090800451 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS- 10551 CASTINE AVE
R'S NAME: DHAiIMESH BHAGATWALA
ER`S PHONE: 40+3090298
u LICEN,,SD CONTRACTOR'S DECLAILaTION
1
Licen,:c Class Lic. #
Contractor
Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is, issued.
_APPLICANT CERTIFICATION
I certify ihat 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
ipon th : above mentioned property for inspection purposes. (We) agree to save
indemnity and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may, accrue against said City in cons:quence of the
granting_ of this permit. Additionally, the applicant understands and will comply
Witt, all non -point source r^gulations per the Cupertino Municipal Code, Section
9.18
Sigr!ature _._____ Date.
G OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
will do fire work, and the st.-,icture is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec 7044, Business & Professions Code).
9 1 hereby affirm under penalty of perjury one of the following three
9 declarations:
1 have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, 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, a:; provided for by
Section 3700 of the I abor Code, for the performance of the work for which this
permit is issued.
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 Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subiect to the `,Worker's Compensation provisions of the Labor Code, I must
forthwi;n comply with such provisions or this permit shall be deemed revoked.
I
Y
APPLICANT CERTIFICATION
1
j I certify that I have read this application and state that the above information is
i 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
i upon the above mentioned property for inspection purposes. (V1.) agree to save
j} r &v and keep harmless the City of Cupertino against liabilities, judgments,
C. .rd expenses which may accrue against said City in comequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point soA a regulations per the Cupertino Municipal Code, Section
19.18 yl . t, -. t 1
Signature
CONTRACTOR: VILLA PLUMBING
PERMIT NO: 09080045
(0 VIA ROBLES
DATE ISSUED: 08/10/2009
/YLAMO, CA 94507
PHONE NO: (510) 719-2138
f
BUILDING PERMIT INFO:
BLDG ELECT PLUMB
f—
r
MECH
RESIDENTIAL COMMERCIAL
,JOB DESCRIPTION: WATER
HEATER REPLACEMENT
Sq. Ft Floor Area:
Valuation: $200
APN Number: 32644035.00
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
ssued by:
Date:
RE -ROOFS:
111 roofs shall be m.;pected prior to any roofing material being installed if a root is
nstalled without first obtaining an inspection, I agree to remove all new materials for
nspection.
signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6-95 of the
California Health & Safety Codc, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
iafety Code, Section 2.5.532(a) should I store or handle hazardous material.
%dditionally, should I use equipment or devices which emit hazardous air
zontaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance oI work's
for which this permit is issued (Sec. 3097, Civ C'.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF
CUPERTINO
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
091ce 00��
APN# O � �
�.
Date: , i 1®I 0
Building Address: i o �S► C q -ST iN r-_ Avg ; C. U Pe41-T%N b , (-A��-
Owner's Name:
Phone #:
(409) )-b,3 a2gs3
Contractor: U �'� 0, ��v ,
Phone #g 10 �J
Fax#: V 488306`"
Cupertino Business License #:
Contractor State License #:
Contact:
Phone #:
Fax #:
Building Permit Info:
Bld ❑ Elect ❑ Plumb ❑ Mech ❑
Residential [ Commercial ❑
Job Description:
Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement
Valuation (cost of project):
Project Size: Express ❑ Standard Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to
the application or if applicable, include in plan set & the sheet index.
Green Building Points achieved:
Revised 01/07/09
CM Of
CUPEi�TINO
CITY OF CUPERTINO
WATER ]SEATER
PERMIT APPLICATION FORM
Quantity
Fee ID
Fee Description
Fee
Grou
Permit Type
1 PCWHEATR
Commercial )Nater
HeaterNent
B
PCWHEATR
I
1BCBSC
Cal Bldg Stancards
Commission F, -Ie
B
ALL PERMIT TYPES
1BSEISMICOM
Seismic Commercial
B
1PRWHEATR
Residential W,Lter
HeaterNent
B
PRWHEATR
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Residt;ntial
B
1 PPERMITFEE
Plumbing Permit
P
1 TRAVDOC
Travel &
Documentatio:i
B
1BUSLIC
Business License
B