11110141 CITY OIC PERTINO BUILDING PERMIT
BUILDING ADDRESS: 18477 EDMINTON DR CONTRACTOR:AMERICAN PERMIT NO: 11110141
RESIDENTIAL SERVICES OF CA
OWNER'S NAME: MADHAV MARATHE 965 RIDGE LAKE BLVD STE 201 DATE ISSUED: 11/23/2011
NER'S PHONE: 4088650220 MEMPHIS,TN 38120 PHONE NO:(408)982-0405
13 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL
License Class—3l Lic.9 760 rl 5S INSTALL 50 GALLON WATER HEATER
Contractor cS 4-o Date/f n .24-11
1 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.
1 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 whichthis permit is issued. Sq.Ft Floor Area: Valuation:$2423
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 APN Number:37522068.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and slate laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY7 FROM LAST CALLED INSPECT N.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, //�
costs,and expenses which may accrue against said City in consequence of the r(/ Date: //'V`3 ��
granting of this permit. Additionally,the applicant understands and will comply Issued by:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
-,/ryr_ li hlf'ra QQ �r a� to// RE-ROOFS:
Signature �( � ��/r ..YU:-U'(/�'' Date 0(fi! All roofs shall be inspected prior to any roofing material berg installed.If a roof is
Mh installed without first obtaining an inspection,I agree to remove all new materials for
IF
inspection.
OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole com{ensation,
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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: health&Safety Code,Section 25532(x)should 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for whichthis permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2.5505,25533,and 25534. q
Section 3700 of the Labor Code,for hhe performance of the work for which this /� I1 oc3-1 J
permit is issued. Owner or authorized agent:1444'y{'Ie, �,{�Date:
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person inany manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 slate laws relating
to building construction,and hereby authorize representatives of this city to enter
the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
nify and keep harmless the City of Cupertino against liabilities,judgments,
. ,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
D U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT#
OWNER'S NAME: j PHONE WP
GENERAL CONTRACTOR:95sc-u4s a0 t BUSINESLietNSE#
ADDRESS:° ?49 ,e/e —8 ,r4A4eJAAA1 CITY/ZIPCODE:
*Our municipal code requires all businesses & 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. �,,- � �
1 am not using any subcontractors: .y�`� �
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
• CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37522068.00
DATE ISSUED. . . . . . . : 11/23/2011
RECEIPT #. . . . . . . . . : BS000015400
REFERENCE ID # . . . : 11110141
SITE ADDRESS . . . . . : 18477 EDMINTON DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MADHAV MARATHE
ADDRESS . . . . . . . . . . : 18477 EDMINTON
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : AMERICAN RESIDENTIA
CONTRACTOR . . . . . . . : DONALD KARNES LIC # 21504
COMPANY . . . . . . . . . . : AMERICAN RESIDENTIAL SERVICES
ADDRESS . . . . . . . . . . : 965 RIDGE LAKE BLVD STE 201
CITY/STATE/ZIP . . . : MEMPHIS, TN 38120
TELEPHONE . . . . . . . . : (408) 982-0405
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
-ADMIN HOURS 1.00 41. 00 0. 00 41.00 0. 00
1BCBSC VALUATION 2,423 .00 1.00 0. 00 1.00 0. 00
1BSEISMICR VALUATION 2,423 .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 156 .50 0 . 00 156.50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 156 .50 8128005921
---------------
TOTAL RECEIPT 156.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------ ---------------------------- -------- ----------------------------
518 WATER HEATER
GENERAL PERMIT APPLICATION �� M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �\0
CUPERTINO (408)777-3228• FAX(408)777-3333• building(8,cuO�ertino.org M ' S
PLUMBINGMECHANICAL CTRICAL MISCELLANEOUS � /�[��[�
PROTECT ADDRESS .E/� ►1 D i✓C... AM— -7� 22 D Lo C�
OWNER NAME d^ K/ O6(�D�n/, E MAII.
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OWNER AGENT CONTRACTOR 13CONTRACTOR AGFM C3 LT CJ EHmNEIER 13DEvELoPER ElTENANT
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ARCHTTECUENGINEERNAME LICENSE NUMBER BUS.LIC a
COMPANYNAMB' E-MAIL FAX
STREET ADDRESS CITY,STATE.ZIP PHONE
RES OF ❑SFO m DUPLEX MULTFFAMILY PROJECT IN WILO AND ❑ YES PROM=IN ❑YES D THE BLDG AN ❑YES
BUDDUJp: 13 COMMERCIAL URBAN INTERFACE AREA 1`NO PLOOD ZONE WO EIQ6ER HOMET ATNO
DESCRIPTION OF WORE D
TOTAL VALUATION �a300 RECEIVED BY: /
By my signature beloti,I certify to each of the following: I Ron 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 have read the Description of Work and verify it is accurate. I agree m comply with al]applicable local
ordinances and sante laws relating m building c s ctioa I sorb represrntativa of Cupertino to enter the above-identified property for inspection puiyQSCS.
Signature of Applicent/Ageatt' Date:
SUPPLEiVIENTAL INFORMATION REQUIRED OFFICE USE ONLY
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ALIEPIdtscApp 1011.doc revised 06/11/11
I. . m\ OM ` __Z�
CITY OF CUPERTINO
• FEE ESTIMATOR— BUILDING DIVISION v�
ADDRESS: 18477 edminton dr. I DATE: 11/23/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $2,423
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/Repair
PRIMARY SFD or Duplex PENTAMATION PRWHEATR
USE: PERMIT TYPE:
WORK install 50 gallon water heater.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $26
TOTALS, $26.00
.1fe,•h. Plan Ch"'ek Plumb.Plan Check 0.0 hrs $0.00 1slcn. P/nu Check
:Mach. Pe 'wi;Pee: Plumb.Permit Fee: IPPERMIT 1i70:. Pernun Fee:
hap. Other Plumb Insp. 0.0 hrs $44.00 Other 13 er, Gasp. ED
Meek.Inw, t"ec l'fwnG. lrr-yp.1.P,r. Idiee,Imp. Fee:
NOTE:This estimate does not include fees due to other Departments(Le. Planning,Public Works,Fire,Sanitary Sewer District,School
District etc. . These fees are based on the prellidna in ormation available and are only an estimate. Contact the Dept for addn'I into.
FEE ITEMS(Pee Resohnion 11-053 LY! 7/1/1/I FEE QTY/FEE MISC ITEMS
Plan CheJ Fec.
Supp/, PC Fere
PME Plan Check: $0.00
Permit Fce: .
Suppl, hasp Fee
PME Unit Fee: $26.00
PME Permit Fee: $44.00
Construction nix
Administrative Fee: IADMIN $41.00
Work Without Permit? O Yes e) No $0.00
,lJvance d Planning Fees:
Travel Documentation Fee: ITRA VDOC $44.00 A.
• Shone Motion Fee: IBSEIShfICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $156.50 $0.00 TOTAL FEE: 1 $156.50
Reyifsed: 10/01/2011