06020093 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTOR INFORMATION
BUILDINGADDRESS: HOT WATER INC PERMTNO.06020093
7532 ORANGE BLOSSOM DR
OWNER'S NAME: PERMIT LgUE DATE
SOMANI BASANT K AND PUSHPA 2531 GRACELAND AVE. 02Z15/2006
NE: SANITARY NO, CONTROL NO.
(650) 298-8494
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a a a a
�Op LICENSED CONTRACTOR'S DECLARATION
hap Job Description
Y
I hereby affirm that 1 am of the
Bu under provisions of Chapter 9(commencingsis P
wi,M1 Scaion]nrx))of Division Jof the Businesaand Pmfcssiuna Code,and my license is
iicmxccje.ndef� g REPLACE WATER HEATER, SEISMIC RESTRAINTS
5�? LicenAu Class Lk.« f(023(0 t 2
0 o Dam comraemr�pTION T & P TO EXTERIOR F�NALED
E',y ARCHITECTS DECLA AT1072 - N —
9 w� 1 undesssand my plans shall M uutl u public records
a
k O h Licensed Pmfessin=1
g S OWNER BUILDER DECLARATION P. nJ �8 O�
2<I 1 hcrchy affirm Nm 1 oro exempt from the Contractor's Licensc Law for the IAII O� ,�
C po following mossan.(Section 7113 L5,Business and Profesco a Code:Any city or county
e e m K which requires v Permit to ennatruet.alter,improve,demolish,or repair any atmewm
yie prior m is issuance.else requires the applicant for such permit to file a signed statement
E S� thin he is licensed purtuanuo the provisions of the Contractor's License Law(Chapter 9 Sq. FL Floor Area a
is`-
0 (commencing with Section 7")of Division J or de Business and Professions Code)or
that he is exempt Nemfrom and the buss for the alleged exemption.Any violation of
Section 7031.5 by any applicant fon permit subjeca the applicant o a civil penalty of APN Number Occupancy Type
not mom man five hundreddAtims(tsar). 36611066 . 00 P y YP
❑1,as owner of the property,m my employees with wages As their sole compewaon,
will do the work,and the swctum is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contmctoes Licence Law does not apply M an owner of Required Inspections
property who builds m improves thAmen.and who gas such work himself or through his
Own employees,provided mat such improvements art not intended Mortared formic.If,
however,the building or improvement is mid within one year of completion,the owncr-
builder will have she burden of proving that he did nm build or improve for purpwe of
role.).
❑1,as awar of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7064,Business and Professions Code:)The Conuacmr'a LI-
come Law does not apply m an owner of property who builds or improves thereon,Md.
who contracts for such projects with a comueloKs)licensed pursuant in the Comraeto6
License taw.
❑1 am exempt under Sec. ,B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury o=of the following declarations:
I hire and will maintain a Ceniftcate ofComenl As AuIf-mmm for Workers Compere
cation,As provided for by Section 37)0 of the labor Code,for the perfomtaace of the
work for which this permit is issued.
t�2"1 have and will maintain Workers Compensation Inuum m.as inquired by Sccdon
'57
1
10 of the labor Code,rot the performance cruse work for which this permit is issued.
My Worker's Com,Mmtion Insurance`carrier and Policy number am:
Career. Ie FI t7 Polity Na.: I5462i 8(n_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Th6 Auction need nothccamPlemd if the Permit Is free=hundred dollars(SIM)
or leas.)
1 cattily thin in the perf mance of to work for which this permit is is tied,I shall not
employ any person in any manner so as An become subjccua the Workers'Compeuzhon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenificate of Exemption,you should
become subject to the Worker's Compensation previsions of the labor Code.you must
J O forthwith comply with such provisions or this Permit shall he deemed rooked.
Z N CONSTRUCTION LENDING AGENCY
[—� I hereby al0fm that them is a convection lending agency for me Performance of
C' thc work for which Nis Parini,u Wood(Scc.309],Civ.C.)
W p Lender's Name
z Lenders Address
U Q 1 certify that I have mad this application and state that the above information is
IL F coricct.I agree to comply with all city and county ordinances and state laws misting in
0 building convection,and hcmby authorize mpmaenatives of this city to mmr upon the
Fkl abnvomenuonWPropeny for i expenses
purpose.
y (We)agree to save,indemnify and keep harmless the City of Cupertino against
to inconsequa o,ofth,preening e preening Of thisespecifeit. may in any way v<cmc againstaaid City
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date S^G�
SOURC EG LATIONS.
2I inc Re-roofs
S t�rcof App1 aHAZARnor am
U HAZARDOUS ATERIAIS DISCLOSURE Type of Roof
Will the applicant ter factum building ettupvnt,store9.1 or handle Health AndSafrmaterial
As Oc0=d by the Cupertino Municipal Code.Chapmr 9.13,and the Halm and Safety
Ade.seption zssu(a>+ All roofs shall be inspected prior to an roofing material being❑Yes ❑Nr P P Y g g installed.
Will the mrllicam or fumm building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ius hazafdnus air contaminants as defined by the Bay Arta At,Quality Management
ictl all new materials for inspection.
❑Ycs E)N.
I have mad the hvnmms mamrials mquimmenrs under Chapter 695 or the Califon
ma Health A,Safety Code.Secdons 255)5,35533 and 25534.1 undersand that ifthe building
does not curremly have a tunant.that it is my msponsibllity As notify the aeupam of the
mquimmen whlehmeatbcmetpr;ormi::raneeeraCcrtifinteorOcmpa=' Signa[ureofApplicant Dale
ow er ,rmrrimd.gmt ,� All roof coverings to be Class"B"or better
£ - Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: PERMIT#
ORa Vos-_.�orn DR, O o2a a 4 3
OWNER'S NAME: 5 PHONE # ' $ 25 -0954o
GENERAL CONTRACTOR: ��y `` , �J�%l ca/ FAX#
I am not using any subcontractors: 0%a . I/ 21
Signature Date
Please check applicable subcontractors and complete the followin 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 '
Owner/Contractor Signature Date
00
00a 3
CITY OF CUPERTINO
WATER HEATER
' CUPEkTINO PERMIT APPLICATION FORM
APN#
t6
C0 Date:
Z 1 d/o
Building Address:
. 2 e
Owner's Nam Phone#:
12
C�o� 99tractor: Phone: License#:
/70, 11/c�fC/' �rIG. GSo - &- - ,'Slcs� 7(a3�/��
Contact: / Phone: Cupertino Business License#:
C/irts 49u-S
Building Permit Info: �/
BldgEl Elect El Plumb E Mech ❑
Job Description:
eerier- _eisrn -rr P f-0 r=fC�erior-
Residential Commercial ❑
Cost of Project: �A500
Strapped On Platform ❑ Bonded
New Location ❑ Replacement
Qty. if
A licable Fee ID Fee Descri tion Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMrrFEE Plumbin Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING
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