08010013 CITY OF CUPERTINO x �a.7,777-777, 77,777,"'n-
BUILDING DIVISION PERMIT "Vlr;�=y4i�� �".e"llYlrJl\v '
BUILDING ADDRESS: - PERMIT NO.
22681 QUEENS OAK CT BAY AREA REP7PES 08010013 .
OWNER'S NAME: PERMI7ISSUE DATE
VIVEK ASHARMA P 0 BOX 7462 01/03/2008
ONE:
(408) 371-5763 SANITARY NO. CONTROL NO.
ARCHnECfYENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Maffirm MCILICENSEDCONfRACnOR'SDECOf CON Job Description
rd� 1 mby t 1 em licensed unJer pmvisioall a Of Chapter Y(commencing
r1 ' wimSection 7sew)of0iviAon3of the BuvneerRod Froth aiovend/e�,andmylicense la REPIPE W/COPPER DOWNSTAIRS ONLY. BAY AREA REPIPES
rn full force and eff�� RL Q .g V
a M Z Lieena CI a Lk.M J
Dam o PD RENEWAL FEE 1/3/8
comramr
ARCHITECTS DECLARATI �Q 2�
U I understand Mail my pins W used records
public rJs��K'
[a 1
es
o� LrccnseJ Pmfcsnonal
co5 y� Oat I am exempt f an Me CoATION
o hereby.(firm that I nm Brumpt from me Communes OL L cense law for the
coo following recon.(Section 703 Aram BaineuAnd
ve darua COLIC:Any city orcounty
$ which requires•permit Re caavuct a@n improv,d)Permit
t ri repair any ntnmun
zy patho,ItsiensedprsuaRequires he meepplianf forMe sucConnector's
License,
Law Chapter
5gmovisions of 9 Sq.Ft. Floor Area $3000 Valuation
thannott1A.T main tScetion 7000)MDdult farMlWBain)aandon.Any
Code)or
r3— mat he u Section 31.5 b thertfmm and me bub for Ile alleged esempdaIn Any l Pennon of
not mom than fin hundredldollars(S3W it subjects dm Applicant a civil penalty of Number Occupancy ane Type
p y yp
❑1,an owner of the pmmny,or my mnPlayces with wages u their sole compenadon,
will do the work,and me structure is not intended or offered for$We(Sec.7014.Business
and Pmfessiaa Cade-TW ConuscmYs Licence Law dead not apply to an owner of Required Inspections
pmpeny who build.or improves thereon,and who dos such wank hmself or though his
awn employees,provided Nat such improvements art not intended or offered(orale If.
however,me building or imp ovemenl usold within mu you of completion,the awner-
bullder .will ban the burden of proving that he did not Wild or happen for pumoa of
sale.).
❑1,As owner of the property,am esclainly contracting with licensed contractom in
coatroct the Pmjcm(Sec.7011,Business and Professions Cade:)The Contractofs U.
Combe law does not apply an an owner of property who Wilds or impmna desmon,and
who contracts for such Pmjecu with a conaamar(s)Licensed pursuant an the Canuacwr's
Lismac Law.
❑1 A esempt under Set ,B k P C formiv on
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby anrm under penalty of perjury am of the following dalardons:
ha. ad will maintain a Certifrcum of Consent m self-insure far Werkees Com on-
n.,As provided far by Section 3700 of me Labor Code,far the performance of the
work for which this permit is isswd.
0 1 haw And will maintain Worker's Compensation Laurence,As required by Smdan
37[X)of Me labor Cade,fur me per(armance of the ooh for which this permit a Wood. '
MY WorkeQ qrsmrp. 7W role carrier And Polity numW.r Ame:O>
Cartier. VJ�.'1ite� x(LA Polity No.: 7i(Js z/
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
or leu)Thu
( section wed not W completed i(1W permit is for one hundred dollar(S 101)
1 Comfy that in the performance of me work for which mit Permit is issmd,l shall not
employ any person in any manner an As in hocome subject m tiro Workup'CamPenudo
Laws of California Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificam of Ercmplion,you should
Waame subject in the Worker's Compensation provisions or me labor Cade,you mesa
.,O raMwith comply with such provisions or this permit shall be deemed Invoked.
'Z'y CONSTRUCTION LENDING AGENCY
H I hereby alno Net mer iso construction Lending agency for me performmce of
the work far which this permit is Wood(Sec.3097,Cih,C)
AUndoes Name
A4 .� Undoes Address _ ..
t.)Q i certify ren 1 how read this application and sum ren the show information it
(pr cou"OOL I agree m comply with all city and county ordinances and state Iowa mining to
DU building connection,and hereby aumodm mpmsenupws of this city as enkr upon the
shave-mandomd pmperty for inspection purposes.
U a (hoc)Agreegl of esew.indemnify add keep harmless me City of Cupertino agolat _
to liabilities,Jadgm rtarl.m and espeaev which may in anyway acme against sold City
()7 in eaaegmnm of Me graun[a(mis Permit.
rte- APPLICANT UNDER S AND WsouILL COMPLY WI AL NON-POINT Issued by: Date
e Re-roofs
Sign
HAZARDOUS MATERIALS DISre.,MeE Dam Type Of Roof
Will tiroapplicantor(uwm Wlidingaceupantmom wand the
Health Rod
As dented by the Cupertino Municips de.Chapter 9.12.and tie Hevlth and Safety
Code,Section 13532(a)? All roofs shall be inspected prior to any roofing material being installed.
r]Y. Na
(uIf a roof is installed without first obtaining inspection,I agree to remove
Will the applicant ofuturebuilding aceupant see equipment ser devices which g an ection
P g
W'rudoa aircanmminanU u def by the Bay Area Air Quality Management all new materials for insp tion. -
❑Yes a
I ban mad me meadous materials rcquimments unJer Chapmr6.95 ofine Califor-
n ulmaSafetyeadc,s tiaa15505.25S33am125531.1urbentsndthaffma Wilding
Jmanotc d W. aa.thus it u my mspoaibilitY mnout,Je msupantof me
mquin m 'aruissuanmofa Ccrufeal af0 upynry.
_ o Signat e o Applicant Date
Owner mmorindagent Dam All roof coverings to be Class "B"or better
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk,: Lot: - -
APN . . . . . . . . : 34232067 . 00
DATE ISSUED. . . . . . . : 01/03/2008
RECEIPT # . . . . . . . . . : BS000003602
REFERENCE ID # . . . : 08010013
SITE ADDRESS . . . . . : 22681 QUEENS OAK CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : VIVEK ASHARMA
ADDRESS 22681 QUEENS OAK CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5616
RECEIVED FROM . . . . : BAY AREA REPIPES
CONTRACTOR . . . . . . . : JOHN SWANSON LIC # 23773
COMPANY . . . . . . . . . . : BAY AREA REPIPES
ADDRESS P 0 BOX 7462
CITY/STATE/ZIP *. . . : SAN JOSE, CA 95150
TELEPHONE (408) 371-5763
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------'-- --------- ---------
1BPFIXTURE NO OF FIXTURE 3 . 00 , 24 .48 0. 00 24 .48 0. 00
1BSEISMICR VALUATION 3, 000. 00 0. 50 0. 00 0 .50 0. 00
1BUSLIC FLAT RATE 1. 00 110 . 00 0. 00 110.00 0. 00
1PPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0: 00
1PRSEWER UNITS 1 . 00 20.40 0. 00 20 .40 0. 00
1TRAVDOC FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 236.96 0. 00 236 .96 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 236.96 #4021
---------------
TOTAL RECEIPT 236 . 96
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
r
��ol ooi 3
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
o� OCO � 0 O o`ZOO
Building Address: f1� Oi
2 Z(Pe/
Owner's Name: Phone#:
/379
Contractor: Phone#:
33-7 /-5--7 63) e Fax #:
Contact: Phone#:
(J�� ►1 �G d166 n/ Fax #:
Contractor License#:
Cupertino Business License#:
Job Description:
1�C i Pc I.0 t� C� e1' Dot-,)n 4A r S o vi
Residential Commercial ❑
Valuation:
e3 000 . W
Green Building Check list must be completed and attached to this application.
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial P
1BSEISMICR Seismic Residential---P
1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
3 1BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
1BPGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
1PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp. P
1TRAVDOC Travel &Documentation Fee B
1BUSLIC Business License B
i
Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Buildin De artment
JOB ADDRESS: PERT
uwkh
OWNER'S NAME: D l kv$p PHONE # 3
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: Q�j ,200
Signature Date
Please check applicable subcontractors and complete the following:-
information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
IIectrical
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
er on arf ctor Signature-- Date