13080027CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22025 CREEKSIDE CT
CONTRACTOR: ECONOMY ROOTER PERMIT NO: 13080027
OWNER'S NAME: ABI-IAY BHORKAN & MANSI MODAK
PO BOX 2252 DATE ISSUED: 08/05/2013
OWNER'S PHONE: 4082422169
SANTA CLARA, CA 95055 PHONE NO: (408) 249-4922
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
I"icense Class Lic. #
MECH i RESIDENTIAL [— COMMERCIAL
Contractor Date
JOB DESCRIPTION: REPLACE 40 GAL WATER HEATER AT'I'HE SAME
I hereby affirm that I am licensed under the provisions of Chapter 9
LOCATION.
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 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
Sq. Ft Floor Area: 0 Valuation: $700
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 32639039.00 Occupancy Type:
APPLICANT CERTIFICATION
1 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
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,
may accrue against said City in consequence of the
180 DAYS FROM LAST CALLED INSPECTION.
costs. and expenses which
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Date:
9.18.
Issued by:
Signature Date
❑ OWNER -BUILDER DECLARATION
RE; ROOFS:
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:
I, as owner of the property, or my employees with wages as their sole compensation,
inspection.
Date:
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Signature of Applicant:
Business & Professions Code)
1, 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
Code, Sections 25505, 25533, and 25534. 1 will maintain
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
performance of the work for which this permit is issued.
Safety Code, Section 25532(a) should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should I 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
If, after making this certificate of exemption, I
Owner or authorized agent:
Compensation laws of California.
Date:
become subject to the Worker's Compensation provisions ofthe Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT
I hereby affirm that there is a construction lending agency for the performance of work's
,CERTIFICATION
1 certify that 1 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 relating Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, 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
the Cupertino Municipal Code, Section
I understand my plans shall be used as public records.
with all non -point source regulations per
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1283 POPPY WAY CONTRACTOR: WES'T'ERN ROOFING PERMIT NO: 13080033
SYSTEMS
OWNER'S NAME: ZHAO ALLEN AND HUANG MELINDA 1328 WHITE OAKS RD DATE ISSUED: 08/06/2013
OWNER'S PHONE: 4089961283 CAMPBELL, CA 95008 PHONE NO: (831)278-1837
LICENSED CONTRACTOR'S DECLARATION
License
BUILDING PERMIT INFO: BLDG ELECT PLUMB '
Class Lia #
r_
Contractor Date
MECH RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: TEAROFF WOOD SHAKE AND INSTALL METAL SHAKE
(commencing with Section 7000) of Division 3 of the Business & Professions
PER ER
Code and that my license is in full force and effect.
3098-28SQ
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
permit is issued.
Sq. Ft Floor Area: 0 Valuation: $15500
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
APN Number: 36618020.00 Occupancy "Type:
correct. 1 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 msave
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
this
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18,
Signature Date
Issued by: Date:
13 OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. It'a roof is
1, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
1, 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 BETTERI
hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
California
permit
I have and will maintain Worker's Compensation Insurance, as provided for by
Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
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.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
1 certify that in the performance of the work for which this permit is issued, I shall
contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
n compliance with the Cupertino Municipal
Health '& Safety Code, Sections 25505, 25533, and 2.534e, Chapter 9.12 and the
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
Owner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked.
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
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
I 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.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITEC"T"S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional