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11070113 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18816 TUGGLE WAY CONTRACTOR:JUST WATER HEATERS PERMIT NO: 11070113 INC OWNER'S NAME: AYYAR MANI AND RAJESHWARI TRUST 3400 INVESTMENT BLVD DATE ISSUED:07/18/2011 4ER'S PHONE: 4082554161 HAYWARD,CA 94545 PHONE NO:(510)293-9901 ❑ LICENSED CONTRACTOR'S DECLARATION y� BUILDING PERMIT INFO: BLDG Ir ELECT PLUMB � 7 License Class �' f� \O Lic.# � � `}t�� 41 ,� k" 1 1 MECH' RESIDENTIAL COMMERCIAL Contractor�� Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE WATER HEATER,NO LOCATION CHANGE (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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. Sq.Ft Floor Area: Valuation:$1100 I 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. APN Number:37532030.00 Occupancy Type: 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 and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FRO LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply r- with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: / Date: 7-13-11 9.18. ' /1 �1 Signature k�1 Date RE-ROOFS: �. OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the p Health&Safety Code,Sections 25505,25533,and 25534. 1 certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Owngr��nth riz t: p Compensation laws of California. If,after making this certificate of exemption,I 14;) Date: t become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save -mnify and keep harmless the City of Cupertino against liabilities,judgments, ,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37532030 .00 DATE ISSUED. . . . . . . : 07/18/2011 RECEIPT #. . . . . . . . . BS000014079 REFERENCE ID # . . . : 11070113 SITE ADDRESS . . . . . : 18816 TUGGLE WAY SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER AYYAR MANI AND RAJESHWARI TRUS ADDRESS 18816 TUGGLE WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : FAST WATER HEATER CONTRACTOR . . . . . . . : GILROY, JOHN LIC # 15128 COMPANY . . . . . . . . . . : JUST WATER HEATERS INC ADDRESS 3400 INVESTMENT BLVD CITY/STATE/ZIP . . . : HAYWARD, CA 94545 TELEPHONE . . . . . . . . : (510) 293-9901 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 100. 00 1 .00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 1, 100 . 00 0 .50 0 . 00 0 . 50 0 .00 1PPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 .00 1PRWHEATR UNITS 1. 00 26 .00 0 . 00 26 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 44 .00 0 . 00 44 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 115 .50 0 . 00 115 . 50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 115 .50 5573 --------------- TOTAL RECEIPT 115 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER CITY OF CUPERTINO \�C' itsFEE ESTIMATOR-BUILDING DIVISION ` ADDRESS: 18816 Tuggle Ave DATE: 07/18/2011 REVIEWED BY: RDW APN: 7 � BP#: '"VALUATION: 1$1,100 "PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR USE: PERMIT TYPE: WORK Replace Water Heater SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $26 TOTALS: 1 $26.00 Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT Other Plumb Insp. hrs 0.0 NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (Fee Resolution 11-053 bjf 1.-11) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $26.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes No $0.00 Travel Documentation Fee: ITRAVDOC $44.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bids Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $115.501 $0.00 TOTAL FEE: $115.50 Revised: 07/04/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CU PERTI NO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: %%&,U �n 1)\1 PERMIT# -70 113 OWNER'S NAME: Arvo(� , VAPSN k PHONE # 4vg 25.5 ' -I�r t GENERAL CONTRACTOR: Y 01(k" .'- \APAI` BUSINESS LICENSE # ADDRESS: \Vj r \ 04t vA CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: LA 4-1 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date GENERAL PERMIT APPLICATION A& MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• buildlnQ C�'CUDertinO.orq MISIC CUPERTINO PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS If 1JOw w T U)(\ t wayAPN# OWNERNAME PHONE /1(l�_ {�� `j E-MAIL STREET ADDRESS 1 t� `i ^ (�G� vt WAV CITY, STATE,ZIP �NQ��SIVja L(k FAX CONTACT NAME L' Y ry J PHONE ` E-MAIL STREETADDRESS CITY,STATE, ZIP FAX DOWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME f � �� It; t��' R LICENSE NUMBER f3 t �(� LICENSE TYPE h V BUS.LIC# 9 i i rL 31 COMPANY NAME „f P V i��!1 R E-MAIL J ll FAX STREET ADDRESS (/'`` J 1 Vj 4 (� 1�1 J� e I CITY,STATE,ZIP t �a J� �R, (7(j�JL PHONE /t/1� ARCHITECT/ENGWEER NAME �1 LIC SE NUMBER v T BUS.LIC#`f 1 �7 COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD.DUPLEX V MULTIFAMILY PROJECT IN WILDLAND ElYES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK TOTAL VALUATION: RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct.J 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 c�o�n�s=cctiioon`I authorize representatives of Cupertino to enter the above-identified property for inspection puiposes. Signature ofApplIicant/Agent: a/«`'► —`� Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER ❑ EXPRESS Y U ❑ STANDARD U ❑ LARGE ❑ MAJOR MEPMzscApp_2011.doc revised 06121111