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07080220 777. CITY OF CUPERTINO BUILDING DIVISION PERMIT CN'�'ItAGT ? Z IU14TUN PERMIT NO. BUIL(�Ii�G�,iTI-ARNHART AVE STREET PLUMBING & ROOTER 07080220 j y l l PERMIT ISSUE DATE OWNER'S NAME: ATUL GUPTA 2293 WALNUT GROVE AVE 08/24/2007 SANITARY NO. CONTROL NO. PHONE: (408) 496-1155 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH O z LICENSED CONTRACTOR'S DECLARATION Job Description W O I herebyaffirm that I am licensed under provisions of Chapter 9(commencing z UW with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE ELECTRIC WATER HEATER <v. in full force and effect. License Class Lic.N p Date Contractor F ARCHITECTS DECLARATION i a a I understand my plans shall be used as public records CL W y Licensed Professional t N OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the in o following reason.(Section 7031.5,Business and Professions Code:Any city or county 01 which requires a permit to construct,alter,improve,demolish,or repair any structure Zr prior to its issuance.also requires the applicant for such permit to rile a signed statement Ft.Floor Area Valuation a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 `q $610 i t=— (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of A p]�Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 37509032 L(J'(} not more than five hundred dollars(5500). 0 1,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 of 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.). as owner of the property,am exclusively contracting with licensed convectors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law docs not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(&)licensed pursuant to the Contractor's License Law. 0 I am exempt under Sec. B&PeC for this reason OwnerDate WORKER'S MPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Workees Compen- an,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number arc: Carrier: Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is Cor ane hundred dollars($100) or less.) I certify that in the performance of the��wohrk for which this permit is issued,1 shall not employ any person in any manner, rl!f subject to the Workcri Compensation Laws of California.Date Applicant NOTICE TO APPL.ICA r:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. z, CONSTRUCTION LENDING AGENCY - CA 1 hereby affirm that there is a construction lending agency for the performance of p�.> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name z Lender's Address U 0 I certify that I have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating to r, U building construction,and hereby authorize representatives of this city to enter upon the 0a above-mentioned property for inspection purposes- (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 U z in consequence of the granting of this permit. Date ►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE RE ULATLONS. �,,.-.J��� 4"161 Re-roofs - � Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of F.00f 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. 0 Yes O Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, agree to remove ;it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. strict? WIC oC 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 does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which St be met p�rio�w iss ance of a Certificate of Occupancy. SignaturE of Applicant Date ;�-���' gj�'W1 All roof coverings to be Class"B"or better Owner or authorized agent Datc Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Buildinjg De artment JOB ADDRESS: PERMIT # (.0ji-k T i N o, U9 - qsz 1 y ?®� � OWNER'S NAME: AAV Q1At- G v PT,i PHONE # 408 3 3 2 q2-46 GENERAL CONTRACTOR: S-r f— PL M8 11 FAX # I am not using any subcontractors: 2-,fd Date Signature Please check applicable subcontractors and comr lete 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 _ T- 2-41 7 Owner/Contractor Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMI`I RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 37509032 .00 DATE ISSUED. . . . . . . : 08/24/2007 RECEIPT #. . . . . . . . . . BSC00002475 REFERENCE ID # . . . : 07C80220 SITE ADDRESS . . . . . : 19C11 BARNHART AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER ATL L GUPTA ADDRESS 19C11 BARNHART AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : AANCHAL GUPTA CONTRACTOR . . . . . . . : MAF.K STREET LIC # 29069 COMPANY . . . . . . . . . . : STF.EET PLUMBING & ROOTER ADDRESS . . . . . . . . . . : 22S3 WALNUT GROVE AVE CITY/STATE/ZIP . . . : SArf JOSE, CA 95128 TELEPHONE . . . . . . . . : (4C8) 496-1155 FEE ID UNIT QUANTITY IMOUNT 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 40.79 0. 00 40.79 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 86 .44 0. 00 86 .44 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 86 .44 MC --------------- TOTAL RECEIPT 86 .44 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF CUPERTINO WATER HEATER CUPERTINO PERMIT APPLICATION FORM APN# 3.15 Oq 032 Date: �_ 24�-G? Building Address: 19011BARNHART Avf. , CUPL TING, CA q5 Owner's Owner's Name: Phone#: ATuL (�Up-rA 6ggNCHAf_ GUPTA yog 5-50 3499 Contractor: STP- T PLuM6iNCS License#: 21 Contact: _ +q 6— /1 S� Cupertino Business Icense #: Building Permit Info: Bldg ❑ Elect O Plumb ® Mech Job Description: Re-place elec.t_0iL Wa4eM 4" Residential in Commercial ❑ Cost of Project: $ 610 Strapped © On Platform ❑ Bonded New Location ❑ Replacement 19 Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BEN ERGY Energy BUILDING BUSLIC Business License BUILDING