08060149 CITY OF CUPERTINO »w;yav;va7 "
BUILDING DIVISION PERMIT _C�NTRACT,(1R;TNFORMATION
PERMIT NO.
Bo1Lg1�G�798LENVIEW AVE FAST WATER HEATER 08060149
OWNER'S NAME: PERMIT ISSUE DATE
YKARNALA, SATYA & NEERAJA 12601 132 AVE NE 06/23/2008
NE:
(800)454-8955 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
X00 LICENSED CONTRACTOR'S DECLARATION Job Description
1 provision rm out I me licensed under provisioof Chapter 9(commencing
with Section 7pM/)or Division 3 ofthe Business and Profusions Codc,and my license is RMV/RPLC GAS WTR HTR
in full force and effem
j Z Llan Class LAC P
F p Da¢ ContraMr
££7W ARCHRECT'S DECLARATION
W6 1 unMnland my plus mW be used As public=cords
g Licensed Professional
3 OWNER-BUILDER DECLARATION
.� E I hereby affirm that I am ca mpl from line cone mors License Law for the
y
20
following maven(Section 71131.5,Business and Professions Cote:Any city ar caunly
which requires a permit to cnnsuuct,alcor.tarpons.dcmolixh,or repair my structure
prior en is insuame,also requires the applicant for such permit.file a signet statement
< that be is licensed pursuant to the pmvisiMs of f Canuactea ucomo Law(Chapm 9 Sq.FL Floor Area $449Valuation
H
yhQ (commencing with Section 7000)or Division 3 of the Business and Pmf,ssions Code)or
_ that be u exempt rhmefmm and the baso for the alleged exempdon.Any violation or
Schon 7031.5 by any applicant for a permit subjects the applicant in a civil penalty ofNumber Occupancy
Inst come,than fine hundred dollen ISM 3 6911027 ! Pane Y Type
will❑L as awtrrk.Um pmpeny,a my u intended with wages r mens sok cam.Buss on,
And do the work and the he Cm u Commune,License
or AW do Tarsale(Sec.]061.Business
And property
who
ease:The rem,Lian law does nark apply m ern owner is Required Inspections
pmpem who Madsvi edpowthmmr and who donsuchwarthimselfor Nn sle his
awn employer,provided that.wch improvements sold within
in not ear of rmoRmed(mask.Owner.
bov,evWilder r,the Wilding s mien overnennumadwithin arc year of m=ove foron.da,etose of
Milder will love the burden of proving that Ire did not Mild or improve far purpose of
sale J.
❑1.u owner or the Popery,em texinively canuaning wide licensed mnuanars an
construct the pmaect(Sec.1044,Business am Profenmm Code:)Tbe CnOaemrs U.
cense Law dos not apply to an mor of property who Milds or imP=m theman.and.
who Contracts for such projects with a ecntx=r(s)licensed Pursuant an the Consomme&
Linn Law.
❑I am exempt undo Set .B d P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby afrlm seder penalty of perjury am of the fallowing declaration:
I bsn and will maintain aCmtifhnteof Consnt m self-insure fo WarkcrsComperr-
amen,a provided for by Section 3700 or the Labor Code,for me Performance of the
work for which this permit is issued.
❑1 bane and will maintain Workers Compcnsauon Inroa.as required by Section
3Tlo of me labor Codes,fm the Kdormanceof the work for which this permit Is issued.
My Workers Compensauom lotus carie,and Policy number are:
Carrier. Policy NO.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rMisscctm rad trot he completed if lbe permit is fmmm hundred dollars(SIM)
or less)
I comity than in the performance of ted wart for which this Permit is usual,I shall not
=ploy any person in my mammrm As An become subject to the Wmkers'Compensadon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Ccrificale of Exemption,you should
become subject an me Watch Compensation provisions of me labor Cade,you mons '
.J O famewim comply with such provisions o this Permit shall k deemed revakcd.
'Z'-v CONSTRUCTION LENDING AGENCY
I hereb dfnm this them u a cmumKuno kndin a
I-' Y . gear for Use perfomtamm of
6i L e work for which mu permit is issued(Sec.3(19'/,Civ.C.)
QLenders Name
�Z Lenders Adnm..
CJ Q 1 mriry that I have rod this application and sou mal tar above uquoun uun is
[Lr^ comma I agree m comply with all city and county on inancea and sum laws miming m
.C)SCJ: Wilding convection,and hereby tummies representatives ofthis city in enter upon the
W above-mentioned popery for..panus puryasea
F g). (We)alto,m nK,indemnify and kap harmless f City or Cupertino against
n l,lZ lis Consequence rota,crosAnd of the grartfing ofpensmit. may in anyway accuse agalnslsald City
C)z APPLICANTQCUNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued b Date
SOURCE REGULATIONS. Y-
'
Srgnatu=of AppliCm✓co Dale Re-roofs
HAZARDOUS MATERIALS LSSCLOSURE Type of Roof
WillftApplicant mfMuni buildinge.Chain SCAM orAnd to Heardousmamrial
Conic.
Sed io the Cuperdna Municipal Calc.Chapin,9.13.=d to Health ml Salcry
sate.scotion us33(,)7 All roofs shall be inspected prior to any roofing material being installed.
(]Yes ❑No
Will the applicant or fwum Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it lulZm um Airconuminou AS defined by dee Bay Arta Air Quality Management all new materials for inspection.
Disuict7
❑Yes ❑No
1 ban TOM me hvardous materials requirements under Cbepmr 6.95 or the Califor-
niaHcalmkSatclyCadnScti.m 5115.35533ua125534.1un�d0uifmc Wilding
does cot Currently have•tenant.than II is my responsibility m unity the oceulm,of the
requirements which mus be met prior to issuance of a Cclifinm of Occupancy. Signature of Applicant Date
Owner or atthoried agent Date All roof coverings to be Class'W'or better
CITY OF, CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36911027 . 00
DATE ISSUED. . . . . . . : 06/23/2008
RECEIPT # . . . . . . . . . : BS000005182
REFERENCE ID # . . . : 08060149
SITE ADDRESS . . . . . : 10377 GLENVIEW AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER YKARNALA, SATYA & NEERAJA
ADDRESS . . . . . . . . . . : 10377 GLENVIEW AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4510
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 '
•
016OO p 1�..�C�407350
' Permit No:
(office use only)
City Of Cupertino Building Permit Application
E-Mail: Buildinq-Permits(a)cupertino.orq (Address is case sensitive).
Jobsite Address:10377 GLENVIEW AVE Date: 6/23/08
Assessor's Parcel Number: 0 69 1 1 0 ,P-1 , OcC l
Owners Name: YKARNALA, SATYA& NEERAJA Phone No: (408)255-6112
Project Valuation: 449.00
Building Permit Info: Bldg_ Elect Plumb X Mach
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 Llc. No: 877489 Explratlon Date: 5/3vio
Worker's Comp No: 1761660 Expiration Date: 12/1108
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.
Community Development
j 10300 Torre Avenue
i Cupertino CA 95014
Telephone(408)717-3228
Fax(408)777-3333
•CUPEf�TINO
Buildin Department
]OB ADDRESS: 10377 GLENVIEW AVE powTr#
p O �ab1L+9
OWNER'S NAME: YKARNALA, SATYA& NEERAJA PHONE# (408)255-6112
GENERAL CONTRACTOR:FAST WATER�HEATER CiO�MPAN FAX# 425-814-9516
I am not using any subcontractors:.... /�' `°" P 6123108
Signature Date
Please check applicable subcontractors and com Tete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets&Millwork
Cement Finishing
Electrical
Excavation
Fencin
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