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10040100 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 999 NOVEMBER DR CONTRACTOR:BETTER WATER PERMIT NO: 10040100 HEATERS F 3010 RIDGEGATE DR DATE ISSUED:04/15/2010 INER'S NAME: SIVA POREDDY SAN JOSE, CA 95133 PHONE NO:(408)250-6672 OWNER'S PHONE: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB. i r' j, License Class Lie.# MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION:WATER HEATER REMOVAL AND REPLACEMENT IN THE Contractor Date SAME I hereby affirm that I am licensed under the provisions of Chapter 9 PLACE (commencing with Section 7000)of Division 3 of the Business&Professions Code 4nd 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 Sq.Ft Floor Area: Valuation:$1483 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Occupancy Type: Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36213050.00 permit is issued. APPLICANT CERTIFICATION PERMIT EXPIRES IF WORK IS NOT STARTED I certify that I have read this application and state that the above information is THIN 180 DAYS OF PERMIT ISSUANCE OR WI correct.I agree to comply with all city and county ordinances and state laws relating 1 DAYS FROM LAST CALLED INSPECTION. 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, Date: costs,and expenses which may accrue against said City in consequence of the Issued by: granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE ROOFS. Date— All roofs shall be inspected prior to any roofing material being installed.If a roof is nature installed without first obtaining an inspection,I agree to remove all new materials for inspection. rthefollowing OWNER-BUILDER DECLARATION Date: Signature of Applicant: y affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER two reasons: I,as owner of the property,or my employees with wages as their sole compensation, will da the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE 1,as owner of the property,am exclusively contracting with licensed contractors to I have construct the project(Sec.7044,Business&Professions Code). California dHealth&Safety Code,the hazardous Sections 25505,25533,and 25534. I will under Chapter 6.95 oft e er 9.12 I hereby affirm under penalty of perjury one of the following three Health maintain&Safety Code,Section 25532(a)should Istore oor handle thazardoud the us declarations: I have and will maintain a Certificate of Consent to self-insure re for Worker's air contaminants as defined by the Bay Areaent or devices which emit Air Quality Management District I Compensation,as provided for by Section 3700 of the Labor Code,for the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and performance of the work for which this permit is issued. the Health&Safety Code,Sections 25505,25533,and 25534. 1 have and will maintain Worker's Compensation Insurance,as provided for by Date:_ Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: permit is issued. I certify that in the performance of the work for which this permit is issued,l shall CONSTRUCTION LENDING AGENCY 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 work's for which this permit is issued(Sec.3097,Civ C.) become subject to the Worker's Compensation provisions of the Labor Code,[must 1 hereby affirm that there is a construction lending agency for the performance o forthwith comply with such provisions or this permit shall be deemed revoked. 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 .)uilding construction,and hereby authorize representatives of this city to enter ARCHITECT'S DECLARATION ,)n 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 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. Date. Signature """