BLD-2020-0705BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
OWNER'S NAME: PHADKE SHAILESH AND PATWARDHAN VAISHALI
OWNER'S PHONE: 4084316879
CONTRACTOR:
HARRIS WATER HEATERS INC, 21508 GAIL DRIVE CASTRO VALLEY
CONTRACTOR PHONE:
DATE ISSUED 5/30/2020 8:56:15 AM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $1708
JOB DESCRIPTION
(N) 40-GALLON WATER HEATER LIKE FOR LIKE SAME LOCATION
LICENSED CONTRACTOR DECLARATION
LICENSED NO: EXP DATE:
1026214 1 1 /30/2020
(commencing with Section 7000) of Division 3 of the Business & Professions Code and that my
CONTRACTOR:
HARRIS
I hereby
license
I hereby
WATER
is
have
work
I have
affirm
in full
affirm
and
for
and
issued.
comply
LICENSED CLASS:
HEATERS INC C36 PLUMBING
that I am licensed under the provisions of Chapter 9
force and effect.
under penatly of perjury one of the following three declarations:
will maintain a certificate of consent to self -insure for Worker's
which this permit is issued.
will maintain Worker's Compensation Insurance, as provided
that in the performance of the work for which this permit is issued,
laws of California. If, after making this certificate of exemption,
with such provisions or this permit shall be deemed revoked.
Compensation, as provided for by Section 3700 of the Labor Code, for the performance
OI
of the
for by Section 3700 of the Labor Code, for the performance of the work for which this
I shall not employ any person in any manner so as to become subject to the Worker's
I become subject to the Worker's Compensation provisions of the Labor Code, I must
V
is
I certify
nermit
Compensation
forthwith
HAZARDOUS MATERIALS DISCLOSURE
6.95
the
air
the
project.
of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have read
An EPA
Firm
No EPA
the hazardous materials requirements under Chapter
with the Cupertino Municipal Code, Chapter 9.12 and
V
compliance
Additionally,
compliance
Health & Safety Code, Section 25532(a) should I store or handle hazardous material.
contaminants as defined by the Bay Area Air Quality Management District I will maintain
Health & Safety Code, Sections 25505, 25533, and 25534.
Firm Certification No:
should I use equipment or devices which emit hazardous
with the Cupertino Municipal Code, Chapter 9.12 and
Lead -Safe Certified Renovator will be responsible for this
Name:
Lead -Safe Certified Firm is required for this project.
Certified
V
CONSTRUCTION LENDING AGENCY
lending agency for the performance of the work which this permit is issued (Section 3097, Civil
Lender's Address:
I hereby
Code).
Yes
affirm
under penalty of perjury that there is a construction
No
Lender's
Name:
APPLICATION CERTIFICATION
information
city
judgements,
will comply
is correct. I agree to comply with all city
to enter upon the above mentioned property
costs, and expenses which may accrue
with all non -point source regulations per
and county ordinances and state laws relating
for inspection purposes. (We) agree to save
against said City in consequence of the
the Cupertino Municipal Code, Section 9.18.
I certify that I have read this application and state that the above
to building construction, and hereby authorize representatives of this
indemnify and keep harmless the City of Cupertino against liabilities,
granting of this permit. Additionally, the applicant understands and
Signature:
;�
.