08030036 CTT
BYU . G DIVisION' PERMIT aCOi�I,TRACTQR�INF(?.RM,� E1 ,'„
BUILDINGnOF AIIINDDRESS: PERMITNO.
10430 CHERRYTREE LN FAST WATER HEATER 08030036
OWNER'S NAME: PERMR WUEDATE
PHANINDRA YARLAGADDA 12601 132 AVE NE 03/07/2008
ONE: - SANITARY NO. CONTROL NO.
ARCHITECffENGINEEK: BUILDING PERMRINPO
REMOVE/REPLACE GAS WATER 'BLDG eLEcr rn.uMa Mecx
�o0 LICENSED CONTRACTOR'S DECLARATION HEATER
l Job Description
OF 1 herby affirm that 1 we Become under pmvWom of Chapter 9(commencing p
with Seedan7" Di onlofdm Budnw sad Praia i' C stand mylkenseu
n , in ruff some andd arc D4 `
j�z License Cl Lk.S
RCHlsdust man7rS DECLIRA ON
q 1 understand my plans slur]be uarA as public records
IIIi�CCCC Licensed Professional -
h OWNER-BUIIDERDECLARATION
Co. hereby.Rite that I I.S.teempt from Om ConuanCo L ante city
o for the
1§9 D following moa.(Sado]O]Im.abler. and Wofufaiom Cade;Any rity or aunty
which rtquira n e.also ru emmrme Applicant
nt for demolish,m repair any Branum
Nprior mitsissompursamquime pre ilio of ranechpnmit bicesufile am awJrnmmem
S< that he(comesaliantedpurction7 the pmviai000fthc (Chapter 9 Code)or Sq.Ft.Floor Area Valuation
Us. men..,tScNona andtfDivision]close Buaimssninon.M vi Code)or
Out ha u ettmpt,M,wlmm and the basis for era aikged rumptiom My violation of
Section 7071.5 by nryappliant for a permit subjects the applkanl in a civil penury of APN Number Occupancy pry
tet..non fico hundred dollars(57001. P y '1I�
❑L u owner Jf the pmputy,ter my eruployces with wage as theirsale eompemaOen,
will do the.&and theamdum is not intended oraRemA ronak(Sm.7044,Business Required Inspections
and Profession,Cade:The Commutes Licum Raw dn onal apply m an owner of q p
property who Wildsorimpmra Jvmn.and who doessuch wortbivumlfo through his
awn emPlayeets,provided that improwmats art not intended ooReeed foraale.U,
havnec era Wilding or Improvement is sold within oro year of completion.the owner.
Wilder will have the Wuen of proving that he did not build or improve for purpose of
said.).
❑I.u owner of the property are tentatively contracting with Iron-A anuacmn to
construct dm project(Sec.7044,Business and Profession Code:)The Commmors U.
cense law docs that apply n an owner of pmpeny who builds or hap.themed.Ne,
who contracts for such pmjcm with amanlnemK+)licensed punant n the contractors
License Law
❑lameaemptunder Sec ,BkPCrothkrtuon
Date
WORKERS COMPENSATION DECLARATION
I hereby anion under penaity of perjury one of the rolbwing declarations:
❑Thaw and will for by Section
3au of Camentr,CodefumfoWarkeraCompo-
soul,.r pmvidhi for by Britian 1T00 of tic Iabor,Code for the perlomatc of the
wah for which this permit k iseucd.
1 save and will maintain Workers Compensation huntsmen,as required by Section
7700 ofne labor Conn.for the performance of the work fowhich this permit It issued. '
My worese C t e W ce nim and Policy nm
Cartier. Policy No.:
CERTIFICA OFEXEMPIIONFROM I ER '
COMPENSATION INSURANCE
mdo seed.need not be completed i f Ow permit is fa arc hundred dollars($100)
or less)
1 certify era,in the Per..of the work ra which this permit Is louse,l nail m,
employ any person in any manner an as m become subject ro the Workcta'Comper adon
Laws or California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemptim,you should
broom subject le the Workers Compensation provifiom of the saWr Code,you most
.,O forthwith comply with such Provldomi a this permit Mall he second Imminent.
Z D! CONS RUCTION LENDINGAGENCY
[tea I hereby salon that Vco
them is a conuction endingagemy for the performance of
fYr the wish for which this permit ts issued(See.3097,Civ.Q
al Lander.Name
M Z LadCeh Md.
U 0 1 certify that 1 haw teed this application end sum the the.bow information is
UL correct I agree t0 comply with ail city and county consonants and ems laws totting u
0 Wilding concoction,and bcmbyaunoriu repraautiws of this city an cover open the
Lit above-mendom!property for Inspection purposes
C twc)awee m sew,indemnify add keep hamlas the City of Cupertino against
t.y IA Iiabilitim udgmenu.cau and tepenaa which may In any way amne against said City
In consequence of the granting of this permit,
APPLI UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
Sign K Mpplianu an r
T—Dam Re-roofs'
HAZA US MATERIALS DISCLOSURE Type of Roof
WIII the applicant or uturt building=opal or handle havauom maotlal
as defined by Om Cupertino unkipal Code.Chapter 9.12,and the Health and Safety
ede,Section 25532(x)] All roofs shall be inspected prior to any roofing material being installed.
❑Ya o
wit IM applicant or future Willing occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit handon air cmtsmi nu u defined by the Bay Ams Air Quality Management all new materials for inspection.
District?
N.
No
I have mW the It Ject lis requirements under Chapter 6.95 ofthe Caifor.
nu Health @Safety Cade.Sadao 25505.25577 and 25534.I understand noir the Wilding
does tet currently have a oda,Out h e my msP.Mbi]iLY m notify the aeupu,of the
mqm mchmu:tW=Iinner thwtranceOfaccedfesm Signature of Applicant Date
r771701?
owneroraa d7tc!agent D All roof coverings to be Class'J¢"or better
• CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31633047 . 00
DATE ISSUED. . . . . . . : 03/07/2008
RECEIPT #. . . . . . . . . : BS000004105
REFERENCE ID # . . . : 08030036
SITE ADDRESS . . . . . : 10430 CHERRYTREE LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PHANINDRA YARLAGADDA
ADDRESS . . . . . . . . . . : 10430 CHERRY TREE LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2006
RECEIVED FROM . . . . : FAST WATER HEATER
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
---------- ------------- ---------- -----7---- ---------- ---------- ----------
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
IPRWHEATR UNITS 1 . 00 24 .48 0. 00 24 .48 0. 00
1TRAVD0C 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
----------------- --------------- --------------------
CHECK 106 . 56 3519
---------------
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
From: 02/25/2009 14:26 11390 P.003/009
CITY OF CUPERTINO 395692
'' WATER HEATER
0 COPE TING PERMIT APPLICATION FORM
APN# O 3
/� 2✓ 64/700
70O Date: 2/25/08
Building Address
10430 CHERRYTREE LN
Owner's Name: Phone#:(408)757-5205
YARLAGADDA, PHANINDRA
Contractor: Phone#: 800-454.8955
FAST WATER HEATER COMPANY
Fax#: 425-814-9516
Cupertino Business License#: Contractor State License#-
29100 877489
Contact —
Phone#: 800-454-8955
Carol Randall
FaX#: 425-814-9516
Building Permit Info:
ld Elect Plumb x Mech
Residential ❑x Commercial ❑
Job Description:
Remove/Replace Gas Water Heater
Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement
Valuation:
449.00
Green Building Check mast be completed and attached to this application.
Green Building Polos achieved:
From: 02/25/2008 14:28 #390 P.004/009
395692
CITY OF CUPERTINO
WATER HEATER
CUPER,TINO PERMIT APPLICATION FORM
Quantity Fee lD Foo Description Fee Permit Type
Grou
ICWHEATR Commercial Wates B PCV4MATR
Heater/vent
BSEISMICOM Seismic Commercial 13
1 I Pit TR Residential Wator B PRV EEATR
HeateTNemt
BSEISMICRE Seismic Residential B
( / pPlumbing Parmit p
TRAVDOC , Travel & B
Documentation
BUSLYC Business License B
a Community Development
130 Torre Avenue
Cupertino CA 95014
TM Telephone(408)777-3228
CITY OF Fax(408)777-3333
*UPEkTINO
Building De artment
JOB A D KESS: PERMIT #
I�u�1� adv 30 6 40C 1-6'
OWNER' NTAfvff. PHONElv
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 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
4�� 6'1
Owner/Contractor Signature Date