B-2016-2153CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2153
10821 NORTHOAK SQ CUPERTINO, CA 95014 (316 41 022)
EFFICIENT WATER
HEATERS INC
SAN JOSE, CA 95110
OWNER'S NAME: MEDAMPALLI THIRULOGACHANDAR KAND SUJATHA
DATE ISSUED: 06/16/2016
OWNER'S PHONE: 612-845-4135
PHONE NO: (408) 393-3187
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-36 Lie. #1008381
Contractor EFFICIENT WATER HEATERS INC Date 10/31/2017
X BLDG —ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
- MECH X RESIDENTIAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
REPLACE WATER HEATER (50 GALLON).
I hereby affirm under penalty of perjury one of the followingtwo declarations:
ll m intain a certificate of consent to self insure for Worker's
, as provided for by Section 3700 of the Labor Code, for the
f the work for which this permit is issued.
ll maintain Worker's Compensation Insurance, as provided for by
Vec
of the Labor Code, for the performance of the work for which this
ed.
Sq. Ft Floor Area:
Valuation: $1375.00
APPLICANT CERTIFICATION
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
316 41 022
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, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applic tunderstands and will comply with all non -point
'
source regulations r e Cupertino Mu ' I Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date/6 16/16
Issued by: SEAN HATCH
Date: 06/16/2016j/1/
WNER-B ERDECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
i. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an. inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 6/16/16
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 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
performance of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Luper ' unicipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Se io 25505, 2 , . 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.T
Owner or authorized agent:/
APPLICANT CERTIFICATION
Date: 6/16/116
I certify that I have read this application and state that the above information is
CONTRU LENDINGAGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there isnstruction lending agency for the ,performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
I understand my plans shall be used as public records.
Licensed
Signature Date 6/16/16
Professional
GENERAL PERWT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333' _buifdingecueetno.org
CUPERTINO.
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By my signature below: I cerrify to each of the following: I am the property o,, ner or authorized agent to act on the propem, owner's behalf. I have read this
application and the information I have provided is collect. I have read the escription of lWork and verify it is accurate. I agree to comply A ith all applicable local
ordinances and State laws relating to buildinP truction. I autho ' e repres ntatives of Cup-., ino to enter the above-identi .,d pr ertg for inspection purposes.
Signature of AopiicantiAgent: Date: f� �
SII MENTA I- FORAfATION REQUIRED
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AIEP.447sc,4pp_?011.doc revised 06121111
June 9, 2016
Northpoint Homeowners Association 10880 Northpoint way, Cupertino, CA 95015
Donovan Lazaro j Planning Intern
City of Cupertino I Community Development
10300 Torre Avenue, Cupertino, CA 95014
RE: Thiru Medampalli —10821 Northoak Square, Cupertino
Dear Mr. Lazaro,
Thiru Medampalli has contacted the Association to request permission to install a new water heater.
The Association approves the installation of the water heater by a licensed contractor and the owner of
of unit 10821 Northoak Sq, Cueprtino, CA has submitted contractor Joseph Castro, CA LIC # 1008381.
At this time the HOA has no cause to prevent this installation a nd it is approved for install. The owner
and said contractor may apply for permits per the City's codes and regulations.
If there are any further questions, please contact me directly at the information listed below.
On behalf of the Northpoint HOA,
Zayra Yves, General Manager
Northpoint HOA
10880 Northpoint Way
Cupertino, CA 95014
Office: 408-996-3734
Fax: 408-996-0226
email: manager@northpo athoa.com
10800 Northpoint Way, Cupertiuc, CA. 95015
Mina •er.a_orthnoigtoaxom
IN