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08120045 CITY OF CUPERTINO BUILDING DIVM:ON PERMIT SCON TRAM OR I.�1�F�O�R,MAT ON,w BUILDING ADDRESS: PERMITNO. 1052 B BB RD HOME DEPQT OWNER'S NAME: PERMIT L%M DATE SA CONTROL NO. ARCHITECffENGINEER: BUILDING PERMIT INFO RMV/RPLC GAS WATER HTR BLDG ELECT PLUMB MECHO O O O woo LICENSED CONTRACTOR'S DECLARATION Job Description 1 hwby affioa Nat 1 w li.ivN under provisions of Chapter 9(commencing p riN Section7OW)ofD(vlelmn 3ofd Businwanditfcaelons Code.amimyIkerocu In full for¢Nd cflom Umma aav Lk.8 . ^ DIM.Contractor ee� ARCHITECTS DECLARATION Y 1 andvsund my plans shN be usW u public records I. u gLicensed Professional OWNER-BUILDER DECLARATION I hereby aRrm that 1 am exempt from the,Commcnoes Leaman Law for Ne p O following reason.(Section 7031.5,Business and Professions Code:Code:My city or county u m which expires•permit to consuuc4 after improve,demolish,or repair any svm uurc _ ;`2 prior to its issuance,also inquires the applicant for such permit a rile a signc l wtem.t x that he is licensed puwant an the provisions of the Convacoaa Liars Law(Chapter 9 Sq.Ft.Floor Area Valuation yF$ (commencing with Section 70D))of Division 3 of the Business;and ProfeaSions Code)or dist he is emmpt Nwfrosd and the basis for the alleged cadmption.My violation of Section 7031.5 by ad, pplae,for+permit sabjecu the applicant m a civil penalty of APN Number Occupancy Type not mos Nan Taw buMmd dollars(5500). ❑1.u owrter of the p.purty,a my wployces WN wages ss titek sole cwpnavtian, WRdotieswork ands: he Craeuand's Lnded,Law do Tarsale(Sec.7014,Buelness ami Prafesdons Code:The Cmnuacoh Liana law does net apply o an.atter of Required Inspections propenywho Wildsaimpronto ..Ami whodoeseachwmk himselfm though his own employers.provided that such improvements are not intended araffered forsak If. however,the Wilding or impovemot is old within am year oftompletion.the owner. Wilder WB law the Wood,of proving that he did ret Wild or improved for purpose of sok.). 1,as owns,of he property,and exclusively convecting with licensed..veto.an comtmct the project(Sec.7044.Badness and Profusions Cade:)The CoaManmrs Li- cens law dean not apply to an owner of property who Wilds or impom thereon,and, who.nvaN for such projccu WN+cmnttawr(sl licensed pursuant m Ne Convenors License law. 0 lwuwptunder See ,B&PCfordusreawo Owner Doe WORKER'S COMPENSATION DECLARATION 1 hereby affirm uMer penalty of perjury ors of the fallowing declarations: Iham ami will for by.e n..3eute of the Labor ame.for fa onfinsmar.of the Hon,r provided(pe mi Section 3-!110 of the uWr Code.far Ne peRorman¢of the woh for which this permit is issued. , 1 have and will maintain Workers Compensation Ins..,u,Ogoi.d by Section 3700.1'Nd Mbar Cade.for the perfarmrrmc of the work for which this permit is heated. My Waiters Compensation htmran¢carrier and Polity number are: C+oier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE finds mi.¢td rot he completed arms permit Is forma hundred dollars(SIM) m 4ss) I cvtify that in the pmfmrmarcc of the work for which this permit is Lead.I shell not employ any person in any mannero as as become mbjwi to tin World.'Cwpewtion Laws of California.Dau Applicant NOTICE TO APPLICANT:IL afar making this Certificate of Examption,you should become subject to me Worker's Compensation provisions of tite Labor Crock,you must .,Q foMwith comply with Inch provisions or this permit mail W deemed molted. z '--' CONSTRUCTION LENDING AGENCY 1 hereby affirm Mass there is..o no.lending agency fm the performanceof C'> the work for which this permit at issued(Sec.3097.Civ.C.) Gp Laminas blamed z Landers Address U Q 1 arsHfy that 1 haw mad this applicant n W suis Mau rite show information is Is. ^ comet-1 agree an comply WN all city and county aniiwtas and suis dos relating to .C) Wilding construction,and berehg mtbown representatives of this city an cater upon lit L17 shove-mentioned property for inspection purposes CL. (We)agree to saw.indemnify and keep harmlw the City of Cupertino against .F.,fn liabillfim j.dgments,costs andexpnuu which may In any way ac.almost aid City V Z in cmveq¢ae of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. - Re-roofs Signarure of AWlinnVConvsmr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tite applicant an fumrd Wilding¢cupant sore or handle hacardou mautia] as defined by tite Cupertino Mumap+l Code.ClupMr 9.13,LAW tite Health and Safety Code.Section 15533(+)? All roofs shall be inspected prior to any roofing material being installed. ❑Yu ON. NIrl]the.,It.,or to.Wilding a¢mpnt ma eq.1pm.t.1 devieel which If a roof is installed without first obtaining an inspection,I agree to remove t haramou air commitments Is dc0tud by the Bay Arca Air Quality Management all new materials for inspection. arita? ❑Yea ON. y 1 hew real the to a dm s mvedatsrequlmments under Chapterai.95 of thc Califer. nia Hcx th&SafetyCdl Sections 25505,15533 and 35534.]understand thxtif the Wilding does not cuwntiy haw a Meant.that it h my responsibility an notary the decupent of the requmoveras which most W met prior at Issuance of a cerifuau of Cecupertey. Signature Of Applicant Date Owner or sumo bud agent Date- All roof coverings to be Class'W'or better CITY OF CUPERTINO • 4 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 36204014 . 00 DATE ISSUED. . . . . . . : 12/04/2008 RECEIPT # . . . . . . . . . : BS000006763 REFERENCE ID # . . . : 08120045 SITE ADDRESS . . . . . : 1052 BUBB RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SID NANDI ADDRESS . . . . . . . . . . : 1052 BUBB RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JEFF JORDAN CONTRACTOR . . . . . . . : FRANK BLAKE LIC # 30610 COMPANY . . . . . . . . . . : HOME DEPOT ADDRESS . . . . . . . . . . : 12601 132ND AVE NE CITY/STATE/ZIP . . . : KIRKLAND, WA 98034 TELEPHONE . . . . . . . . : (425) 636-7054 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 449 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1PRWHEATR UNITS 1 . 00 24 . 48 0 . 00 24 . 48 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 106 . 56 0 . 00 106 . 56 0 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ----- --------------- - - 518 WATER HEATER • aOOF Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 iFax(408)777-3333 •CUPERTINO Building De artment JOB ADDRESS: 1052 BUBB ROAD PERMIT# 0� /"2 L/ OWNER'SNAlYlE: NANDI,SID PHONE # (408)446-8483 GENERAL CONTRACTOR HOME DEPOT r� FAX# 425-814-9516 I am not using any subcontractors:_ C' w l` ,. &,o7 11/4/08 Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring:Carpeting Linoleum/Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile • Owner/Contractor Signature Date • - t Permit No: 6 C) 000000 (office use only) City Of Cupertino_Building Permit Application • E-Mail: Building-Permits(a7.cupertino.org (Address is case sensitive). Jobsite Address: 1052 BUBB ROAD Date: 11/4/08 Assessor's Parcel Number: J�(va� `i`� / `/, o0 Owners Name: NANDI,SID Phone No: (408)446-8483 Project Valuation: 449.00 Building Permit Info: Bldg Elect Plumb X Mech Job Description Remove/Replace Gas Water Heater Contractor Information Company Name: HOME DEPOT Phone No: • Contact Name: Carol Randall Fax No: 800-454-8955 Address: 12601 132ND AVE NE E-mail:-carolr@fastwaterheater.com City, State & zip code: KIRKLAND, WA 98034 State Contractor's Lic. No: 602331 Expiration Date: 9/30//o Worker's Comp No: 1928756 Expiration Date: 3/1/09 Carrier: AMERICAN HOME ASSURA City of Cupertino Business License No: Prpo kke_ C 3� Credit Card Information Credit Card No: Expiration Date: 11/10 Name on Card: Jeff Jordan Visa ® MasterCard ❑ American Express ❑ • The Building permit application and a completed & signed contractor/subcontractor form need to be submitted with each permit.