08040204 (2)CITY OF CUPERTIV
BUILDING DIVISION " PERMIT
:QCoL�s:L,tl�t14"�TFV'SIr.x QitM„ATI.O
BUILDING ADDRESS:
MiUaM NO.
10913 NORTHFIELD SQ
FAST WATER HEATER
08040204
OWNER'S NAME:
FMZMrr ISSUE DATE
RAJIV KAMBLI
12601 132 AVE NE
04/28/2008
E
SANITARY NO. CONTROL NO.
(800) 454-8955
ARCHITECnPhIGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTORS DECLARATION
Job Description
1 hcreby ,farm Wt I sm liaxmed under provisions of Chapter 9 (ammencmL
with Scedon7005) ofoivhmn 3 ofine Business sod Profession, Code, and my license is
R&R GAS WATER HEATER
in full farce end effect.
License Class Lm.Is
Dam Contractor
ARCHITECTS DECLARATION
I andcramoi my plus mall W used as public meardt
Licensed Fred ..iand
OBUILDER DECLARATION
1 hereby amrm that I am1. exempt Ism the Contractors fs Uccnse Law far me
following moon. (Section 7(n 1.5, alms, and nn, Cade: Any city m aunty
Improve. do
eL alter, Improve, demolish, or sig any aummm
which mquim • permit re enres
ft
prior m its iuume, amu requires the applkcem for such rermil I iter a a1LmdChamal
e a
Duh itFormal 70the pmviaissnaafgmheBuiness lJansUW(Chupar9
Sq. Ft. Floor Area
Valuation
(commencing Business cour nd Profmtimi Code) or
n 3for
icommeMncept Section7000)ad
-
$449
the event the al )stepson. Any vioimon of
that he u exempt dmmfmm and tie bum for the
CU
Section acy for. remit wbjecu Loume applicant to •civil Penalty of
°ifb� Number
Occupancy Type '
W mdse Nan ase hundred dalton (g300).
a now five red dollars
31637022
01,uawnmoftbpml ny,mmyeoploymawithcagesugahseecompewdon,
Required Inspections
wig do da WIXk and the Busiwa
mtmmnded IXA.
toON,
ad he Contra
clues
Cod): Cennama:a t Law does asst apply to a owner of
ero2adona
mpr dwW mwork himrlfmchmuahhis.
smvmrove its
propertywhobuikda IXed
Own cmploym,provided thatimprovementsme not
prov)h
buildingorImprovementg midwithin mayearamcooveforcherower-
in
wiB have gte bsrden of Proving dun he did at build m Improve (m purpose of
sale.).
am.).
0 1, as owner a the property am exclusively contracting With licensed conuactors In
canatwn the prole) (Sac. 7041, Business and Professiana Cada:) The Cmbsemr's U-
ceme law does eon apply to a owners of Property who build, or Improves dmrmn, sed,
who contracts for such projects with a rnnuumr(s) licensed pursuant to the Consort cc's
License Law.
0 lameaemptunder See .Bh PCfmmhmsson
Do. Dab
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury oro of the following daluadone
Mw and will maintain a Certificate of consent se r bee m fm wart esCampus-
Oman. a provided for by Section 3700 of the Labor Code, for the performance of tier
work for which chis permit is issued.
0 I have and will maintain Worker's Compensation Insurance, as inquired by Secdon
3700 of the labor Cotler, fm the performance of the wart fm Which this Prmtin la blued.
My Worknes Compensation Inwunce artier W Policy number am:
-
Canier. Policy No.:
CERTIFICATE OF BKEMP ION FROM WORKERS
COMPENSATION INSURANCE
CNet section need not he completed if de remit Is foram hadiaddogars (510)
or Dae)
1 mrufy that lo the Mr.... of me wort for Which this perch is issued, l mall rot
employ any Person in nay counter a as he become ubject tome Wohare'Compenudon
._ .
Laws of CeifoMt Dam
AppEcat
NOTICE TO APPUCAND IL after making this Ce tifinm of Exemption, you Amid
become subject to the Worker's Compensation provisions of da law Cade. you mesa
forthwith comply with such proviams or this permit mall ba dmmcd Doted.
CONSTRUCTION LENDING AGENCY
1 hemby amen than gem is a conuuc0a lending agent for the perfomw¢ of
dm work for Which this permit Is issued (Sec. 3097. CIV. C)
'
Lender's Name
Lenders Address
' 1 certify that I have rand this applicmon and some that me shove INomada is
'
mmct. 1 agree to comply With LI city and county online mm and sum laws elating to
Wilding construction, and hereby Ruthenium mpresenudvm of this City to enter upon me
ahove-mengssmd property for inspection puspssas
(We) acme to ave, indemnify sed Yccp harmless the Cty of Cupertino against
limilidesludtmens,cosss and upenrca which may in nay way amus apfn,t said City
in conagmme of the grating of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS,
Re -roofs
Type Of Roof
Dam
Signwue of AppliaHAZA HAZARDOUS
xAt
orto=SMATERIALSDISCLosuRE
Wig m fou eceupataom IX handle materia(
Wilipal
u defined Cc
the CuPerum Muninpal Code. Chapter 9.12. sed the Halm ad Safety
y t e Caperton ni Health
io
code. section zs532(47
All roofs shall be inspected to any roofing material being installed.
❑Yin []No
prior
If a roof is installed without first obtaining an inspection, I agree to remove
ZWill he applicat or future building occupant use equipment or devices which
u air cmuminans as defined by me Bay Ama Air Quality MaaLemenl
all new materials for inspection.
soI
Gres ❑Nu
1 have mal the hesaNms materials mguhcmeeu under Chapmr6.95 of de Califon
nh HulLhk SafetyCade Sued. 25505.25533 ad25534.I understom thuif gte Wilding
des rot cummly have • anal that It is my mspanibihity, to ratify the ..wt.f the
requirements which may he mel prior to issuance of* Certificate of Occupancy.
Signature of Applicant Date
All roof coverings to be Class'W' or better
Owner m aumorhN ,germ Dam'
LJ
•
0
Permit No: b v 0 1 �401689
(office use only)
City Of Cupertino Building Permit Application
E -Mail: Building-Permitsna cugertino.org (AHdress is case sensitive).
Jobsite Address: 10913 NORTHFIELD SQ Date: 4/25/08
Assessor's Parcel Number: 31.103-10 2-2-, 00.
Owners Name: KAMBLI, RAJIV Phone No: (408)973-1058
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
Contact Name: Carol Randall
Address: 12601 132ND AVE NE
City, State & zip code: KIRKLAND, WA 98034
4
State Contractor's Lic. No: 877469
Worker's Comp No: 1761660
Carrier: California State Fund
City of Cupertino Business License No: 29100
UI.M- ►•
Fax No: 800-454-8955
E-mail: carolr@fastwaterheateccom
Expiration Date: 5/31/08
Expiration Date: 12/1/08
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.
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31637022.00
DATE ISSUED.......: 04/28/2008
RECEIPT #.........: BS000004605
REFERENCE ID # ...: 08040204
SITE ADDRESS .....: 10913 NORTHFIELD SQ
SUBDIVISION ....... .
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............:
RAJIV KAMBLI
ADDRESS ..........:
10913 NORTHFIELD SQ
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-0515
RECEIVED FROM ....:
JEFF JORDN
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
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
CREDIT CARD
106.56
---`---------------
VISA
---------------
TOTAL RECEIPT
106.56
VOICE ID DESCRIPTION
-----
VOICE ID
DESCRIPTION
--------------------------
518 WATER HEATER
--------
----------------------------
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0
a0m
CUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
inn Debartment
JOB ADDRESS: 10913 NORTHFIELD SQ I PERMIT # O C)H (0 �Ut
U� 'ENEXAL CONTRACTOR: FAST WATER HEATER COMPANY FAX # 425-814-9516 1
I am not using any subcontractors: — / "` 4125108
Signature Date
Please check annlicable subcontractors and rmmnlata +ho FnllnTv nv ;nFnrmaiinn•
Owner/Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
o
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
The
Owner/Contractor Signature
Date