08070007 CITY OF CUPERTINO v"'"
BUILDING-DIVISION- PERMIT �kCON>TRA.C'�TOR,INF,ORMON
A pRE55: PERMIT NO.
BUILDING
1'7.1.8 HUNTRIDGE LN ALL VALLEY PLUMBING 08070007
NER'S NAME: PERMIT ISSUE DATE
MINI HARIHARA 3345 SELDON CT 07/01/2008
PHONE:
SANITARY NO. CONTROL NO.
ARC HRECffENGINEER: BUILDING PERMIT INFO
WTR HEATER REPLACMNT BLDG ELECT PLUMB MECH
0 0 0 0
u00 LICENSEDCONTRACTOR'S DECLARATION Job Description
ZC 1 hereby affirm Nat 1 am limmd uMer pmvisiam of ChaPms 9(commencing
<U whh geiDivivon3of NC Business and Pmfeuiou Cade.and mylke�u
jeFp in full fame andoff, 3 bn� Lim acCLic.
Dam 0 Y S v7�SGT�
cmanoun
' W ARCHITECTS DECLARATION
! 7 L understand my plans shall be asd u public recorder
JyV
g y Licensed ProfcsUanal ,
OWNER-BUILDER DECLARATION
F I lemony efforts Nal L am exempt from the Contrutoes License Law far the
_O o following reason.(Section 7101.5,Busi.and Pmfetiou Cade:Any cityerr county
3_ which requires a parmil m cawauc4 shot,improve,demolish,or repair say aructum
Prior to its iauance.Also mqutres the applicut for each permit to filo a signed statement
that hn i,licensed pursuant to the provisions of to Contractor's Liconse law(Chaptm 9 Sq.FC Floor Area Valuation
E�$ (commencing wide Section 7000)of Division 3 of the Business and Professions Code)or
that he b esempt theref r m and the basis for the alleged exemption.Any violation of
Section 70313 by say applicut for 0 permh subjecu dee applicant m a civil penalty of ApN Number Occas
mm mate man fdw ane hundred dollars(S500). Occupancy Type
O 1,at owner of des property,ar my employm with wages as their sole compensation,
will do the work,and the an,,..is not intended or affected for sale(Ser.1144.Business
and Professions Code:The Commoner Lianx law does net apply an u owner of Required Inspections
property who builds or improves demon,and who does such work himvR or through his
own employees,prwidcd that uch improwmems are not intended or offered for sale If,
however,the building or imp rewsnehd is sold within arc year of completion,the owmr-
builder ,will hne the burden or proving that he did rot build or improw for purpose of
ask.).
0 I,as oweem of the property,am excluinly contracting wide paved contractors as
construct the project(Sec.7044.Business and Professions Code)The Conuncteri U.
cove law data not apply m an owner of propcny who builds or Improv thereon.and.
who comsat for such pmjeeu with a concussions)licensed pursuant us the ConuanaYs
License Law.
0 l am exempt under Sec .B B P C fu this resume
wri Data
WORKER'S COMPENSATION DECLARATION
L hereby aRren under pcnsity,of perjury ane of the following declaations:
❑L hsm and will maintain•CaNOmm of Consent to self-insure for Workoes Compen-
mean,as provided for by Section 3700 of the Iabor Code,fm dee performanm of dee
work fer which this permit is issued.
❑I haw and will maintain Waukee,Compensation Inunnw,u required by Section
3100 of the lather Code.for the performance ofdee work forwbiche this permit Is issued. '
My WorkeYs Compensation lummuce,carrier and Policy number are:
Cartier. 23,2,01 TN Policy No.: gnikl 03
CERTIFICATEOFFXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Missectime recd teat he completed iftk permit is foram hundred dollen(5100)
err loss)
I eutify met in me performance of the work for which this permit u issued.I shall nm
employ any person in my maromrso as to became subject to tM Workers'Compensation -
taws of Califomia Data
Applonat
NOTICE TO APPLICANT:If,after making thk Certificate of Esempdon,you should
become ubjest an ren Worker's Compcwdon provisions of the labor Code.you mus
.JO forthwith comply wire such pmvisians.chi,permits hall M w
accrued mkcd.
z CONSTRUCTION LENDING AGENCY
[-. l h nchy affirm duet then I,.consWClium lending agency far the pmformarom of
C, the weak far which this permit's issuell(Sec.3 ,Civ.C.)
GQ Lendces Name
:) z Lendees Add=
V Q 1 certify that i low read this application and sum cher the also.inlmarmi u
correct.l agree m comply with all city and county oNat
inmes and sum laws renting to
C) buildirts.mmuction.aM beabyuthuice representatives of deo City brnmrupan me
E
F yshove-mentioned property for inspection purposes
(We)agree to new.indemnify and keep harmleu the City of Cupertino against
y liabilities,judgments.toss and expenses;which may in sty way smut against said City
U z in consequence of the gnarling of this Permit.
^d APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATI�
O7DoI�o2 Re-roofs
Stguaure of ApplianUContr pare
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will deeupe
Cu
ntfuture WildingntammmhaMk hesaNns
amaterial
u defend by the Cupertino Municipal Code.k.ChChaptar 9.13.ma alta Health and Safety
cmk.Sedan 25532(D7 - All roofs shall be inspected prior to any roofing material being installed.
0s. e16
Will the applicant or future building occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardnus alr conmatnanta as defined by the Bay Area Air Quality Martagcmcm all new materials for inspection.
District?
❑Yes Q;In-
I he.mad the baaamms matcriasmquimmcnu under ChaPtar 6.93 of dee Caller-
nuHcaldeBSalctyCaCc,Savors25505.25533"u 334.1umttvu iftic bulding
does not Currently have a¢renter,that it is my mapoasibtlity,b notify the=upset or the
regainceen4which mw!Ir n,LPllamysa.."""uamarO Signature of Applicant Date
Owner or umorvsd agent
O g
e -) (off All roof coverings to be Class'%W'or better
Dam'
CITY OF CUPERTINO
• 4 ITEMS OF 12 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 35906046 . 00
DATE ISSUED. . . . . . . : 07/01/2008
RECEIPT # . . . . . . . . . : BS000005310
REFERENCE ID # . . . : 08070007
SITE ADDRESS . . . . . : 7710 HUNTRIDGE LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . . MANI HARIHARA
ADDRESS . . . . . . . . . . : 7710 HUNTRIDGE LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4206
RECEIVED FROM . . . . : ALL VALLEY PLUMBING
CONTRACTOR . . . . . . . : MARY SANDBRINK LIC # 23015
COMPANY . . . . . . . . . . : ALL VALLEY PLUMBING
ADDRESS . . . . . . . . . . : 3345 SELDON CT
CITY/STATE/ZIP . . . : FREMONT, CA 94539
• TELEPHONE . . . . . . . . : (510) 376-4816
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 750. 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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 319 . 68 #1381
---------------
TOTAL RECEIPT 319 . 68
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----- -------------------------- -------- ----------------------------
518 WATER HEATER
•
CITY OF CUPERTINO OfD7 0c) 6-7
-Si-1 WATER HEATER
C,1V OF
• CUPE-VINO PERNUT APPLICATION FORM.
Date:
AP-N
C) C)
-?A0A---
F".!; d.Hn-I Address:
257
Fax
-—--------
C'uner-rinc, Busifness Lictmse Contractor 7L\r-
a�
tate J-1cen
Picone' Contacl:
Fax
Plumb
Job Description.
. .........
Strar)ped P!a-fomq Bonded NevLocation Replacement
cctz
a I U a
Green Building Check must be completed and attached to this application.
Green Building Points achieved-
CITY OF CUPERTINO
w WATER HEATER
SCUPEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BSEISMICOM Seismic Commercial B
r 1PRWHEATR Residential Water B PRWHEATR
HeaterNent
1BSEISMICRE Seismic Residential B
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel & B
Documentation
1BUSLIC Business License B
I
- Community Development
Vi`µ 10300 Torre Avenue
wk �- Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Buildin De artment
JOB ADDRESS: I PERMIT # 0k 07 0 o " -7
10'A 957bOWNER'S NAME: a - a PHONE # 0�-
GENERAL CONTRACTOR: FAX #
I am not using any subcontractor .
Signature Date
Please check applicable subcontra rs 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