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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
GONTRACTORINFORMATION •„
BUILDING ADDRESS:
SOUTH BAY PLUMBING
PERMIT NO 05090064
OW NER'S NAME:
PERMIT ISSUE DATE
KRISHNA KUMAR
441 N CENTRAL AVE
O5
NE:
SANITARY NO. CONTROL NO.
(408)370-3535
ARCHITECrIENGINEEK:
BUILDING PERMIT INFO
BLDG ELECT PLUMB0 MECH
0 0 0
LICENSED CONTRd underSOEC11s of ChapION
1 ion 7 orate that 1 am licensed under provisions of Chapter 9 (commeneing
n]deffec Division7of NC Business and Pmfcuinm Codc and my license is
wifell
Job Descri tion
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I. '"aerren. .,) -
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REPLACE WATER HEATER j-„�I
Licenlse Cl LmR
It__
Dam ConlrxC rs `�'^
A CHDDELLA ATION
iese rtcords
1 undcnJ my shall x uxtl u
rsa
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plans public
2005
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Licensed Pmfessla..I
OWNER -BUILDER DECLARATION
hereby afErm thal I am exempt from the Contractors License Law far nx
mv1
folling so
rean. (Section T(D 1.5, Buincuand Profcs uta Code: Any city or county
k. ]. .', �y3
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which requires a permit in construct. alma improve, demolish, or repair any suuctum
�7 4 75
prior fa its issuance. also requires the applicant for such permit in rile a signed statement
.that he is licensed pursuant o Be pmvisiou or the Conuscon's License law(Chapmr 9
Sq. Ft. Floor Area Valuation
(commencin8 wish Section ]000) of Division 3 of the Business and Pro(esstou Cole) or
that x is exempt therefrom and the buts for the alleged esemption. Any violation of
Section 7031.3 by any applicant for a permit subjects she applicant to a civil penalty ofCCU
O—Type
nut more Nan five hundred dollars (5500),
panC Y yp
❑ 1, Is owner of she proprny, a my employes wish wages Is these xlr compewtio i,
will do the work, and the swctute is not intended Oroff.MA for W. (Sec. 7W. Business
and Professions Code: The Con ructr's uaue Law tinea not apply m an owner or
Required Inspections
property who builds or improves themon, and wh sdoes such work himself or through his
awn employcu, provided that such improvements are not intended or offered for We. IL
however. she Wilding or improvement is mid within one Your of completion. the owner
builder will have the burden of proving that x did not Wild or improve for purpose of
sai
El I, as owner of IM progeny, am excite mly contracting wife licensed commemrs m
construct Ne project (Sec. 7044, Business and Profeuiou Cade:) The Contnetor'a Li.
come Law it= not apply W m owner of propsomy who Wilds or Irnpmve5 formes. Nd
who contracts for such projects wit a conuactor(s) liunmd pursuant o the Contractors
Liceme Law.
❑ I am mempl under Sec . B & P C for this rcawn
Ow r Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury done of tx following declarations:
1 have and will maintain a Cenifiam of Consent m self-mosm for WorkersCompen-
ution, u provided for by Section 37W of the Labor Code, for the performance of the
wIrk for which this permit is
❑ 1 have and will maintain ensotion Insurance, u myvimd by Suction
3]00ofthclaxr Cude.fortoftrworkforwhichthispcmrituissued.
QOF�
'
My Weak on o pc on omond Policy nu rare
Cartier. Policy Na.:
CERTIFICATI ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need rut W completed if Be, permil is for ane hurWmG dollars (5 10(1)
,or less.)
I certify then in she life-- of the work for which this Permit u issued, I shell out
employ any person in any manner an as to become mbjcct to the Work a' Compensatlan
Laws of California. Dare
Applicant
NOTICE TO APPLICANT: IL after making this CcniOcam of Exemption, you should
xcome subject he to Workers Compcuslon previsions of the Labor Code. you muss
forthwith comply wish men provision or this Permit mall x domed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby aRrm tat from is a construction lending agency for she perfurmance of
she work for which this permit is issued (Sec. 3097, Cl, C.)
Undoes Name
Lenders Address
I eenify Nat 1 have rad this application and sum that the move information is
comma I agree to comply with all city and county ordinances and state laws relating in
building construction, and hereby authorise, mpruematiscs or this city to color upon the
axon -mentioned property for ie pe gonuses purprwhich .
(We) a9. ro um, indemnify and kec h.l. due City of Cupertino against
and expenses which gay in anyway accrue a8eiw aid Cly
iin colfa,jud8mcnacosts
nennxy enaaraegmnting� t p yiL
A Z ;E IS
U S AND WILL OMPLY WITH ALL NO -POINT
S E R ,GU ATIONS.
Issued by: Date �_/ --g9
T'
4' 44 6e
-roofs C7`f
nature oMPplic uCon fee r Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
will dm applicam or future building Occupant store or handle hauummus material
u defined by the Cupertino Municipal Code, Chapter 9.11, and the Hcalt and Safety
Calc. Section 25331(a)?
❑Yes VN.
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant esu equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
Cmil handous air contaminants as dcOncd by she Bay Area Air Quality Management
all new for inspection.
Disuicl]
materials
❑Yes No
I have read da, harardma nobouismqui menuunderCMpmr6.95oftcCalifor-
niaHealSafclYCode,SeclOaM5dS,25533
& 'd 25574.1undersand thmifthe Wilding
doe I�curen0y h a ten that it'u my r mileiliy u Molly the aoupam .(ft
ntawhch, 1priormissum oraccnirNamor
Signature of Applicant Date
ore
All roof coverings to be Class "B” Or heiter
Inr retire agent
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CITY OF
#UPEkTINO
e
JOB ADDRESS:
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building.Department
PERMIT #
I 2 r Y— 0 S^b 4 006 C-/
OWNER'S NAME: PHONE # C10 -
GENERAL CONTRACTOR:
I am not using any subcontractors:
Signature batle
Please check avvlicable subcontractors and complete the follnwino infnrmai-inn-
Date
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
Date
F�
0
(05-A
CITY OF
CUPERTINO
CITY OF CUPERTINO
WATER HEATER `l '6"'Y
PERMIT APPLICATION FORM
APN # .�3 0
Dat : +
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Building Address:
Plumbing Permit Issuance
PLUMBING
Owne 's Name:
�-
Phone #:
woe
BUILDING
Contr ctor: Phone:
l � 3 3s
License #:
s86
1
Cona Phone:
Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect El Plumb la
Mech
El
Job Description
V-
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Residentia✓ Commercial ❑
Cost of Project:
Strapped ❑ On Platform ❑ Bonded ❑
New Location ❑ Replacement
,
Qty. if
Anolicable Fee ID
FPB De.,crintinn
Fry ( rnnn
BPWHEATER
Water Heater / Vent
BUILDING
PPERMTI'FEE
Plumbing Permit Issuance
PLUMBING
BENERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING
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