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09080009 (2) CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 10080 IMPERIAL AVE CONTRACTOR:DONE-RIGHT!ROOTER PERMIT NO:09080009 AND PLUMBING,INC OWNER'S NAME: RAJ JAKKANPUDI 736 CHARCOT AVE DATE ISSUED:08/03/2009 T cR'S PHONE: 4087505326 SAN JOSE,CA 95131 PHONE NO:(408)432-1412 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT— PLUMB License Class Lic.# 10$1– `t' � MECH RESIDENTIAL COMMERCIAL Contracto;,Viwiz, -� JOB DESCRIPTION:REPLACED 50 GALLON WATER HEATER;DONE 1 hereby affirm that I am licensed under the provisions of Chapter 9 RIGHT ROOTER (commencing with Section 7000)of Division 3 of the Business&Professions &PLUMBING RENEWD BUS LIC#30175 8/3/9 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$900 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35722012.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. y Issued Date: Signature Date 3' U S �l G ❑ ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should 1 store or handle hazardous material. Additionally,should 1 use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 wn or ut�ofizecj'agept; n ate: become subject to the Worker's Compensation provisions of the Labor Code,I mus: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relatin; Lender's Name to building construction,and hereby authorize representatives of this city to enter ur--the above mentioned property for inspection purposes.(We)agree to save Lender's Address y 11ify and keep harmless the City of Cupertino against liabilities,judgments, ca,,.,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPER '�v� v w � TINO WATER HEATER CITY Of CUPEkTINO PERMIT APPLICATION FORM APN # Date: Building Address: f 0o q Sc) I Owner's Name: Phone #: amu) ��tojA t $ 1-7 50 3 � Ctoontractor:` t Phone #: 466 wnv __DI y Fax #: 40(F5' Cupertino Business License #: Contractor State License #: x /`75 �06k � Contact: Phone #(4WO 4 3a +4 k-.)- Fax #: (400 4.3 Building Permit Info: Bld ❑ Elect Plumb Mech ❑— Residential Commercial ❑ Job Description: k f;� S 9�(\Gn U_�a ( ACCL4-e-C Strapped ❑ On Platform ❑ Bonded L j--New Location ❑ Replacement Valuation (cost of project): n� Project Size: Express D—Standar 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 .. CITY OF CUPERTINO WATER :HEATER CUPE Of PERMIT APPLICATION FORM Quantity Fee ID Fee Descripti,:)n Fee Permit Type Grou 1PCWHEATR Commercial Ndater B PCWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission lee 1BSEISMICOM Seismic Commercial B 1 PRWHEATR Residential Water B PRWHEATR HeaterNent 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 INPUT Resources • AD M.Indoor Air Quality and Finishes 1.Use LowMo-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts' y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 . i i 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 .2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor .t Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 Total Points Available: 401 130 57 Total Points Pro'ect Received: 01 01 0 G:data/progsigref!nbuildnaguidelines/remodelers/greenpointsfinal2.12.D4protected.xis Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF ;UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # � OWNER'S NAME: PHONE # "750-- t-) GEI co ca�D f i,oj�NERAL CONTRACT R: ( FAX # -ekOJ5 I am not using any subcontractors: 1,tQ.f�.� Signature Date Please check applicable subcontractors and complete the follow' information: SUBCONTRACTOR BUSI14ESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical —==--------- ----------------- Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing ` Roofing Septic Tank Sheet Metal Sheet Rock Tile owner/Contractor Signature Date