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CITY OF CUPERTINO
BUILDING DIVISION PERMITT�CONTRACTOR
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INFORMATION
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BUILDING ADDRESS:
MIKE COUNCIL PLUMBING INC
PERMITNOO 5090092
10177 N PORTAL AV
OWNER'S NAME:
PERMIT ISSUE DATE
ANANTHAKRISHNA RAMECH
1977 O'TOOL AVE
09/13/2005
ONE:
SANITARY NO. CONTROL NO.
(406)272-4900
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CON 1RACIOR9 DECLARATION
Job Description
I hemby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section TOM) of Division Sof the Best. and Nolesaions Code, and my license ce
In full forte ondenect _ _
License Clw Lk.
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Dam con racer
ARCHITECT'S DECLARATION
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I uMcruand my plana mad! W used u public records
Licensed Professional
DECLARATION
OWNER-exempt
1 hereby affirm that 1 ro License Law for the
exempt iron the Cssions
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followinghicmason. limo 1.5, Business and
de fins Code: Any oily or county
it etee Improve, demolish, any
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O ova. or ¢pair
which requites a permit re cores t.
ter
for mchpermit wmosse Ueduaumen
primniu lensed e. statement
Sq. FC Floor Area
Valuation
malso cron zoite provision of
ccemsedpusauammtiepmvi:ransnrthe
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(mum come eThmi essmdPnse akutsCapmr9
(commencing with Scefrom7000) of
and tamis n3 of thested esasntl Profesa vi Code) or
Nal he m exempt therefrom and six buts fm tins alleged emmptioa Any violation of
XFR
Occupancy Type
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than five Wrtdmd dollars (5500).
0 I, u owner of the property, car my employees with wages u their sole compensation,
Required Inspections
will do the work, and the =lure a not Inmmded oraQered for (Sec. 7014, Budmm
and Professions Code: The Cmarsames License law dans act apply m an m inter of
property who Wilds orimpmves thereon. and whodou suchwmkhimsedfmtiumgh his
owncmployw, provided Wt such Improvements see not Intended mcfemd forsale. If,
however. the building or improvement Is mid within one year of ermplcoon, me mount.
builder will have the burden of proving that he did not Wild or Improve for purpose of
sanstr
0 1, an manner of the property, am exclusively convening with lice Wed co mums, to
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NP4 LIED
Business and Cade:) M Conunhoun,
construct the pmkm (Secapply
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and
of property who anU.d.
dose Inst apply m an owner of property voce Wada or
ants 0 an
ontr anpmwa Com ssr
who contracts for such projects WN a eanwcmrtq Ikensed pursuant m the Conumtah
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01aamexe PC for mu moan
❑Ism exempt under Sea
SEP 2005
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owner Data
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WORKER'S COMPENSATION DECLARATION
I bemby artlrm ondu peulty of perjury ons of the following declantimu:
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1 mw and will msinuin. ceNfieste or convent m self-imuse for WorkersCmnpen-
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sation, u provided for by Section 3700 of the tabor Cade, for the performance of sea
work for which this permit Is issued.
end will maintain Worker's Compensation Insurance, u required by Section
34have
010 of site 1"Code. for the performance of the work for which this permit is issued.
My Workers Com enso Inmrmce d 'u and Policynumber art:
Cartier. iv O r [k olicy No.:
CERTIFICATE OF FXEMP71ON FROM WORKERS'
INSURANCE
pyr,�xyg(N W C�l-�p
(h1PENSSJAffT�ION
(Thissectionse. nOtbCcamptfmd Iftan permit is(mons hundred dollen(Sl W)
or loss.
1 « rify that in the performance of the work for which this permit ts issued, I shall not
employ any person in my mannerse u he become subject m tie Workers' Compensation
Laws of Cafifomia. Dam
Applicant
NOTICE TO APPLICANT: If. after making Nis Ceniricam of Exemption. you should
become subject to me Worecr's Compensation provisions of the Labor Code. you mum
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fothwith comply with such provisions or this permit shall be domed revoked.
CONSTRUCTION LENDING AGENCY
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1 thereby affirm hast them is a cemsvunion lending agency for the perfurmsme of
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the work for which this permit u issued (Sec, 3097, Civ, C.)
QLenders
Name
,
Lenders Addmas
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I certify that I have read this application and sum that the above Infotmallun is
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coned. 1 agree to comply with all city and county oudinanmund sum laws totaling m
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building consvucdon, and mmbyanthodm mpmxnudet of this city to enter upon the
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above-mentioned property fm inspection purlwes
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(We) agree m save, indemnify and keep harmless he City of Cupertino against
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Ilabilitu,judgmcnWcoauandexpmuu which may In my wayaceme against said City
in consequence of the of this
granting Permit.
APPLICANT LINDERSTAN ND WILL COMPLY WIT ALL NON-POINT
Issued by: Date
EGULATION
SOU REGULATION"
9 %31 V
Re-roofs
Si ofAT71 HAZARDOUS MATERIALS DISCLOSURE Date
Type of Roof
Will de applleam m future Wilding oceupmt mom or handle hasallous material
as defined by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety
,iggede.
Section35533(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yoe
�No
Will the epplicam or hat te building occupant We equipment or dcvicaf which
If a roof is installed without first obtaining an inspection, I agree to remove
It hmumdous air cmuminsnts u dc0nsd by the Bay Am. Air Quality Management
all new materials for inspection.
WICIT
C] Yes �Nu
I have mW the Mmniota materials requirements under Chapter 6.93 of the Califor.
nia Huth& Safety Code, Stations 35315, 35533 and 35534,1 understand that it the Wilding
does not rftTtly ham a ensm, that it is my responsibility to mtil'y the up t of the
tegm ntwhichmumW 'rmlsa or aCeruncateofgcylY q
�IJiDaam'lall�
Signature of Applicant Date
All roof coverings to be Class "B" or better
Gwne ruthmiudgent-
C
aClOF
UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
1x177 N, arJ.
PERMIT #
I o5`0`iC6i Z
OWNER'S NAME: v AV% rA
PHONE 44ot - -1'515
GENERAL CONTRACTOR M& Cq,q �,�„
FAX # M o( 3; - S 754
I am not using any subcontractors: J 1,�2 S o -
Signature 11Date
PIease check applicable subcontractors and complete the following information:
er/Contractor Signature
`1113101
Date
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
er/Contractor Signature
`1113101
Date
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$CUPERTINO
CITY OF CUPERTINO q
REPIPE/SEVERS/MAIN SERVICE U—
PERMIT APPLICATION FORM
APN #Date:
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Bldg. Permit Fees
BUILDING
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Building Address:
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, PN.
PPERMITFEE
Plumbing Permit Issuance
Owner's Name:\
v.ri5 It,
q h
w,
Phon #:
o — 36b- 1315
Con traG r:
Phon :
(4 - 20>-410K)
License #:
6? -1u
Contact: S
eq.. Cav�si�
Main Water Service
Pho e:
( off
— 434- 171b
Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑
BPSEWAGE
Plumb 14
PLUMBING
Job Description: 61
Jlc 1 C
Main
q�fr S�rv►�P
BUSLIC
Residential Commercial ❑
BUILDING
Cost of Project:
is
Qty. if
Annlicahle Fee ID
Fee Descrintion
Fee Groun
BPERMFEE
Bldg. Permit Fees
BUILDING
BPGAS
Gas Piping System Fee
PLUMBING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Repipe of Fixtures
PLUMBING
BPFD{TURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING