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B-2016-3005
CITY OF CUPERTINO BUILDING PERMIT BUILT) G ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3005 6715 LIFFORD DR CUPERTINO,CA 95014-4557(369 11 042) STREET PLUMBING AND ROOTER SAN JOSE,CA 95128 OWtR'S NAME: SHAH RAKESH AAND PARUL R TRUSTEE DATE ISSUED:10/27/2016 a OWNER'S PHONE:408-482-0590 PHONE NO:(408)496-1155 i NSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic.'#5B2217 Contr ictor STREET PLUMBING AND ROOTER Date 12/31/2017 X BLDG _ELECT X PLUMB _MECH X RESIDENTIAL_COMMERCIAL I here by affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE 50 GALLON WATER HEATER(SAME LOCATION) I here y 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: Valuation:$1200.00 APPLICANT CERTIFICATION cert�y that I have read this application and state that the above APN Number: Occupancy Type: information is correct.I agree to comply with all city and county ordinances and sate laws relating to building construction,and hereby authorize 36911042 representatives of this city to enter upon the above mentioned property for inspe.tion purposes. (We)agree to save indemnify and keep harmless the City cf 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. .Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ',Signature Date 10/27/2016 Issued by:Abby Ayende Date:10/27/2016 OWNER- ER DECLI her4E by 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 ofApplicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date;10/27/2016 I her by affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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. 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 a. I 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 shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous 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 Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&SafetyWCode, ' 4-255 an25534. Labor Code,I must forthwith comply with such provisions or this permit shall '"be deemed revoked. Owner or authorized agent APPUCANT CERTIFICATION Date:10/27/2016 1 certify that 1 have read this application and state that the above information is CONSTRUCTION LENDINGAGENCY iffirm that there is a construction lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws I hereby a 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 sale indemnify and keep harmless the City of Cupertino against liabilities, judg lents,costs,and expenses which may accrue against said City in Lender's Address cons quence of the granting of this permit. Additionally,the applicant understands and ill comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Cod. Section 9.18. I understand my plans shall be used as public records. Licensed Signature--- Date 10/27/2016 0 - Professional GENERAL PE [SIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE-AVENUE-CUPERTINO,CA 95014-3255 . 1 S (408)777-3228•FAX(4.08)777-3333•buildingp_cupertino_ond Rn UPERTINO- two PLUMBING ❑MECHANTICAL ❑EL.ECTRICAi ❑mISCELLAN'BOUS PR JECT ADDRESS /_(„Q'_+' 5- V L' F F D De_f Y c APN P a�[ O NAME J�dr�/.-FS V r/ PHOAE Q %BZ—OSriO I E-MAff ST ET ADDRESS J �I r �,L/��tl» it 1` CITY,STATE,ZIP C/U�POZ/ //O{ C4 I Fes, COTACT AAVIE PV kONE i v V V14i�- �G, C.e►'W� � ,,Ci3Vi STIEET ADDRESS 2 2q3 V/ n wt G r3 M CITY,STATE,ZIP ,-t JT6 8 E /' .1 [Ji S Y�p FAX G VV t .`r L AN O!f l�/t ! ! O ❑ r* B�VVNM 11 OR'NER-BUILDER ❑ OA'AERAGEN'T CONTRACTOR ❑CONURACTORAGEtZ Q ARCMECT. ©EN'GLNEER 0 DEVELOPER 11TEA_An*L li F01,1TR_'ACT0RNAME //' � '�+� LICENSEI�UMBER {�(� �7 LICENSETYPE !!'j/ BLTS.LICI�ME Qn� jPL:tWa/kCS Y'ks�Y1Cf WISE/1=STtETADDPFSS V '�(I y- ��,y 2 Z 3 v�+�L I�I �/_`"�4- ' STATE:ZIP ARTHITECTIENGIN-EERNAME LICENSE-NTLWBEi2 BUS.LIC- COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHOI`E `I z US OF X_S`F�or Duplex [IMWti-Family PROJECT IN\VILDLAN� PROJECT LST F, s-rjLicTLtRE: ❑ Commercial URBANINTERFACEAREA ❑ Yes 0 No FLOODZONE ❑ Yes ❑ NO DESCRIPTIOn'OFWORK �50 cl cc n-- Cl` Ir ° 44 I� Cmc 1 n TOTAL VALUATION: REC.EI1>£DBY £ I i By my signature below,I certify to each of the follow ina: I am the property owner or authorized agent to act on the properly owner's behalf. I have read this ap lication and the infotination I have r vi i is correct ead the Description of\�jork and verify it is accurate. I agree to comply with all applicable local or nces and state laws rely i 1 g �Itb rize n resentatives of Cu to enter the above-identifi d prop for inspection purposes. Sigpature of Applicant/Agent Date: lT S PLE NIA ORMATION REQUIREDi xF - N 1.., � OFFICE,IISE OIv'LY�..,-�. _ HE COLIv3ER all :FxP RESSsv a t j sus l� STANDARD x - U II4EPnfisct4pp_2011.doe revfsed 03IJ 5111 r 11 L