08070195 (2) CITY OF CUPERTINO .x- -?�n' ts;
BUILDING DIVISION pERNIIT s�,C���ONTRACTCQ"NFQRWTION
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BUILDING ADDRESS: PERMIT NO.
7573 RAINBOW DR FAST WATER HEATER 08.070195
OWNER'S NAME: PERMIT ISBt1EDATE
MUKUND GHONASGI 12601 132 AVE NE 07/28/2008
NE: SANITARY NO. CONTROL NO.
(800) 454-8955
ARCHTTECTIENGINEER,' BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Op
O
LICENSED CONTRACTOR'S DECLARATION O O O
v 1 herev by AM.dun 1 am licensed under provisiaof Chapter 9(commencing Job Description
_ MthSection7(1111)of Division 3ofNeBecomes and Professions Cocks,and myliccncu RMV/RPLC GAS WTR HTR W/TNKLS UNIT
n,e in full fore aMtt
.11e
pnZ License Cass Lica[ .
nF Dau Comrsmor
ARCHITECTS DECLARATION
1 understood my plans shall W used As public Memrde
D.,U
Licensed Professional -
3 OWNER-BUILDERexemptDECLARATION
EOC 1heahy.(Gm theI1 exempt from tits Canrano's :Mycyor forted
y p o following won.permit
"10313,Busims. and improve.
dooum Cale:Any coy m county
3 4 which requires a permit re cooar«4 alma.impmsu demulLN,fi repair any awnani
_Z e prior to its iatvncedtku re to the the Applicant far Cede pe tor's ce A signed(uumem
�ct (C moencing sed pSemanuo the of Division
of the Business
Licenulso(C Cork)or
Sq.F[. Floor Area $ Valuation
s 121heIscoomptthrefromon 00)and
ivisiofro(duBuilruvandon.AnyovCode)of 449
— dot he u exempt therefrom and ten burs it Ne.Allegeddos excerption.Any l pommy of
notcanlml.sbr,ry.pddolize«.prod ube ane.ppleantw,eialp penalty of Number Occupancy Type
not mare nse fin hundred Galan(SSW). 36224002 . . P Y YP
0 1,u owner.!tha pr ..try,or my employees with wag.as their sole Campevadon,
will do the worth.and the structure latest homestead«offered for ask(Sec.70".Business
and Prokuions Code:The Contraclarr License Law does net apply n an owner of Required Inspections
PmpenywW Wildsorimpnsm tan.Andwoodwsueiwonhimselfornroughhist
awncmplayces,poridea dtusuch improvements am not Intended«offered for sale If.
however.Ne have
th[«imprtowmat ts sold a did
c t year or aporm,1owm-
sahider calm haw do cameo or paving then In aha tot atilt«improv r«purpose.f
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contramn to
construct the project(Sec 1000.Business and Professions Code:)The Colossuses U.
cents Law dors not apply to an owner or property,who builds or improves thereon,and,
who contracts for such projects with a contractor(s)liceved pursuant to the Commutes
Liana Law.
O lamexennpunderSea ,B&PCfnr1M. on
Owner Data
WORKER'S COMPENSATION DECLARATION
40 1 hereby affum under penalty or perjury ore or the fallowing decimations:
0 1 haw and war someone A Certificate or Cove.to self-insure f«W.rtrla Conown.
suction.As provided r«by Secs+.n 3700 of the Labor Code.fee we performance of the -
wort for which this permit is isrucd.
0 1 have and will mainuin Wonce3 Compensation Insurance,u required by Section
37M of Ne Isb«Code,for the Performance of du work for which this permit Ice issued.
My WorkeYs Compensation hmoance artier and Policy number sae:
Cartier. Polity No.:
CERTIFICATE OF EKEMPRON FROM WORKERS
COMPENSATION INSURANCE
('This secfiW Ceti not W completed if the permit Is f«ane hundred dollars($100)
or lea)
1 Milify Nat in the Performance of the won for which this Permit is issued,1 shall two
employ anypermn in any maorcrse as n become subject to the Workui Compensation
Lawn of California.Dau
NOTICE
ant
NOTICE IV APPLICANT.IL ager making this Vi3hm3 of of Exemption you.haw
.J Obecome subject m the Workcro Compensation this pmvit steal of the Ish«Code,you menu
forthwith comply with such pavuiov or this permit shall be lamed revoked.
Zy CONSTRUCTION LENDING AGENCY
I hereby affum mu dem is amvuuctinn lending agency for the performance of
cC> Nc were for which this Permit u issued(Se.3097,Civ,C.)
W Q Lender's Name
]z Lmoses Atldw
fJ Q 1 certify that T haw rad this application and sou the the above information is
lir !' corrin.i Agra or comply win all City asd aunty«dittata.and sum laws relating to "
Q LS^1 Wilding cowmcdon,aM hereby auNarias mpreaeeutives of this city u ams upon Ne
chose-mentioned Property for inspection whichpurposes.
may
�,t y (Wer)agoas m saw,indemnify and keep harmless the Cly of Cupertino agilest
fA incoidee,jede of thec.tsand.Penuswhech they in any way accrue agilvt.Wd City
f,J Z A APPLICANT
of the UNDERSTANDS
of nix permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Stgro nauofARlicanContrachor Data Re-roofs
]HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding«.Chap storecrismalle IncautiousIncautiousmaterial
As dented io the Cupertino,Municipal Code.Chapter 9.11 3,and the Health and Safely
Cash.salon 25532(a)?
❑Y. aha. All roofs shall be inspected prior to any roofing material being installed.
Will tin,Applicant or future boldin oats .t ore If a roof is installed without first obtainingan inspection,I agree to remove
pP e e egdpttunt«tic dna ement P 8
L haramnv air conumittanu u de0ned by du Bay Area Air Quillly Management all new materials for inspection.
DisuicR
0Ya Dole
I haw tend the backed.materisH reluitemeou under Chap=6.95 of the Calif«-
maHealth[:Safety Coda.Satiav ViMl.15533 anal 23330.1 undusuna thaifdu Wilding
dors an,cunendY have a toot Na it is my mu,menibility he entity the aeupoem of do
trquimmencs which moa be met prior to issuance of a CeMiOcau of Oscvrynry.
Signature of Applicant Dale
Owner«euthorimd agent Dare All roof coverings to be Class'A!'or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36224002 . 00
DATE ISSUED. . . . . . . : 07/28/2008
RECEIPT # . . . . . . . . . : BS000005610
REFERENCE ID # . . . : 08070195
SITE ADDRESS . . . . . : 7573 RAINBOW DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MUKUND GHONASGI
ADDRESS . . . . . . . . . . : 757.3 RAINBOW DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5235
RECEIVED FROM . . . . : JEFF JORDAN
CONTRACTOR . . . . . . . : JEFF JORDAN LIC # 29.100
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
------ -- --- ---------- ---------- ---------- ---------- ----------
IBSEISMICR 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
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
Permit No: � I�j Oqo i q 405937
(office use only)
City Of Cupertino Building Permit Application
E-Mail: Building-Permits(cDcupertino.org (Address is case sensitive).
Jobsite Address:7573 RAINBOW DR Date: 7/25/08
Assessors Parcel Number: j/vaa 1( 00 :D
Owners Name: GHONASGI, MUKUND Phone No: (408)252-8824
Project Valuation: 449.00
Building Permit Info: Bldg Elect Plumb x Mech
Job Description
Remove/Replace Gas Water Heater w ,
Contractor Information
Company Name: FAST WATER HEATER COMPANY Phone No:
Contact Name: Carol Randall Fax No: 800-454-8955
• Address: 12501 132ND AVE NE E-mail:carolr@fastwaterheater.com
City, State & Zip Code: KIRKLAND, WA 98034
State.Contractor's Lic. No: 877489 Expiration Date: 5/31/10
Worker's Comp No: 1761660 Expiration Date: 12/1/08
Carrier: California State Fund
City of Cupertino Business License No: 29100'
Credit Card Information
Credit Card No: 4 Expiration Date: 11/10
Name on Card: Jeff Jordan
Visax❑ MasterCard ❑ American Express ❑
The Building permit application and a completed & signed
contractor/subcontractor form need to be submitted with each permit.
Commmrity Development
10300 Torre Avenne
CaPertinD CA 95014
Telephone(408)777-3228
CI OF Fax(408)777-3333
CUPEkTINO
Building De artment
JOB ADDRESS: 7573 RAINBOW DR "T"06070115
MIT0 Q)2O
OWNER'S NAME: GHONASGI, MUKUND PHONE# 408)252-8824
GENERAL CONTRACTOR:FAST WATER HEATER COMPA FAX# 425-814-9516
1 am not using any subcontractors:_ ""`�° 7/25/08
Signature Date
Please check applicable subcontractors and complete the following information:
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
•