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10090032 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 918 COTTONWOOD DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10090032 CONDITIONING "NER'S NAME: SRIDHAR VADDADI 1712 STONE AVE DATE ISSUED:09/07/2010 . .�NER'S PHONE: 4088887062 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Cy c Z U Lic.# ' o c&s 1 / ,' L' MECH r— RESIDENTIAL r— COMMERCIAL� ContractoraYom} �-t i r',1 C C Q- Date �-7-i L, I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE EXISTING WATER HEATER WITH 75 GALLON (commencing with Section 7000)of Division 3 of the Business&Professions IN Code and that my license is in full force and effect. SAME LOCATION 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 Sq.Ft Floor Area: Valuation:$1747 permit is issued. APPLICANT CERTIFICATION APN Number:36918006.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this it: d tonally,the applicant understands and will comply 180 D YS FRO AST CALLED INSPECTION. with all o' t sour logulations per the Cupertino Municipal Code,Section 9.18. 5• l Issued b / ! Date: °'-Mature Date ,t - ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain com with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&S ety e,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Ow e r a orized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: CO TRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name the above mentioned property for inspection purposes.(We)agree to save ;mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address custs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF 2UPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36918006 . 00 DATE ISSUED. . . . . . . : 09/07/2010 RECEIPT #. . . . . . . . . BS000011388 REFERENCE ID # . . . : JOC90032 SITE ADDRESS 91E COTTONWOOD DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SR]DHAR VADDADI ADDRESS 91E. COTTONWOOD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM RA11DO AAA HVAC, INC CONTRACTOR RA11DO, JIM LIC # 8050 COMPANY AAA FURNACE & AIR CONDITIONING ADDRESS . . . . . . . . . . : 17:-2 STONE AVE CITY/STATE/ZIP SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 293-4717 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- 1BCBSC VALUATION 1, 747. 00 1 .00 0. 00 1. 00 0 .00 1BSEISMICR VALUATION 1, 747. 00 0 . 50 0 . 00 0. 50 0 .00 1PPERMITFE FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 . 00 1PRWHEATR UNITS 1 .00 25 .00 0 .00 25. 00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 .00 0 .00 -----4200 ------0_00 ---------- ---------- TOTAL PERMIT 110 .50 0. 00 110. 50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ----- CHECK 110 .50 #37085 --------------- TOTAL RECEIPT 110 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -- 518 WATER HEATER CITY OF CUPERTINO L WATER HEATER CUPEIZTINO PERMIT APPIACATION FORM APN# -, 1 ` Date: Building Address:T/,� JD Q- Owner's Name: S r(d 4},i r- V a ci d ad; Phone #: ZfW - STC- - -�o ( i Contractor: A-�,} P u/N q C0 4 ,4"z- Phone #: racer--29 3 - 11-2 -7 Fax #: G/ai -.-)73 - 6 -7 -71 Cupertino Business License #: Contractor State License #: 76E r Contact: C,G 12 J rP w 7 Phone #: yo& _2-"7 3-4 7/7 Fax #: llo�- - 3k93_ � 7?/ Building Permit Info: Bldg ❑ Elect ❑ :dumb Mech ❑ Residential `K Commercial ❑ JobDescription: �' ,�� I-ev h e /-Z�- Strapped On Platform ET Bonded ❑ New Location ❑ Replacement ❑ Valuation (cost of project): 00 Project Size: Express ❑ Standard ❑ barge ❑ Major ❑ Green Building: Please complete relevant porl ion 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 03/10/10