07050275BUILDING DIVISION PERMIT
MT14hATHERWOOD DR
OWNER'S NAME:
VIVEK GURUD
NE:
ARCHITECT/ENGINEER:
I hereby affirm that I am licensed under provisions of Chapter 9
with Section 7000) of 'vision 3 of the Business ftof ism Cpdc�am
in full S1--cutin
and eff !
License Class Lic. S
Date Comr.
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWN I ER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to concoct, alter, improve, demolish, or repair any structure
prior u) its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
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
not more than five hundred dollars ($500).
❑ 1, as owner of the property. or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sate. If.
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I, as owner of the property. am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a contractor(s) licensed pursuant to the contractor's
License Law.
❑ 1 am exempt under Sec. B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
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I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to Self -insure for Worker's Compen-
ation, as provided for by Section 3700 of the Labor Code, for the performance of the
vork for which this permit is issued.
] I have and will maintain Worker's Compensation Insurance, as required by Section
1700 of the Labor Code, for the performance of the work for which this permit is issued.
Ny Worker's Com cra�OnuraQcecarricr and Poli um /atee'ra[jJPolicy NNE f /� �Z�R TION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($I00)
or less.)
1 certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' 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
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
building construction. and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(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
in consequence of the granting of this permit.
APPLIC.AMT UNDERS�TAANPS AND WILL COMPLY WITH ALL NON -POINT
S AAt -AVO) rtA-�l.4 / 4, 7�j-
Signat of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the 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)7
❑Yes [d No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑ Yes IN.
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
ni Healdt & Safety Code, Sections 25505, 25533 and 25534.1 unde 'd that if the building
d not�aq� ratty have a tenant^}hqt it is my responsihility tify due occupant of the
rcciror(eoLs which rectal be nyeCQrit)n}o issuancs oCa frcatcRJOCCAancy. . ,
Date
PERMIT NO.
PLUMB IN TIME INC 07050275
PERMIT ISSUE DATE
360 MEMORIAL DR 05/30/2007
SANITARY NO. CONTROL NO.
(866)29:3-3031
BUILDING PERMIT INFO
BLDG ELECT PLUMB
INSTALL WATER HEATER.
;;q. Ft. Floor Area
35926052t
Issued by
Re -roofs
Type of F.00f
Job Description
$500
Required Inspections
All roofs shall be inspected prior to any roofing material being installed.
If a roofs installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better
CITY OF
CUPEkTINO
CITY OF CUPERTINO
WATEI: HEATER
PERMIT APPLICATION FORM 4!57,%% �s-
APN # 3
Nater Heater / Vent
BUILDING
Date: -1--3o-c97
Building ddre,�:
PLUMBING
BENERGY
Emergy
BUILDING
zl"p JD r
Business License
BUILDING
Owner's Name:
*61 ��
Phone #:
qt) 10 - q110
vtv
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Contractor:
Phone:
cense
Contact:
Phone:
Cupertino Business License #:
a o
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Building Permit Info:
Bldg ❑
Elect M-1- Plumb
Mech ❑`�
Job Description:
/ I /U,>-�Zt/
Residential
Commercial ❑
Cost of Project:
Strapped
On Platform Ci Bonded
New Location ❑ Replacement -n
Qty. if
Annlirnhle Fee TT7
Fee Descrivtion
Fee Group
BPWHEATER
Nater Heater / Vent
BUILDING
l PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BENERGY
Emergy
BUILDING
BUSLIC
Business License
BUILDING
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
"1 S 13 \nw)Nl e r oo -0 �O CZ
PERMIT, �0
OWNER'S NAME: V '� v Lk CIA c u 0
PHONE # dog • 0n3- CM o
GENERAL CONTRACTOR: _' _ -N "we-
FAX #
I am not using any subcontractors: E;6= _ 51 .10) "1
ignature Date
Please check applicable subcontractors and complete the following information:
Own 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
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Own Contractor Signature Date