12030008 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10355 FARALI-ONE DR CONTRACTOR:TATS INC DBA MR PERMIT NO: 12030008
ROOTER PLUMBING
OWNER'S NAME: RAJA&KATRINE BHADURY 44777 S GRIMMER BLVD STE C DATE ISSUED:03!022012
Pt10NE: 4088731920 FREMONT,CA 94538 PHONE NO:(408)271-2822
LICENSED CONTRACTOR'S DECLARATION JOR DESCRIPTION: RESIDENTIAL 0 CObIMERCIAL
V �_( 7 INSTALL PROPERTY LINE CLEAN OUT
License ClassLic.H ��. 7tr. L S
Contmciormf, jfbEn Date S-Z- I Z-
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
perfomtmtce of the work for whichthis permit is issued. Sq.Ft Floor Area: Valuation:$3283
1 have and will maintain Worker's Compensaicm Insurance,as provided for by
Section 3760 of the Labor Code,for the performance of alerw ch this ,APN Number:36931016.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
(certify that I have read this application mid state tha the above infommtion is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with till city anal tomoy ordinances and state law's relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FRO LAST CALLED INSPECTION. I
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,aid expenses which may accrue against said City in consequence of theme 3-2--12-
graming of this permit. Additionally,the vpplieant understands and will comply Issued by: Date:
with all non-point source r ulaticns per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date -7/ L All roofs shall be inspected prior to ary roofing material being installed.If a roof isi
installed widons first obtaining an inspection,I agree to remove alum materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
hereby affirm that 1 ora exempt from the Contractor's License Law'for one of 1
the following two reasons: ALL ROOF COVERINGS TO RE CLASS"A"OR BETTER
1.as owner of the property,or my et ployms with wages W their sole comp:nsatiah,
will do the work,and the structure is not intended or offered for sale(Sec.7044.
Business&Professions Code)
L as;owner of the property,am escluvvely contracting with licensed contractors to t1AZARDO1IS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
CaliGhrnia llealth&Safety Cade,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following tluree maintain compliance with the Cupertino Municipal Code.Chapter 9.12 andthe
declarations: Ileafth&Safety Code.Section 25532(1)should 1 store or handle hazardous I
I have and will maintain aCertificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit lu zardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District
perfomhance of the work for which this permit is issued will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by tine Health&Safer Code,Section 25505, 533:and 25534.
Section 3700 of the Labor Code,for the performance of tie work for which this Owner or authorize)agenC Datr.�_ L-I
permit is issued. -
1 certify that in the performance of die work for which this permit is issued,I shall
not employ any person inahy manner so as to become udpject to the Worker's
Compensation laws ofCalifomia. If,after making this cenificate of exemption,1 CONSTRUCTION LENDING AGENCY
become subject to die Worker's Compensation provisions of the Labor Code,I most I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this pemnit shall he deemed revoked w'ork's for which this permit is issued(Sec.3097,Civ CJ
Lender's Name
APPLICANT CERTIFICATION Lender's Address
1 certify Una I have read nus application aid scale that the above inforunaion is
correct.I agree to comply with all city anet county ordinances mil slate laws relating
to building construction,and hereby authorize representatives of this city to enter '
upon the above mentioned property for inspection purposes.(We)agree to save
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities.judgments.
costs,and expenses which may accrue against said City in consequence of die I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signmure Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10355 Farallone Dr. DATE: 03/02/2012 REVIEWED BY: RDW
MIAPN: BP#: -VALUATION: $3,283
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition /Repair
PRIMARY' SFD Or Duplex PENTAMATION 1RPDP
USE: PERI%IIT TYPE:
%YORK Install r)rooertv line Cleanout.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Piping, Drainage 1PREPPIPE 1 # $44
TOTALS: $44.00
A@th Phar Ch.rk Plumb. Plan Check 0.0 hrs $0.00 Flex.Plan Chuck
Meeh. Permir Fee: Plumb. Permit Fee: IPPERMIT nee. Pernur Fee:
Otlrer.tfr/t.Imp, Li I Other Plumb lnsp. 0.0 hrs $44.00 (filer Elec. Imp. Li I
Ai,,h lay'. Fee. Plumb. Gray,F.ve: EW.ImIA Fee:
NOTE: This estinwte does not include fees due to other Departntentr(i.e. Planning,Public Works, Fire,Sanilaq SLnver District.School
District,etc). Thesefees are bared on the prelininarj in ornnrtion available and are on/v an estlnmte. Contact the De 1 or addn'l info.
FEE ITEMS Ree Resolution 11-053 EIX 7/1Ml FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0,00
Fermin Fee:
SuppL hup Fea
PME Unit Fee: $44.00
PME Permit Fee: $44.00
Caustntchon Tac:
Administrative Fee: I.aDAIIv $41.00
Work Without Permit? 0 Yes e No $0.00
,lticanced Plannins Fees:
Travel Documentation Fee: ITRA vDOC $44.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $174.50 $0.00 TOTAL FEE: I $174.50
Revised: 1/19/2012
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36931016. 00
DATE ISSUED. . . . . . . : 03/02/2012
RECEIPT # . . . . . . . . . : BS000016169
REFERENCE ID # . . . : 12030008
SITE ADDRESS . . . . . : 10355 FARALLONE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RAJA & KATRINE BHADURY
ADDRESS . . . . . . . . . . : 10355 FARALLONE DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3104
RECEIVED FROM . . . . : MR ROOTER PLUMBING
CONTRACTOR . . . . . . . : TATS INC LIC # 23496
COMPANY . . . . . . . . . . : TATS INC DBA MR ROOTER PLUMBIN
ADDRESS . . . . . . . . . . : 44777 S GRIMMER BLVD STE C
CITY/STATE/ZIP . . . : FREMONT, CA 94538
TELEPHONE . . . . . . . . : (408) 271-2822
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
-ADMIN HOURS 1 . 00 41. 00 0. 00 41 .00 0 . 00
1BCBSC VALUATION 3, 283 . 00 1. 00 0. 00 1 .00 0. 00
1BSEISMICR VALUATION 3 , 283 . 00 0 . 50 0 . 00 0 .50 0.00
1PPERMITFE FLAT RATE 1 .00 44 . 00 0 .00 44 .00 0 .00
1PREPPIPE FLAT RATE 1 .00 44 .00 0 .00 44 .00 0 . 00
1TRAVDOC FLAT RATE 1 .00 44 .00 0 .00 44 .00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 174 .50 0 .00 174 . 50 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 174 . 50 VISA
---------------
TOTAL RECEIPT 174 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ------------------------ -------- ----------------------------
106
--------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
506 GAS TEST 507 FINAL PLUMBING
Building Department
City Of Cupertino
10300 Torre Avenue
Cunertinn.CA 95�14�11_SS
CUPERTINO eicF,ouuo: oma-iii-� ea
Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: cWee �dC,4gyol PERMIT# /2D-7> a'OO
OWNER'S NAME: PHONE # (j/0 5) FSS- O`i
GENERAL CONTRACTOR: b (�wzr (u /M/4/e BUSINESS LICENSE # G2-5'
ADDRESS: C-„c•,,,,. E-,L BIJd, Fee.� CIA .7y<-i3 CITY/ZIPCODE: 9 s
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY NSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL BCOi` CTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors:
3 44 !Z
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
Painting/ Wallpaper
Paving
Plastering
Plumbing ftv—
Roofing
Septic Tank
Sheet Metal
Shect Rock
Tile
n t . for Signature D•rte
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 w w I
CUPERTINO '\r/�(408)777-3228 • FAX(408)777-3333• buildingocu°er4'no.or° v\
INieLNG ❑NEECHANICAL ❑EUCMICAL ❑NUSQ.r_A.NE//O��U1S ' In 3 D�JU�
PRCIECT ADDRESS / °Er.-•l r aR�ti �NG{J R-•G, AFN
Wa ✓`_ 3I V I.I.Y
ONR NAME f�f1t Ql/N//�, j� _ 1. 1W EMAIL
iO3s?HESS ar. \� t /c CITY. STATE)�QZIP
, /. FAx
CONTACT NAM.. -IAU�'Ji1 l2e:nYACG� D tj/ (J✓O^�1> a E - e C I r
95 ORFSS grm SCAT$ FAX
->j;rw6-rwe rs(ao(, CA 9ys3g
❑OWNER ❑ OWNER-BUBDR ❑ ❑CONfRACTORAGE.NT ❑ AIrCfII1F1T ❑ENDaVEA ❑ DEVEOPR ❑TENA.Ni
CONTRACTORNAMEJI1 c�T C� SE LI �E�S LICENTYPE EUS.LICd'
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COMPANY NA.�L ) � �7G�-.JC �'u4^\_ E-MAd. FAX <, z�/-
1771
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ARCHITECGENCINEFA NAME LICENSE 1IIM3R BUS.LIC I
COMPANY NAME' E-MAIL FAX
ST=ADDRESS CITY,SCATE ZIP PHONE
USE OF RSFO.DUPLEX ❑ MULTI-FAMEY PAOtECT Bt WBDLAND ❑ YES I PRGIECT IN ❑ YES MS BIDGAN ❑YES
BUR.Dw'0: ❑COMMERCIAL ISL9AN wR'ERFACE AAEA ❑ NO FTDODZONE ❑NO EICHLER HOME? ❑NO
DESCRIPRCN OF
TOTAL VALUATION: RECEIVED BY:
By my signature below,I certifytoeach of thefall g: I am Le property owner or authorized agent m act on�e property owner's behalf I have read ilds
application and the i¢fonnadon I have :tied Is L have tc+d the Dacpaon of Mork and verify it is accvr3te. [agrx to cortmly wid:all applicable local
ordinances and sae laws relating w "ding col non. I autheriu representatives of Cupertino to enter the abav7-idegfifed property for inspection pu@oses.
Signature of AppU=L/AgrnD Daze: vie
S urt; I' t7ON REQU D I
OFFICE USE ONLY
y ❑ OVER-THE-COUNTER
❑ EXPRESS
Y
U
u ❑ STANDARD
U
< ❑ LARGE
❑ MAJOR
MPPbfuc4pp 10II.dac revised 0621/11