B-2017-1403 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1403
20064 NORTHWIND SQ CUPERTINO,CA 95014-0552(316 38 058) ECONOMY ROOTER
INC
SANTA CLARA,CA
95055
OWNER'S NAME: SALLA NAVEENA AND VOODARLA HARISH KUMAR TRU DATE ISSUED:08/22/2017
OWNER'S PHONE:408-368-2570 PHONE NO:(408)249-4922
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lica#892045
Contractor ECONOMY ROOTER INC Date 05/31/2018 X BLDG _ELECT X PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby 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:
(N)50 GAL WATER HEATER-GARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
t. I have and will maintain a certificate of consent to self-insure for Worker's
ilik Compensation,as provided for by Section 3700 of the Labor Code,for the
pi -
tAq, erformance 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:$0.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 316 38 058
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 agai t said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,th>:•'licant understands and will comply with all non-point
source regulatio -.-i,
the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
, ‘ASignature �. Date 9-14-2017 Issued by:Jasmine Archbold
Date:08/22/2017
OWNER=BUILDER DECLARATION
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
1. 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:9-14-2017
I hereby,affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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
3. 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 is y Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the (uertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of thethe Health&Safety Cod"a:%ions 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be,deemed revoked. ' 1�
. Owner or authorized agent..wrq.
APPLICANT CERTIFICATION Date:9-14-2017
I certify that I have read this application and state that the above information is CONST''i CTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction 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'indernnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,arid 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 9-14-2017 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1403
20064 NORTHWIND SQ CUPERTINO, CA 95014-0552 (316 38 058) ECONOMY ROOTER
INC
SANTA CLARA, CA
95055
OWNER'S NAME: SALLA NAVEENA AND VOODARLA HARISH KUMAR TRU
OWNER'S PHONE: 408-368.-2570
LICENSED CONTRACTOR'S DECLARATION
License Class C-38 Lic. #892045
Contractor ECONOMY ROOTER INC Date 05/31/2018
I hereby 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.
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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.
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 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
may, accrue against said City in consequence of the granting of this permit.
Additionally, the a !cant understands and will comply with all non -point
source regulatio 'per the Cupertino Municipal Code, Section 9.18.
Sig ure Date 8/22/2017
OWNER -BUILDER DECLARATION
DATE ISSUED: 08/22/2017
PHONE NO: (408) 2494922
BUILDING PERMIT INFO:
X BLDG _ ELECT X PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
(N) 40 GAL WATER HEATER -GARAGE
Sq: Ft Floor Area: Valuation: $0.00
APN Number: Occupancy Type:
316 38 058
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Jasmine Archbold
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
r. I, asowner of the property, or my employees with wages as their sole installed without fust 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: 8/22/2017
I hereby affirm underpenalty of perjury one of the following three declarations:
1. 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.
2. 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,
s. I certify that in the performance of the work for which this permit is issued, I
shall 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 become subject to the Worker's Compensation provisions of the
Labor Code; -I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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 may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply withal] non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 8/22/2017
11 A 11
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the B R
Area Air Quality Management District I
will maintain compliance with the p"rtino Municipal Code, Chapter 9.12 and
the Health & Safety Code ons 25505, 25533, and 25534.
Ow r authorized agent:
2 /201
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CUPERTINO
PROJECT ADDRESS
APNn
O6
D 9.9?
OWNER NAME j QK I� VOA i2
1
PHO 36
6 �, 7-o
E-MAIL
STRE ADDRESS
CITY, STAT ,ZIP FAX
CONTACT I�'AME
Z~ t9 2Gf l N'0
PHONE _
E-MAIL
STREET ADDRES I / �h4
r �
CITY, STATE, ZIP (?A � 731D
FAX
[TOWNER 11OWNER-BUILDER OWNER AGENT IZCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER [:]'TENANT
CONTFR.ACT'ORNgELICENSENTUMBI
�
LICENSE
BUS. LIC'#//D 0,�
7
COMPANY NAM
E-MAIL
FAX
STREETADDRESS r'
,-� I �-
CITY, STATE, ZIP
s e� sr --5,o
PHONE
OZZ
ARCIIITECT,ENGINEERNAME;
LICENSE NUMBER
BUS.'LIC #I
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ 'SFD Or,Duplex ❑ Multi -Family
. PROJECT IN N4LDLAND
PROJECT IN
❑ :Corrlmercial
URBAN INTERFACE AREA ❑ Yes ❑ No
FLOOD ZONE ❑ Yes ❑ NO
STRUCTURE!
❑ SOLAR PANELS
❑ ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
ER: lJ V
FOR SOLAR PANELS. NUMBER OFPANELS/UNITS:
KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION: 10 O. Oro
DESCRIPTION OF WORK
�J
/� /) I
k1,t4,
c -CS
�� S ` u—
i
By my signature below, I certify to each of he following: I am the property owner or authorized' agent to act on the property owner's behalf. I have read this
application and the information I have pro ' d is correct. I have
read the Description of 1' pork and verify itis accurate. I agree to comply with all applicable local
ordinances and state laws relating to build st uction. I authorize representatives of Cupertino to enter the above -identified property for inspection proposes.
Signature of Applicant/Agent:
Date:
SUPPLEMENTAL INFORMATION REQUIRED
r Gi FiCE`vsE olt ,
` �U "
w❑ O\ ER TH1rrCOU1\TER ,,,„ �Q �'
, x U
yy;���,y
PVApp_2011.doc T-evised 03116111