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B-2017-1496 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: 'PERMIT NO:B-2017-1496 10057 STERN AVE CUPERTINO,CA 95014-3641(375 11 054) STREET PLUMBING AND ROOTER SAN JOSE,CA 95128 OWNER'S NAME: POPAT SATYEN AND SURESH THEJA DATE ISSUED:09/07/2017 OWNER'S PHONE:404-518-7495 PHONE NO:(408)496-1155 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic.#582217 Contractor STREET PLUMBING AND ROOTER Date 12/31/2017 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-SAME LOCATION IN CLOSET I hereby affirm under penalty of perjury one of the following two 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. :a 1 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:$1400.00 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 375 11 054 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 applicant understands and will comply with all non-point source regulations per the C rtino Municipal Code,Section 9.18. i 180 DAYS FROM LAST CALLED INSPECTION. sjp.10 Date 9/7/2017 Issued by:Abby Ayende Date:09/07/2017 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 t. 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:9/7/2017 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 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 t: Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with t e Cupe tino Munici a al Code,Chapter 9.12 and . exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety 4 ode,Sec ons 25 i 5,2553'-,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall .be deemed revoked. O,4sI authorized uthorized agent: /11 APPLICANT CERTIFICATION a,g 9/7/2017 I certify that I have read.this application and state that the above information is ( vY I►-Ti II► '�t ► _ correct.I iagree 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 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 9/7/2017 Professional i • - •• • ARTMENT BUILDING DIVISIONGENERAL PERMIT APPLICATION-• • toy,„., COMMUNITY DEVELOPMENT DEP ME' _ .,,, 10300TORRE AVENUE.CUPERTINO,CA 95014-3255 irUPEEtT1N8 (408)777-3228-FAX(408)777-3333.buiIdino acupertino.ord . M I S C . - gPPLUMB1NG ( 0MECHANICAL DELECIRICAL DMISCEEI:ANEOUS PROJECT ADDRESS 005-7_ V7 4116,- c� !C --:"Lt _.p _ O RNA- 5, j PO ' J PHS If- O/r-7q r E-MAILv STREETADDRESS boor? Sir n ' CITY,STA Ka, CA i y I FAX" CONTACT NAME OAA r or, •P ffo8' 1196 •.(/ &A : STREET: ADDRESS '2'a3 Wo./I` y e G� �/�,1 p !moi (lV Cask_h... C1iYV""'�J�C. !/41 C 11�(/O FAX _!r^ 96•L S� D-MINA ORTIIR�tIIID)R ❑OWNERAGENP / '1C@i7$ItL1pR ❑COhIIt4 croaAGE�'3 ARCEDFEECf: '❑ENGINEER C❑'f`/')DAYSAPER 0 TELZdANT CON]ItAQORNAME I SEIVtTMBIB .` Movri ` cc*cr.- _S822 7 LICE ejc � TCO �, - ,- COAPANYNAME \S pi , .Iw)/►�1' =s ¢ ; �Mv►IJ 1 fir, COL. FAX�/ -" `� STREET ADDRESS3 CTI:yr. �, nino lijat h'sr . - ARCHFlECT/ENGINR .yAME I LICENSENUMBER BUS.LIC# - COMPANY NAME -MAn. FAX . • STREET ADDRESS CTTY.SrATE,2lP PHONE .usa of ASFD or Duplex 0 Multi-Family Psoz.cr IN wn.ur.ND . _ - [mazer mi ,• STRUCTURE' ❑ CAmi ercial URSANINIERFACEAREI, 0 Yes • 0 No REOC ZONE 0 Yes 0 No , SpI (A)A-xci-r- .kii-"Alc-K- tri---e--ewr-,v4- 0 6IctAr---- DESCRIPIION.OFWORK '' Un a TOTAL VALUATION 4o-D „. '` v j ` z, ..:-,,.....„ ..kr-F-- a „,_„..s.„,„,„y g � ^C-yam d,� •�y -�� . By my sioatare below,'Ioertifytoeach ofthefoll.•,cr I am 9,' :..periyowner orauthorized agent toactontbeprdpadyowner'sbehaIE1Ihaveicadthis application and deinfmmatiou Ihave provided i ,.veread •---:.,-an of Waticaadveriyitis accurate.I amen)comply with all applicable local ' -- ordinances and state laws mlatnigtobml. •,..,,.,'R' ,:, ,,, Wives ofCupe�otoentertheabove-id s,.J,edpmperyfel'dI`spectionpurp� ' Signature ofApphcant/AgeoC' �ff�e� Date: g . 1 117 I , I', , 1 ;j, ' Supp,eliriAlIFAL 113141 •TION REQUIRED , _ n I - MEPM?scRpp 201Ldoc revised 03/16/11