06090076 (2) CITY OF CUPERTINO
.BUILDING DIVISION PERMIT mCONTRAGTOR INkORMATIOIV
BUILDING ADDRESS: CUPERTINO PLUMBING PERMIT NO.06090076
21069 RED FIR
OWNER'S NAME: PERMIT ISSUE DATE
Alk ANANTA KARANAM 1300 DELL AV09/12/2006
NE: SANITARY NO, CONTROL NO.
(408) 253-0618
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
too LICENSED CONTRACTOR'S DECLARATION lob Description
mF I bemby affirm that 1 am licensed under provisions of Chapter 9(commencing P
:ZWwith Section 7000)of Division Sof NC Business and PrOmmumm Code,AM my license u -
!�„ infsnmmaameffect. -,/ COPPER RE-PIPE FROM GALVANIZED
,vjK Li...Clyss Lic.d
iia Date Y-I —O( Conmacmr
ARCHITECTS DECLARATION
i -i 1 undentand my plans shall W used as public records
:yU
'Or~j, Licensed Pmfcraimul
OW NER,BUILDER DECLARATION
q I hctahy affirm Nal I am eacripl from the Conlramo's License Law far the
:CC following moon.(Section M 1.5,Business and Profcamorm Calc:Any city or county
which requires a permit to censwet slot.bnpmw.demolish,or mrsur any Rrunure $5000
Zaprior on its issuance,also recover;Ne applicant for such NMILto rile a signed statement
that he is licensed pursuant to dm provisions of the Cormctar's Uccvc Law(chapter 9 Sq.Ft. Floor Area Valuation
`i--0 (commencing with Section 7000)of Division 3 of the Business and Professions Cade)Or
5 that he is exempt oertfmm and Om basis for the alleged exemptim.Any violation of
Section 7031.5 by any applicant for a permit Snorters the applicant m a civil penalty of miii6ff U U Occupancy Type
our more Nan Eve hundred dollars($500).
0 1,As owner of the property,or my employees with wages an their rola compensation,
will do the work and the smcfu,is not intended or offend for sale(See.7094,Busionss
and Proliferations code:The Grammes Licert:<law roan ter apply As an"net of Required Inspections
property who
yeem,ro ored that sNerm rove who awsuchwohh roffredNmugh his
Own cmr,dom O,provided Nri such improvements art not countedo(c or leered for owntar,
however,Ne building ar improvement u sold within ane year of completion,the owwr-
builder). will have the buNm of proving that k aid rat Wild or improve nor puryae or
sok.).
co 1,Asa owner of tin property,amSec.704.B exclusively controllingfesswith )licensed contractors i-
Li-
to.
Lo the project(Sec.toad,Business and rto(who
Wilds
Cade:)The Conaanon. d
eche law dors nod apply m an owner of Property who builds rs mi ovhe thtnon,and.
whoconmers for such projects wiNaeonvactogs)licensed punmm on Convanah /
l.icimas 1Armvw. a
❑lam exempt undo Scr .B@PC for Nis nam.
Owner Dao /
WORKER'S COMPENSATION DECLARATION
1 hereby alarm under penalty or perjury one of me following declarations:
1 have and will maintain a Cartiawm or Consent m self-imum for Worker's Compete
.tion,an Provided for by Section 3700 of the labor Code,for the,mater ance of Ne
work for which this permit is island.
0 1 have and will mainuin Workers Compeoeuan Inman¢,o required by Section
3700 of the Labor Coda fa the pedaromm.of tha work for which Nix Permit is issued
My Workers Compensation In tem nce,carrier and Policy number arc: 'S 7
Carrier.. f/hVj Policy No.:h lg52- 302
CERTIFlUTE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section wed not he complekd if de permit Is form hundred dollars(SIM)
or las)
1 cenifr that in use performance of the work for which this permit In issued.I shall not
employ My permir in any aranwtm as An became subject to the WmIrcri Ca n,mandm
Laws of California.Dan
Applicant
NOTICE TO APPLICANT:If.after making this Ccnifnam of Enmption,you should
become subject in the Worker's Compensation provisions of the lshw Code you most
,JO foMwith comply with such....Ilia.of N6 permit Nall be armed revoked.
Z CONSTRUCTION LENDING AGENCY
Ihereby whichm that them uand(Seconstruction 097.lending agcwy,for Un performmw of
Jm work Nur which this permit Il iow0(Sec.1097,Civ.C.)
f31 Q Lender's Name
Z I<nders Address .
U O 1 certify that I have lead this application and sass that the shove information is
Ly F correct.l agree to comply with all city and county ardina roes and state laws¢lacing to
QU building construction.and hereby authniz rtprescnutives of this city to enter upon ted
r(10
above-mentioned for inspection which...
FLL (Wer)agree m save,indcmnt fy and keep hamdcss the City of Cupertino alainst
(n liabilitia,judgmenrs,cola and eapeoa which may in any way accrvc agarral City
U Z in eovequewc of the granting of Ni
^
APPLICANT UNDER ILL COMP ITH ALL NON-POINT Issued by: Date
SO CER GI11,ATf0
Re-roofs
Signora : AZA 1O� MA 6DISCLOSURE Date Type of Roof
Will pliantwfurort Wilding occuparamare of handle hinumous material
As derived by Na Cupertino Municipal Code.Chapter 9.12,and the Health and Safely
Cole.Section 25532(x)7 e'��
Dyes All roofs shall be inspected prior to any roofing material being installed.
41 Will to applicant or future Wilding occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit mandom air contaminants as dc0ned by the Bay Arca Air Quality Management all new materials for inspection. '
District?
0Ya
1 have road the hmmdnus materials nquiromenrs undo,C1Wpmr6.95 of the Califon
nia Hahth&SANIYCMc.Se:tiars 25505.25533 and!25534.1 unkmand Natifdm Wilding
Jed not tonally haw a¢nand m asihility m nobly the w=upam of the
yviromcnta whmh�3t, noii' rsa a ere _ ^^err. Signature o f Applicant Date
-12^0 All roof coverings to be Class "B"or better
Owner or urized agent Dam' g
Community Development
e 10300 Torre Avenue
ItCupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
,�2 1 U (�, 9 Ram Fir e-t-.
OWNER'S NAME: ���, t PHONE #GENERAL CONTRACTOR: C,�, .,, pl; /FAX # 25-3-GG7
I am not using any subcontractors:
Si Date
Please check applicable subcontractors and complete the followinginformation:
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
12-
ebv%W-Ifontractor Signature Date
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35905021 . 00
DATE ISSUED. . . . . . . : 09/12/2006
RECEIPT 4 . . . . . . . . . : 35998
REFERENCE ID # . . : 06090076
SITE ADDRESS . . . . . : 21069 RED FIR CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ANANTA KARANAM
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : FRANK CARDIA
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
EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- --------- ----- -------- ---------- ---------- ---------- ---------- ------- ---
BPERMFEE VALUATION 5, 000 . 00 115 . 56 0 . 00 115 . 56 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
--- ------ ---------- ---------- ----------
TOTAL PERMIT 153 . 93 0 . 00 153 . 93 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - --------------- -------- ---- -------- - -- -- -----
OTHER 153 . 93 VISA
TOTAL RECEIPT 153 . 93
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
•
CITY OF CUPERTINO
a('
REPIPE/SEWERS/NIAIN SERVICE
TOF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
9- / 2 - UCa
Buildin Address:
c- ,
Owner's Name: Phone#:
L1 +u- 9/-/G - / 853
�Qntractor: Phone: License #:
l_U- 41. o Q�kn 1j\' F -LS `.?-UG,I v C.,), C-1 9 U5
Conta t, Phone: Cupertino Business License #:
�/"nA�-- e 30-9 - 3(-/ I
Building Permit Info:
Bldg ❑ Elect ❑ Plumb E9'�—
Job Description: U
Residential Commercial ❑
Cost of Project: U U v �-
•
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
BPREPIPE Repipe of Fixtures PLUMBING
BPFIXTURE Pblg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•