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07080090 CITY OF CUPERTINO n — BUILDIN6 DIVISION PERMIT PERMIT NO. eu1LDt "&EsIRWIN LA NEW STRUCTURE PLUMBING INC 07080090 PERMIT ISSUE DATE OWNER'S NAME: VENKAT SIDHABATHUNI P OBOX 111143 08/0912007 E: SANITARY NO. CONTROL NO. (408) 364-2143 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is WATER BEATER INSTALLATION in full force and effect. 't License Class Lic•H o Date Contractor ARCHITECT'S DECLARATION I understand my plans shall be used as public records :J Licensed Professional a OWNER-BUILDER DECLARATION � 1 hereby affirm that 1 am exempt from the Contractor's License Law for the C following reason.(Section 7031.5,Business and Professions Code:Any city or county �i which requires a permit to construct•alter,improve,demolish,or repair any structure } prior to its issuance,also requires the applicant forsuch permit to file a signed statement t; ,Ft.Floor Area Valuation i that he is licensed pursuant to the provisions of the Contractors License law(Chapter 9 S Q o (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $900 m that be is exempt therefrom and the basis for the alleged exemption.Any violation of Sectioh 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 9 2 2 019�kV�Number Occupancy Type not more than five hundred dollars($500). p I•as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner or property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale If, however,the building or improvement is sold within one year of completion.the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 121,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cc=Law does not apply to an owner of property who builds or improves thereon.and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑I am exempt under Sec V B&P C for this n owner I'QYIICA Cl( �n�jl`f1/Kl�.t Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations ❑1 ha re and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the J abor Code•for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number arc: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or las.) I certify that in the performance of the work for which this permit is issued.I shall rex employ any person in any manner so as to become hl�theta orkers'Compensation Laws of California. tc,/ ApplicantfR{!e t NOTICE TO APPLICANT:!Q after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Codc,you must 0 forthwith comply with such provisions or this permit shall be deemed revoked- "" CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of i the work for which this permit is issued(Sec.3097.Civ.C.) a Q Lender's Name Z Lender's Address 0 I certify that 1 have read this application and state that the above information is r-" correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the y W about-mcntiuned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City Z in consequence of the granting of this permit. �- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIO ;, S. L7 Re-roofs �s Signature of Applidni/ConVactor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the.Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes No f` If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑YesNa I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant or the requirements which must be m prior to issuance of a Certificate of Occu Signatureof)f Applicant Date q- Fr. All roof coverings to be Class"B" or better Owner or authorized agent - CITY OF (CUPERTINO WATEIt. HEATER CUPEI�TINO PERMIT APPLICATION FORM v-7agba76 APN# Date: Building Address: � l C U kA'y Lc I' V\ L vi i 'T e 3 ti Y\U C, Owner's Name: , Phone#: Contractor - -- Phone:--/ - f kens( #: Contact: one: Cupertino Business License#: Lee v\ In o S Building Permit Info: BldgEl Elect Plumb Mech Job Description: ��Y I•� �Y � nSt�--�kcL.�.�� Residential PL Commercial ❑ Cost of Project: Strapped 60 On Platform Bonded 7 New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER eater Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY liner y BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 C1TY OF Fax(408)777-3333 C.UPEkTINO Building Department JOB ADDRESS: � " LO PERMIT# C �p o" OD 'rO OWNER'S NAME: �' ,�( - ' 'c L�a ti"i u vu PHONE # c ` - 7'17' - GENERAL CONTRACTOR: N.)w c -tu FAX # I am not using any subcontractors: (LL - ; C SignaYure Date Please check applicable subcontractors and com Clete 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 Owner/Contractor Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT' RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN . . . . . . . . . 35922019 . 00 DATE ISSUED. . . . . . . : 08,'09/2007 RECEIPT #. . . . . . . . . . BS000002325 REFERENCE ID # . . . : 07080090 SITE ADDRESS . . . . . : 76 .0 KIRWIN LA SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : VE11KAT SIDHABATHUNI ADDRESS . . . . . . . . . . : 761.0 KIRWIN LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4357 RECEIVED FROM . . . . : SAILAJA SIDHABATHUN CONTRACTOR . . . . . . . : LEON FRIDLIB LIC # 26052 COMPANY NEW STRUCTURE PLUMBING INC ADDRESS . . . . . . . . . . . P GBOX 111143 CITY/STATE/ZIP . . . : CAMPBELL, CA 95011 TELEPHONE . . . . . . . . : (4(18) 364-2143 FEE ID UNIT QUANTITY 1,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34 . 86 0. 00 BPWHEATER PER HEATER 1. 00 10.79 0. 00 10.79 0. 00 PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 ------ ---------- ---------- ---------- TOTAL PERMIT 84.02 0. 00 84 .02 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 84 . 02 AX --------------- TOTAL RECEIPT 84 . 02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING