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10050093 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21070 RAINBOW PL CO VTRACTOR:VILLA PLUMBING PERMIT NO: 10050093 OWNER'S NAME: RAMESH RIO 340 KISHIMURA APT 1 DATE ISSUED:05/10/2010 WNER'S PHONE: 4089731652 GILROY,CA 95020 PHONE NO:(408)8484102 LICENSED CONTRACTOR'S DECLARATION JO3 DESCRIPTION: RESIDENTIAL❑ COMMERCIAL License Class) ( Lic.# 7 6 REPLACE WATER HEATER Contractor (! 41J Date S D 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. Sq.Ft Floor Area: Valuation:$1500 1 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 APN Number:36626030.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, ] costs,and expenses which may accrue against said City in consequence of the Is,ued by: /!�v Date: S granting of this permit. Additionally,the applicant understands and will comply with all non-poin rce re lations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date Al roofs shall be inspected prior to any roofing material being installed.If a roof is ins talled without first obtaining an inspection,I agree to remove all new materials for in.,pection. L3 OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I Have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three m rintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: H:alth&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's m iterial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. w II maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio O5, 533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:�� L 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 CONSTRUCTION LENDING AGENCY 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 I iereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. w3rk's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION 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 ARCHITECT'S DECLARATION demnify and keep harmless the City of Cupertino against liabilities,judgments, ,sts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 36626030 . 00 DATE ISSUED. . . . . . . : 05/10/2010 RECEIPT # . . . . . . . . . BS000010367 REFERENCE ID # . . . : 10050093 SITE ADDRESS 21070 RAINBOW PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER RAMESF RIO ADDRESS 21070 RAINBOW PL CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM VILLA PLUBMING CONTRACTOR JIM MORENO LIC # 30989 COMPANY VILLA PLUMBING ADDRESS 340 KISHIMURA APT 1 CITY/STATE/ZIP GILRO`.', CA 95020 TELEPHONE (408) 848-4102 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC -NEW BAL- ---------- ------------- ---------- ---- ------ -- . 00 1BCBSC VALUATION 1, 500 . 00 1. 00 0 . 00 1. 00 0 1BSEISMICR VALUATION 1, 500 . 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 42 . 00 ----- 0_00 - ---------- ---------- ---- ----- TOTAL PERMIT 110 . 50 0 .00 110 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------------- CHECK 110 . 50 10027 --------------- TOTAL RECEIPT 110 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------- -------- ---------------------------- -------- -------------------- 518 WATER HEATER CITY OF CUPERTINO WATER HEATER CUPEt�TINO PERMIT APPLICATION FORM ObSC�C APN # Date: Building Address: fl--) 10 7 0 671+( yt, Owner's Name: Phone #: V14 e WO �) 7 -- i ` S Z Contractor: Phone #:c/oPlt6,.47 bp Fax #: Cupertino Business License #: Contractor State License #: -30 qe� � cl? Y�/ 6 (�91 Contact: Phone #: Fax #: Building Permit Info: Bldg ❑ Elect ❑ Plumb 154 Mech ❑ Residential [ Commercial ❑ Job Description: V Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement ❑ Valuation (cost of project): Jam, Z3 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 03/10/10 CITY OF CUPS RTINO WATER HEATER CUPEkTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1PCWHEATR Commercial Water B PCWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICOM Seismic Commercial B 1PCSWHTR Commercial Solar B PCSWHTR Thermal Water Htr 1 PRWI MATR Residential Water B PRWHEATR HeaterNent 1PRSWHTR Residential Solar B PRSWHTR Thermal Water Htr 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel & B Documentation 1BUSLIC Business License B Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 2/ 0 7 P> ,a" .� _�o A— PERMIT# 0 OWNER'S NAME: ,,4:y ,4✓A-r _ PHONE# GENERAL CONTRACTOR: 1A BUSINESS LICENSE# q'{6 0 ADDRESS: 3 yd / S �-vr 2 CITY/ZIPCODE: �t *Our municipal code requires all businesses working in the �,-ity to have a City of Cupertino �siness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Date Signature Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 0 ner/Contractor Signature Date