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08040067 CITY OF rUPF.VINO ' r>:.x. r�-A#ia�G§-' BUILDING DIV] N PERMIT COP(1 TbR RANIPORMATIION BUILN RESS: PERMIT NO. Q fMDDSHADOWHILL LN FAST WATER HEATER 08040067 OWNER'S NAME: PERMIT ISSUE DATE ANJALI DESHMUKH 12601 132 AVE NE 04/09/2008 ONE: SANITARY NO. CONTROL NO. 0.CHrrECT/PNGINEER: BUILDING PERMIT INFO RMV/RPLC GAS WATER HEATER BLIX3 eO PO O 30o LICENSED CONTRACTOR'S DECLARATION M706 Description �i 1 Avthe Aveley M. I am Ifneased under provisions of Chapter m 9(asmemein{ xx with Seamon 70 W)ol Division Sof rex Buuneu and product es Code,and my lzcmcu n=N in full forts andeRat L 14 License Class Lic.Is Dau Contractor. 3� ARCHITECTS DECLARATION I understand my plans shall nd used As public records lad Licensed Prufeuimul h OWNER-BUILDER DE CLARATIDN .�i I I hemhy afRrm that I am exempt from the Convenors License Tuve for Ne Mfollowing mason.(Section IID L5,Business and Professions Code:Any city or county which requires a permit to ctmstrucL Wer.hnpmw,demolish.m minor any structure raPrimtoits iasuenCe,alw mquims Nc applieantfor sucn Permit to file asigmedsuumcot �a that he is licensed pursuant to the provisions of the Contractor's License Law(chapter 9 Sq,Ft. Floor Area Valuation S (commencing with Section 7000)of Division 3 of the Business and Professions Code)Or oto he uexempt therefrom and tiW bub for the alleged exemption.My violation of Section 10316 by any applicant for a pemdl subjects the applicant to a civil penally of APN Number Occupancy Type not¢ort tium five hundred dallars(S9M ❑L u ownsk.die pmprny, r is Out a imeandee w101 wwges u then mu compensation, will da thework.C d d net Con mmes License doesard an[Apply IOM.owne of Required Inspections and Rty,wh ou Cade:mpr Caatrmlars Lunen law aces o r apply to rt owner of q P propertywhob,pro iimpmwch improvements who We nanehwmk himul(or through his ....play=,provided orI prsuchimprowmants ase not Intended arofa oroaertd for Ow IL however.to building or Improvemant is told within one yeas of completion,Ne awmer- builder .NO how the louden of proving that he did rot build on improv for purpose of - ❑1,As owmes of the prapcny Area exciimwly eanvscting with nccesed conhoctora W connum the project(Ser.IOM.Business and Pmfudons code:)The Contactor,U. corse law does not apply to an owner of Property who build,or improves thereon,sed, who contracts for such projects with a eontactar(s)Demand pursuant to the Cantusors License Law. l am exempt under See ,B d P C far thisuuon 0. Dau WORKERS COMPENSATION DECLARATION 1 hereby antra under penalty o(perjuy one of Ne fallowing deelantiow ham and will maintain a CaNOnuaf C..AI to self-Insure for Worker's Comp m- h f n,u provided for by Section 3700 of the[m.Coda,for Ne perform...of tho or whieb thin permit in issued. ❑1 have and will maintain Worker,Compensation InmranCe,As required by Section 37M cities Labor Code,fu Ne performmee of Ne work for which this permit la lusted. ' My Worker's CompenMUon Insurance curia and Polley number am: Cartier, Poliry No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This smedon need notWcompleud Miss permit Is furone hundred dollm(SIM) of less.) 1 artifv dist In the performance of the work for which this permil is Issued,I"I nut employ any person in my summer an as At thecoma subject to the Worlmd Compensation Lave of CalifomiL Dae Applicant NOTICE TO APPLICANT.IL after making this Car ilh ue of Exemption,you should become subject to No Worked Compeaskdon provisions of Ne Tubo Cada,you most O O forthwith comply with such provisions or this permh Wail be dammed reverted., z., CONSTRUCTION LENDING AGENCY 1 hereby affirm that Nom is a construction loading agency for the performance of (Y> the work fa which Nis permil is issued(Sec.3097.Civ.C.) CL,0 L uumes Name .7. z Leaders Addmaa U Ot I Certify that I have road this application and SLAW that the above hoetrmWun is ly U coned 1 agree to comply with all City and county ordinances and mW laws refining In .O building concoction.and hereby authorise rtprt,enLAtiwS of this city to enter upon No Ua above.mentioned properly for Impactton Puryosea (We)agree to save,indemnity and kap hermbaS the City of Cupenino Against ccA liabilideerjudgmenLA,caw and expenw which may In any coy emus Against aid City V 7 in Comsat K sof me granting of this permit. ' w1• APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Si{nuum al AppliesDaW HAZARDOUS S MAigalA15 DISCLOSURE Type of Roof Will tow ertnr form Wilding occupantmarc ar hande hiscommusmaterial defined NCupertino Municipal Cade.Chapter 9.11.and thImdgh and SalaryCaae.senionsss3z(.)7 pYns ON. All roofs shall be inspected prior to any roofing material being installed. Will Na applicant or future Wilding occupant use equipment Or dcvhw which If a roof is installed without first obtaining an inspection,.I agree to remove I haurdous air contaminants as unlined by the Bay Area Air Quality Management all new materials for inspection. riot? ❑3b ON. 1 haw mid the hanrdou materials rtquimmenu uWerf]upur6.95 of the CUlifm- nuHalNkSafcly Cade,Swd u255W,25533and2S534.IaWewndthatlfNo Wilding Jan tot currently have a Imam Nat it Or my ramendhillLY to reify Ne occupant Of da mquiremenu which mus,be nut prior to ouuanco of a CortifusW of Occupmcy. Signature of Applicant Date owney ormtharimea agent Dam - All roof coverings to be Class'%¢"or better CITY OF CUPERTINO • 4 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36230096.00 DATE ISSUED. . . . . . . : 04/09/2008 RECEIPT #. . . . . . . . . : BS000004429 REFERENCE ID # . . . : 08040067 SITE ADDRESS . . . . . : 7494 SHADOWHILL LN SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ANJALI DESHMUKH ADDRESS . . . . . . . . . . : 7494 SHADOWHILL LN CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5052 RECEIVED FROM . . . . : JEFF JORDAN CONTRACTOR . . . . . . . : JEFF JORDAN LIC # 29100 COMPANY . . . . . . . . . . : FAST WATER HEATER ADDRESS . . . . . . . . . . : 12601 132 AVE NE CITY/STATE/ZIP . . . : KIRKLAND, WA 98034 TELEPHONE . . . . . . . . : (800) 454-8955 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 ITRAVDOC 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_ Permit No: 08060(p7 399132 (office use only City Of Cupertino Building Permit Application E-Mail: Building-Permits -)rupertino.org (Address Is case sensitive). Jobsite Address:7494 SHADOWHILL LN Date: 3/31/08 Assessor's Parcel Number: Owners Name: DESHMUKH, ANJALI Phone N0: (408)446-5404 Project Valuation: 449.00 Building Permit Info: Bldg Elect Plumb x Mach Job Description Remove/Replace Gas Water Heater Contractor Information Company Name: FAST WATER HEATER COMPANY 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: 877489 Expiration Date: 5/31/08 Worker's Comp No: 1761660 . Expiration Date: 12/1/08 Carrier: California State Fund City of Cupertino Business License No: 291(13 Credit Card Information Credit Card No: 4417123041349530 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. Community Development 10300 Tarn Avenue i£ Cuper-duo CA 95014 Telephone(408)777-3228 cl o Fax(408)777-3333 ® CUPEkTINO Building Department JOB ADDRESS: 7494 SHADOWHILL LN FERMIT# D 8 Com`( )0( 7 OWNER'S NAME: DESHMUKH, ANJALI PHONE# 408)446-5404 GENERAL CONTRACTOR:FAST WATER HEATER COMPAN FAX# 425-814-9516 I am not using any subcontractors:_ �'" ! 3/31/06 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 Fainting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date