B-2017-1552 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1552
18415 CHELMSFORD DR CUPERTINO,CA 95014-6406(375 22 042) T&N PLUMBING&
ELECTRICAL INC '
MODESTO,CA 95353
OWNER'S NAME: KESHAV VIJAY AND DAYANAND ASWATHY DATE ISSUED:09/12/2017
OWNER'S PHONE:408-218-9741 PHONE NO:(209)408-8078
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10:C-36 Lic.#999455
Contractor T&N PLUMBING&ELECTRICAL INC Date 12/31/2018 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:
REPLACE 50 GAL WATER HEATER-SAME LOCATION
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
.erformance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by
'!rection 3700 of the Labor Code,for the performance of the work for which this
'f
rection
is issued. Sq.Ft Floor Area: Valuation:$900.00
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 22 042
representatives of thiscity 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 pert C .ertino Muni -ode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
gnaturel — % Date 9/12/2017 Issued by:Abby Ayende
Date:09/12/2017
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., ,II,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 • inspections
;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:9/12/2017
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 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 c' _ rode,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Section 533,and 2 534.
Labor Code,I must forthwith comply with such provisions or this permit shall . 1111111..
/
be deemed revoked.
ren r or authorized agent:
APPLICANT CERTIFICATION ®Date:9/12/2017
I certify that I have read this application and state that the above information is I►.TR e►L chin. Y
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.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 9/12/2017 Professional
-70tl-- iC-Z..
\ GENERAL PERMIT APPLICATION M E P
I�/ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
est,•ss 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MISC
(408)777-3228•FAX(408)777-3333•building ancupertino.orq
CUPERTINO
El PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS 18415 CHELMSFORD DR APN# 37522042 •
OWNER NAME KESHAV/DAYANAND PHONE (408)218-9741 E-MAIL
STREET ADDRESS FAX
18415 CHELMSFORD DR CITY, STATE,ZIP CUPERTINO, CA 95014 .
CONTACT NAME DANIEL BONACICH PHONE 209 408-8078 E-MAIL
( ) COORDINATOR@TNELECTRICALPLUMBING.COM
STREET ADDRESS CITY,STATE,ZIP MODESTO, CA 95350 FAX
946 MCHENRY AVE#4 (209)408-0807
' El OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR XCONTRACTOR AGENT ❑ ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME LICENSE NUMBER 999455 LICENSE TYPE C10/C36 BUS.LIC#
FRANCES KUMAR 403271
COMPANY NAME E-MAIL FAX
T&N PLUMBING&ELECTRICAL INC. COORDINATOR@TNELECTRICALPLUMBING.COM (209)408-0807
STREET ADDRESS PHONE
946 MCHENRY AVE#4 CITY,STATE,ZIP MODESTO, CA 95350 (209)408-8078
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF IXFD or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
1 BUILDING: EICOMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE �NO EICHLER HOME? X NO
DESCRIPTION OF WORK'
REPLACE THE 50 GALLON NATURAL GAS WATER HEATER IN THE GARAGE.
TOTAL VALUATION: $900.00 RECEIVED`BYQ,,,��
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the(Lo• 'i'
operty or 's beh f. IIhhalvvee read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: fr-- /c4,44,QA, Date: 08/16/2017
•
SUPPLEMENTAL INFORMATION REQUIRED ,,.'r OFFICE',USE ONLY,
Hp •, 0 OVER THE-COUNTER
¢, ''E. 0.EXPRESS§
W
5; ;0 STANDARD
. LARGE , .,
0 MAJOR, .
•
MEPMiscApp_2011.doc revised 06/21/11