09080177 (2) CITY OF CUPERTIN'D BUILDING PERMIT
BUILDING ADDRESS: 10270 BYRNE AVE CONTRACTOR:FAST WATER HEATER PERMIT NO:09080177
OWNER'S NAME: PEJAVAR MANMOHAN R AND LALITHA 2601 132 AVE NE DATE ISSUED:08/18/2009
ER'S PHONE: 4082557232 I(IRKLAND,WA 98034 PHONE NO:(800)454-8955
❑ LICENSED CONTRACTOR'S DECLARATION r
'.3UILDING PERMIT INFO: BLDG ELECT PLUMB
License ClassLic.#
— MECH f— RESIDENTIAL f— COMMERCIAL
Contractor Date
1 hereby affirm that I am licensed under the provisions of Chapter 9 .JOB DESCRIPTION:REMOVEIREPLACE GAS WATER HEATER
(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:
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 ;;q,Ft Floor Area: Valuation:$1105
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 *,PN Number:35715093.00 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
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Signature Date
RE-ROOFS:
A11 roofs shall be inspected prior to any roofing material being installed. If a roof is
G OWNER-BUILDER DECLARATION nstalled without first obtaining an inspection,I agree to remove all new materials for
nspection.
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons: Signature of Applicant: Date:
1,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,
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm under penalty of perjury one of the following three 1 have read the hazardous materials requirements under Chapter 6.95 of the
declarations: California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle hazardous material.
performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I have and will maintain Worker's Compensation Insurance,as provided for by contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Sections 25505,25533,and 25534.
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall Owner or authorized agent:
not employ any person in any manner so as to become subject to the Worker's Date:
Compensation laws of Caiifornia. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must CONSTRUCTION LENDING AGENCY
forthwith comply with such provisions or this permit shall be deemed revoked. 1 hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued(Sec.3097,Civ C.)
APPLICANT CERTIFICATION Lender's Name
I certify that 1 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 Lender's Address
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
it iffy and keep harmless the City of Cupertino against liabilities,judgments,
c. did 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
P�:',+ C-1 @_ Permit Nw ogcck®t-71 452601
C L)PeC+iy-X0 .c,7r� (office use only)
City Of Cupertino Building Permit Application
E-Mail: Building-Permits cupertino.orq (Address is case sensitive).
Jobsite Address:10270 BYRNE AVE Date: 8/18109
Assessor's Parcel Number: �j� (550 �'a
Owners Name: PEJAVAR, MANMOHAN Phone No: (408)255-7232
CO
Project valuation: Q� ��1 v-5, 4
Building Penult Info; Bi Erect Plumb X Mech
Job Description
Remove/Replace Gas Water Heater
Contractor iinformation
Company Name: FAST WATER HEATER COMF'ANY 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 Lie. 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: 29101
Credit Card Information
Credit.Card No: 4417123044992443 Expiration Date: 11110
Name on Card: Jeff Jordan
Visa ® MasterCard ❑ American E Kpress ❑
The Building permit application and a completed & signed
contractorlsubcontractor form need to be submitted with each pennit
Commemity Developvomt
30300Twe Avenue
Cupwino CA 95014
Tele phono(408)M-3228
*OF Fax(MM)777-3333
CUPERTINO
Buflffing Department
JOB ADDRESS: 10270 BYRNE AVE PERMTr# ®q o go l -7 -7
OWNER'S NPJvffl: PEJAVAR, MANMOHAN PHONE# (408)255-7232
GENERAL CONTRACTOR FAST WATER HEATER COMPAN FAX# 425-638-7085
I am not using any subcorttractoxs:_. �`,�PJ4,, w 8/18/09
Signature Date
Please check applicable subcontractors and corn 1eEe the foIltrwin information
SU'BC4NTRA.CTOR BiJS]NESS NAME BU'SMS LICENSE#
Cabinets&Millwork
Cement Finishing
Electric—al
Fxcavation
Fencing
Flooring Carpeting
Linoleum/Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masaruy
Ornamental Sheet Metal
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date