The URL can be used to link to this page

09010079X00 gU 'DZ $aa DIU H km4. � � y _2< E�C Y CITY OF CUPERTINO BUILDING DIVISION PERNIITd](?C0*1:. BUILDING ADDRESS: PERMIT NO. 10832 WILKINSON AVE FAST WATER HE OWNER'S NAME: PERMIT ISSUE DATE 'HO JARANG, SRIP�ATH 4:2604: 132 AVE NE 2SA CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO RMV/RPLC GAS WATER HEATER BLDG ELECT PLS 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70(10) of Division 3 of the Business and Professions Code, and my license is in full force and effect License Class Lic. # Date Contractor ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from We Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct alter, improve, demolish, or mpair any structure prior to 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 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the B usiness and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type P Y yP Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections 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 sale. If, however, the building or improvement is sold within one year of completion, die owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to constrict the project (Sec. 7044, Business and Professions Code:) The Contractors 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 Contractors License Law. ❑ I am exempt under Sec B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen- anion, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (I7tis 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. Dam 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.) Lendees Name Lender's Address I certify that I 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 accruc against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. Re -roofs Type of Roof Signature of Applicant/Comractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defnned by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code. Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. [I Yes ❑ No a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices whichIf .t hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. ..,trict? ❑ Yes ❑ No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Cade, Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class". ' or better Date Owner or authorized agent 5 ITEMS OF 10 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35613036.00 DATE ISSUED.......: 01/20/2009 RECEIPT #.........: BS000006994 REFERENCE ID # ...: 09010079 SITE ADDRESS .....: 10832 WILKINSON AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER SARANG, SRINATH ADDRESS 10832 WILKINSON AVE CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4732 RECEIVED FROM ....: JEFF JORDAN 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 ---------- ---------- 1BCBSC ------------- VALUATION ---------- 449.00 ---------- 1.00 ---------- 0.00 1.00 0.00 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 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 ---------- 107.56 ---------- 0.00 107.56 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 215.12 --------------- 215.12 REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER ono( 001 430136 Permit No. (office use only) City Of Cupertino Building Permit Application E -Mail: Buildinq-Permitsffcupertino.org (Address is case sensitive). Jobsite Address: 10832 WILKINSON AV Date: 1119109 Assessor's Parcel Number: 3 6tp /.� �J(p , 00 Owners Name: SARANG, SRINATH Phone No: (408)873-9870 Project Valuation: . 449.00 Building Permit info: Bldg Elect Plumb X Mech Job Description Remove/Replace Gas Water Heater Contractor Information Company Name: FAST WATER HEATER COMPANY Phone No: Contact Name: Julie Caskey Fax No: 425-636-7084 Address: 12601 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: A09304455 Expiration Date: 12/1/09 . Carrier: Truck Insurance Exchange City of Cupertino Business License No: 29100 _ Credit Card Information Credit Carel No:Expiration Date: 11/10 Name on Card: Jeff Jordan Visa 0 MasterCard ❑ American Express ❑ The Building permit application and a completed & signed contractorlsubcontractor form need to be submitted with each permit, Community Dcvelopmeut 10300 Torre Avenue r .� Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 CUPEI�TINO unain Department ent JOB ADDRESS: 10832 WILKINSON AV PERAOUT v Cj 01VNWS NAME: SARANG, SRINATH PHONE # 408)873-9870 GENERAL CONTRACTOR; FAST WATER HEATER COMPAN PAX # 425-636-7085 I am not using any subcontractors: , 1/19/09 Signature Date Please check avolicable subcontractors and comolete the followinz information Owner/Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation ry Landscaping Lathing Masonry Ornamental Sheet Metal Painting % Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date