BLD-2020-02171BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 877 LILY AVE Cupertino
APN: 359 03 021
PERMIT NO: BLD-2020-02171
OWNER'S NAME: SATYA DEEPAK AND MALINI TRUSTEE
OWNER'S PHONE: Not Provided
CONTRACTOR: ECONOMY ROOTER INC, P 0 BOX 2252 SANTA CLARA
CONTRACTOR PHONE:
DATE ISSUED 12/22/2020 1:54:24 AM
ISSUED BY:
VALUATION: $750
JOB DESCRIPTION
Replace a 40 Gal gas water heater in the same location
LICENSED CONTRACTOR INFORMATION
CONTRACTOR: ECONOMY ROOTER INC
LICENSED CLASS: C36 PLUMBING
LICENSED NO: 892045
EXP DATE: 05/31/2022
I hereby
force
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
and effect.
affirm under penatiy of perjury one of the following three
I have and will maintain a certificate of consent to self -insure
for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,
I certify that in the performance of the work for which this
laws of California. If, after making this certificate
with such provisions or this permit shall be deemed revoked.
and agree that I am electronically signing and filing
that I have the option of filing a paper copy of this application
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
1
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
this application and that checking the box below has the same legal effect as manual signature. I also
with a manual signature but have chosen instead to file this application electronically.
work
2
issued.
3
Compensation
comply
I understand
understand