06030086 (2) CITY OF CUPERTINO a n"kr � a -
BUILDING DIVISION PERMIT C,C,. .�1 FACTOR TNF'U- M647, qNI-F,.
BUILDING ADDRESS: PERMIT NO.
CUP
o39NM8AJAE GLENVIEW AV PERMIT ISSUE DATE
Or E: AKURATI, EEP 1300 DELL AVE, STE C SANITARY NO3 16 2(DOVLNO.
ARCHITECRENGINEER: (408) 253-0618 BUILDING PERMIT INFO
BLDG PLUMB MECH
O t�
ip LICENSED CONTRACTOR'S DECLARATION Job De i
i 1 bcmby Airman Net I em Been"under provisions of Chapter 9(mmmencin{
with Suction 7fN10)OfDivision3of the BualnesC Profcssiona Code andmyli.mis
in full fortt end eft
z Llcmxe Clans Lie.R
l- D.m R f convaemr a49 r� OPPER REPIPE 2006.
s ARCHREcirs DECLARATIO
1 understand my plans shall he used As public records B1 �f{�i
i LicensedPndcxeinnel BUILDING
OWNER-BUILDER DECLARATION ••S////
i X I hereby Affirm that I am exempt from the Contractor's License law for the
1 o following mason.(Section 7031.5,Business and Pmfcmims Code:Any etty or county
3 which requires A permit At common,ora.improve,damolish.or repsir any sanctum
prior In to issuance.also requirm the applicant fersum permit to rile a signed Comment VaIUBCI 000
ons Wt hehlicensed purimmwtoProvisions ofthe Conmacwr'sUmveLaw(Chapter 9 Sq.Ft. Floor Area
$ (eanmcneting with section 7000)of Division 3 of the Business and Profession Code)or
that he Is exempt therefrom and the bask for the alleged exemption.Any violation of
Sudan 7031.5 by any applicant for a permit mbjtCO the Applicant In A civil penalty of APN Number Occupancy Type
Act more than five hundred dollar.(MM). 36911036 . 00
i ❑I.uowner of the PmP�Y•ormy employes with mgeau shetr sale eompewton,
will do Newark,endue ahrvewmbrot,License,dawdo fmotapply W aa,Business Re uired Ins ections
And professions Cade The Canuecter'a radwho Lew des mr apply lf An owner of q p
properlywho buildsarimgrnssh lmp andmu duce tushworkameatiedthrough bk
own employes,provided that suchemprovemmu tie oat Intended oronered for ole.if.
huilder .Ne building Am or len of pmmt is hath e did
ons year of mules n,the Owner.
seof
builder will haus to beNen of proving that be did rot build ar improve(or Wgexe of
uk3.
1,as owner of to property am exclusively contracting with licensed canaamm to
mnswm the Project(Sec.70".Business and Pmfeulons Code:)The Contram r'a U.
cove law does not apply w an owner of propeny who Wilds An impmves tWmon,and,
who convects for such Projects with A canuumr(a)licensed Pursuant In to ContrAmWa
License law.
❑lemeaempundersec. ,Bl PCfarmkmaCon
Owner Data
WORKERS COMPENSATION DECLARATION
1 bemby affirm under penalty of perjury aro of the following deelaradom:
haus And will maintain•Certificem of Consent W calf-insum for WarkersCompen-
"on,As provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
❑I her and will maintain Worlds Compcmdon Insurance,a required by Section .
3700 of the labor Code.for the performance of to work for which thk permit k issued.
My Wmker'h Compensation lnmmnce carrier and Policy number tie: y�
Center.f�rl'-^�5 Polley No.: A 1 /2 3 U4l
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rhk secilannuA not be complemd if the permit Is foronc hundred dollars(SIM)
A,lea.)
I certify that in the performance of the work for which this Permit k Issued.1 atoll nm
cmployanypermn In any manner an As In hum,abject to the Workers Compensation
Laws of Cellfamie.Dave
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to We Wor ccs Compensation previsions of the later Cede,ynu must
O forshwitb..Ply whh such provkinv or this purnit.hall W deemed mmkcd. _
CONSTRUCTION LENDING AGENCY
I hereby Lill that Nem to a mvuuNnn lending Agency for We performance of
the work for which this permit is issued(Sec.3M.Civ.C.)
0 LendeYs Nurse
z Lender's Address
Q 1 CeNfy that I buss mad this Application and sum that the Above Information is
hCmuL 1 agme to comply with all city and county ordinances and sum lin relating In
U building construction,and hereby authorize mpreunmims of this city to enter upon the
Td Ahnne-memimud PMPeny far taPeeaon Wq�L
❑, (We)agree to sem,indemnify and keep harmless the City of Cupertino against
V) Itebilldes.judgmenu.casts and expenses which may In any way seemagalut said City
CCC7777 in cavegmnce of the grmmng of this Permit.
APPLICANT uND TA AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
souR n %-
Re-roofs
Si{n Athol cane actor
Data
v HA or
MATERIALS DISCLOSURE Type of Roof
WIII theeCupapplicant or future Wilding OccupantChapter
or handle haard Atmaterial
As defined by the Cupertino Munict ,Chapter 9.12,uhd the Halo and Salcey
Code,section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
WIII the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
heowdous Air mnumtums a derwWby the Bay Ana Air Quality Management all new materials for inspection.
net?
❑Ya n<
I have mad the huerdeus mncdalim,pIlmmenu under Chapur6.95 of the Califor.
ni.Hulth@SaleIY 'ats25505.25533uu125531.Iundcvud nhatlfthe Wilding
alms not cu 'a unenL that It k my mspons Ity to notify the Accupat of the
rats whit Ipdor mi a ciruriam of Occupancy. Signature of Applicant Date
opwfa.thmize At J/ DamAll roof coverings to be Class"B"or better
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: bethe
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36911036.00
DATE ISSUED. . . . . . . : 03/16/2006
RECEIPT #. . . . . . . . . : 33599
REFERENCE ID # . . . : 06030086
SITE ADDRESS . . . . . 10481 GLENVIEW AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : AKURATI, PRADEEP
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4512
RECEIVED FROM . . . . : CUPERTINO PLUMBING
CONTRACTOR . . . . . . . : CARDIA, FRANK L LIC # 612
COMPANY . . . . . . . . . . : CUPERTINO PLUMBING
ADDRESS . . . . . . . . . . : 1300 DELL AVE, STE C
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408)253-0618
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
__________ _____________ __________ __________ __________ __________ __________
BPREPIPE NO OF FIXTURE 8.00 72.00 0.00 72.00 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
__________ __________ __________ ----------
TOTAL PERMIT 110.37 0.00 110.37 0.00
METHOD OF PAYMENT AMOUNT NUMBER
____________ ----
OTHER 110.37 VISA
TOTAL RECEIPT 110.37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
•
Community Development
10300 Torre Avenue
i 1 may, Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4FUPERTINO
Building De artment
JOB ADDRESS: PERMIT #
/048 ( Gj � VIci.J &;)60 &6
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: C� d-Ino PLbr4FAX # 2S3
I am not using any subcontracto -
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
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
• �-(G- div
Own Co •actor Signature Date
CITY OF CUPERTINO
• REPIPE/SEWERS/MAIN SERVICE
CITY OF
CUPERTINO PERMIT APPLICATION FORM
D�o3oo��
APN# Date:
5�0 — 1-0.x4 3 -
Building Address:
D'/o 1 Ic view
Oer's Name: Phone#:
cmc= l�u�th (90a — 3 2v 3
Contractor: Phone: License#:
-leo P6 , ba2 253— C)(� 6aL/ 905
Contact. Phone: Cupertino Business License#:
�'!c0 �,_ 309- 3 y 1
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Er_�—
Job Description:
Co e
Residential Commercial ❑
Cost of Project: Yt O vU
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING.
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
g BPREPIPE Repipe of Fixtures PLUMBING
BPFIXTURE Pb] . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING