code.Chapter 9.13.And the Health and Safety
Imqde,Schon 35533(¢)?
❑Yu ON. All roofs shall be inspected prior to any roofing material being installed.
Well the applicant or fulum wilding occupant as equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hanmous air contaminants u dcfincd by the Bay Area Air Quality Management all new materials for inspection.
D40ct?
Oyes ❑Na
Ihlkslth&SafstyCadn,Sccdon25505,25533am125534.1undomm�dWtifthe holding
m not caocmly have a tenrk that It 4 my msposeabi ty m nodry the aaupant of the
uiremcnu whic�n et poor ro kcsuaa of a CertlEcee of Oaccupan Signature of Applicant Date
Owner or autho ed agent U� Data All roof coverings to be Class"Bo or better
alo
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPEI�TINO
Buildin De utment
JOB ADDRESS: PERMIT#
88
OWNER'S NAME: J4 /Z/ 66SCq j-
PHONE
GENERAL CONTRACTOR FAX # -g
I am not using any subcontractors: �� Z
Signature Date
Please check applicable subcontractors and complete 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 c �wC,
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
/ \ Q�
Contractor Signature ✓ Date
CITY OF CUPERTINO
WATER HEATERa3
CUPEkTINO PERMIT APPLICATION FORM
APN # 3 (0&
- & _ 1� _O 3 Date:
Building Address:�U �5 ' a r n 6 a r� P/1
Owner's Name: J Phone #:
Contractor: Pho e: (0License#:
HOT WATER INC. Z-
Contact: 63 INDUS!KIAL ROAD ITD
SAN CARLOS, CALIFORNIA 9N40 0 Phone: Cupertino Business License#:
ai
Building Permit Info: m
Bldg ❑ Elect ❑ Plumb M-// Mech ❑
Job Description: lal -k , ` �
Residential EEK Commercial ❑
Cost of Project: S�Q�
Strapped UZ On Platform EV Bogded
New Location ❑ Replacement
Qty. if
A licable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMTI'FEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLTC Business License BUILDING
46
S