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07080276 CITY,OF CUPERTINO BUILDING DIVISION PERMIT CtITRt�CTC�R IURM�TION PERMIT NO. BUILDING ADDRESS: 19854 BAYWOOD DR WATER HEATERS ONLY 07080276 PERMIT ISSUE DATE OWNER'S NAME: RIYEZ PUTHIYAPURAYIL 970 E MAIN 08/31 /2007 SANITARY NO. CONTROL NO. ONE: (800) 835-5946 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 ZLICENSED CONTRACTOR'S DECLARATION ulp I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description z w with Section 7000)of Division 3 of the Business and Professions Codc,and my license is REMOVE AND REPLACE WATER HEATER 7 H in full force and efte 3 r)Ln License Clas cC 3 Lic.fl 3d . Ftp Dam - 3/-07 -Contractor ARCHITECTS DECLARATION CI understand my plans shall be used as public records �Ua m r Licensed Professional C a OWNER-BUILDER DECLARATION N I hereby affirm that 1 am exempt from the Contractors License Law for the a0 following reason.(Section 7031.5,Business and Professions Code:Any city or county $ which requires a permit to construct,alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to frac a signed statement Valuation a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $800 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). 31631013-. 00 ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 67I have and will maintain Worker's Compensation Insurance,as required by Section 700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's CC1om nsation Insurance carrier and Policy number are: Carrierd �'tye��'"�" Policy No.: 0. CERT CATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (this section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workcrs'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must O forthwith comply with such provisions or this permit shall be deemed revoked. N 0 ' CONSTRUCTION LENDING AGENCY I hereby a[Grtn that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) Q Q Lender's Name Z Lender's Address 0 l certify that I have read this application and state that the above information is 4►* correct.I agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorize representatives of this city to enter upon the y W above-mentioned property for inspection purposes. y CL (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City Z in consequence of the granting of this permit. Date � AP ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b�': 1 S REGULONS. 00- 3 D Re-roofs Signatu fApplican ontractoi Dam Type,Of Roof MATERIA DISCLOSURE Wi applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof: shall be inspected prior to any roofing material being installed. ❑Yes No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes 1 have read the hazardus materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.l understand that if the building d of urrently have a tenant,that it is my responsibility to notify the occupant of the req ' nts which m t be mot to issuance of a Certificate of Occupancy. SignatuP;of Applicant Date 3```)/ All roof coverings to be Class"B"or better Owner or authorize agent Date CITY OF C UPERTINO WATER HEATER MN F -UPEkTINO PERMIT APPLICATION FORM D1 D6 APN# Date:�143101 W 2S" Building Address: 31ceywodd "D, Owner's Name: Phone#: �s 3 eTuAl )� Cilour ';4"'I nY 2s 7- Contrac or: Ph ne: License#: ?wS-SW 4 3 -244S -7 3 Contact: Phone: Cupertino Business s� License#: Building Permit Info: Bldg ❑ Elect Plumb Mech Job Description: Ae ,- R Residential 0Commercial ❑ Cost of Project: "trapped On Platform CT Bonded INew Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER W ater Heater/Vent BUILDING 1 PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY E:ier y BUILDING BUSLIC B usiness License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY F&x(408)777-3333 IPEkTINO Building Department JOB ADDRESS: 17 (f, K 3-y6u),:�_4 (�r PERNII0-7 OS,,) 2 7 ,5/ OWNER'S NAME: ;ye z , f k U r PHONE# Z,5 7- ZZ GENERAL CONTRACTOR ,Q FAX# I am not using any subcontractors: l. �c Signature Date Please check applicable subcontractors and com 1<!te the following' o tion: 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 � e, ;g �2� tv ley Roofing Septic Tank Sheet Metal Sheet Rock Tile - Owner/Contractor Signatur Date a. CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN . . . . . . . . . 31E31013 .00 DATE ISSUED. . . . . . . : 08/31/2007 RECEIPT #. . . . . . . . . : BSC00002533 REFERENCE ID # . . . : 07C80276 SITE ADDRESS . . . . . : 19E54 BAYWOOD DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : RIYEZ PUTHIYAPURAYIL ADDRESS . . . . . . . . . . : 19f�54 BAYWOOD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2316 RECEIVED FROM . . . . : EDWARD GREGORY CONTRACTOR . . . . . . . : MCGEE, PAT LIC # 18986 COMPANY . . . . . . . . . . : WATER HEATERS ONLY ADDRESS 970 E MAIN ST CITY/STATE/ZIP . . . : GRl,SS VALLEY, CA 95945 TELEPHONE . . . . . . . . : (800) 835-5946 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34 . 86 0. 00 BPWHEATER PER HEATER 1. 00 10.79 0. 00 10.79 0. 00 PPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 - -------- ---------- ---------- ---------- TOTAL PERMIT 86 .44 0. 00 86.44 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 86 .44 MC --------------- TOTAL RECEIPT 86.44 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING