08100198 CITY OF CUPERTINO 0 r':
BUILDING DIVISION PERNIIT CON?TR -&T. Wi1NI`'0RNIt ( N
,r,.„ a: '.,t.'�k..y 4,r, d7t,}+S°zw� �'.. :i. e
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: MEHTA PERMIT L95UE DATE
6 ONE. CONTROL NO.
ARCHI'IECTIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0
u00 LICENSED CONTRACTORS DECLARATION
I heathy M.that 1 am licauand order pmviuons of Chmuur 9(commencing Job Description
with Sadon 90M))of Division 3 afthe Business and Professions Code.and myliecom is
^ „ infull to=aud offectDRAW GAS CONN TO KTCHN FOR GAS RNG, NRST GAS
Dan.nseClm ChoirmasterAPPLNC IS WTRHTR ACRS RM APPRX 15FT AWAY, PIPE LD
e� ARCHITECTS DECLARATION
y I unmruand my plans shall W used as public nand; UNDR HSE
JyU
k G t; Licensed Professional -
OWNER-BUILDER DECLARATION
H2 1 Wm c affirm Nal I am exempt from the Contractors License Law for IW
0 o following ressan.(radon 7031.5.Business and Professions Code:Any city On,county
5$ which requlrns a permit to construct.alter.Improve,demolish.or repair any structure
prior m its issuance,also requires de applicant forsuch permit to Bk asigocd statement
< dot le on licensed pmsuwtle,Ne povisInns of the Cumrecmrs Uansc Law(ChsPmr9 Sq.Ft.Floor Area ' Valuation
�O (ewnmeMng with Scedan 7000)af Division 3.fde Business and Professions Codc).r
`C$ thin be on compo therefrom and One lesson for the dlegcd reception.Any violation of S150
Section 7031.5 by arty applicant fora permit mbjecu Ne applicant to a civil penalty of APN Number Occupancy Type
amt some Nan five hundred dollars($500). P Y YP
❑Luowner tattle prnprrty,mmr moplaym wBh wages uNe"v sok mnpensWon, 31625032 . 01
will&the wart and themscrom is not Intended or offered for sate(she 7014,Busimas
and Profmtiam Cade The Contractors Limine Law Ones act apply b an Owner or Required Inspections
Property Won builds Or Improvestherron.and whmdoeawch workhine elf er through his
owncmployru,presided thin such improvements ase not immmded oroReted(onsets IL
however,the building m improvvmwst u sold within one,)ear orcompkdan.the..
Wilder will have the hmdm of paving this he did rot build or improve for purpose of
L�(,a owner of the property,am eselusively contracting with licensed wnhacan a
construct the pmjcm(Sec.7614.Business and Professions Cade:)The Com eactors U. _
team law dors not apply as an owner of property who builds or improves license,Ord,
win,contracts for such prolcas with a rnnurtm(s)licensed puesuamt to the Conuaemrs
License Law.
0 lam eaemptupger$ee. .B B PC for Nia n
owner Not 0
--31N6 KERSCOMPENSATIONOECLARATION
"em"
drum under"cushy of perjury sue of Ne felbwing dcc,"ohim¢
ko1leave and will mdnWn a Cenifiateof Consent m self-imaum forWormers Co.,..
n,as provided for by Seen.3700 of the labor Code,for des pedmmance of the
for which Nis permit is leaned.
0 1 have and will mdnuim Watters Cono,m them formance,asinquired by Section
3700.17Ne La W,Cod,jorthe per(ournme.of Ne wort forwhich this pormiti,issued. '
My Workers Compenaadon Insurance artier and Policy number am: -
Cmrkr.. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TTds rceriom nccd Out be completed if Ne permh]at...hundred dollen($100)
Or less)
1 o-nify Nat in do performance of the wolt for which this permit u Wood.i shall nor
employ any person in my in 'en Worker'Compensation
Laws of Califotyip.Dale -
"'Pliant / I
NOTICE rO APPLIG :IL a er maWng Nu Cenifiate of Faemption,yo should
bGame lunjl'CI b tht oatrl'1 L'ampCortheMiLons of lit labor ym.A
O forthwith amply with such pr.".in this
u or permit shill W dceminvoked.
oked..
Z " CONSTRUCTION LENDING AGENCY
(~^ I hereby affirm mut Nene is a construction kndingageney for the performance of
cite wwk for which this permit u Lssmd(Scc.3099.Co,C.)
(y Q
Lender's Name
.0.7 Z lenders Address
U 0 1 aatiry Neo 1 have tend this application and sate thin the above information is '
IL !' comer.I agree m comply with all city and county ordinances am sum laws relating m
.C) rV' building construction.and hereby authorim representatives;of N6 city m notes upon Ne
r un ahmt-mcutioned property(in inspection purposes
6. (W.)agnea in rase,indemnify and keep harmless the City of Cupermw agdat
iFy fA liabilities,judgmcnta,coo and espouses which may in any way accrue against mid City
U Z in consecrUnce Of the gam ng of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 6/77,Y
SOURCE REGULATIONS.
IIJ i M oft 7Diat Re-roofs
Signer p tan mnbmmr Dem
xnwfDDusM"ig AphustomDISCLOSURE Type of Roof
Will deapplicants eCupertm Town buildinge.Chapter
co handle harutlrammateriel
C de. cW by de Cupertino Municipal Cade.Chapter 9.13.Amb the NesIN and Safety
Code.section 25532(.)7
Cl Y. rQ No All roofs shall be inspected prior to any roofing material being installed.
Will cite a,licam or furore Wilding Occupant use equipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ire bavam
ans dr ecnumimdew
nu as ed Ne ley Bay Ama Air Quality Manm
.geem all new materials for inspection.
ct9
❑Yes (No
I hese road dre bvaedaus materials requirements under Chapter 6.95 of the Cdifor.
.is Health ds SdctyCede,Scch.25505.25533 and 25534.1 understand!that ifde Wilding
dyes rot currently have a¢mane thin it u my responsibility to mtify de occupant of de
ucIuhOjZr met poor missuance of.certificate eraapyRY./ef Signature of Applicant Date
�/
DamAll roof coverings to be Class'%¢"or better
Own uoharvt0 ogee '
CITY OF CUPERTINO
e 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot: .
APN . . . . . . . . : 31625032 . 01
DATE ISSUED. . . . . . . : 10/29/2008
RECEIPT # . . . . . . . . . : BS000006504
REFERENCE ID # . . . : 08100198
SITE ADDRESS . . . . . : 20286 VISTA CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . . NIKUNJ MEHTA & PRATIBHA MEHTA
ADDRESS . . . . . . . . . . : 20286 VISTA CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : NIKUNJ R MEHTA
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : NIKUNJ MEHTA & PRATIBHA MEHTA
ADDRESS . . . . . . . . . . : 20286 VISTA CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . :
eFEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------------- ----- ------ ----- ------ ----
1BSEISMICR VALUATION 150 . 00 0 . 50 0 . 00 0. 50 0 . 00
1PGASRES OUTLETS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
TOTAL PERMIT 143 . 27 0 . 00 143 .27 0 . 00
METHOD OF PAYMENT AMOUNT PREFERENCE NUMBER
--------------- --------------------
CREDIT CARD 143 .27 AMEX
---------------
TOTAL RECEIPT 143 . 27
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------- -------------------- -------- ----------------------------
301 ROUGH PLUMBING 507 FINAL PLUMBING
e
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
eA. / All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
4v�
Property Owner's Signature: N; 4111 _[; M eu;� Date:
Job Address: 2-02.9 & Vshi C1. Ctwof1 o 611 'I.w j 4 Permit#
I
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
• Department.
CITY OF City of Cupertino Building Department•
Ct I p C A I 10300 Torre Avenue
U P[k)I O Phone: (408)777-3228
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of .
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a .
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is$200 or more for the entire project,and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer, you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs, and unemployment compensation•
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish, the U.S.Small Business Administration). For more specific information about your
obligations under state law, contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino •
Printed on Recycled Paper
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4UPE(�TINO
Building Department
JOB ADDRESS: PERMIT #
202$6 V;sht CSP C eA'n-v cA qui¢ 0c4�
OWNER'S NAME: N,tful i If64, PHONE # .¢og-4¢6 .-2-11-3
GENERAL CONTRACTOR. -- FAX# K31 - ew?
I am not using any subcontractors: U s' ZAug
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
• Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
/D f/was
Owh7W/ Signature Date
09/001 q �,
CITY OF CUPERTINO
' REPIPE/SEWER/MA1N SERVICE
CITY OF
• CUPERTINO PERMIT APPLICATION FORM
" # 316 - 25- 032-> O/ Date: )912, 12.008
Building Address: 202g6 Vista Court-
Owner's Name: , Phone #:
N;katYt Melita .� ,al,'bla N��h 4129- 761- 7146
Contractor: Phone#:
�/A Fax #:
Contact: NJ." Phonc#:4-9$, 761- -114-6
Fax#: 4-Iq- 831 - 8601
Contractor License#: 01A
Cupertino Business License#:
Job Description Dfa]U a Gfl�neco� 1p I�r k,'fcR¢„ a. 9Rn Y e .
Neayeaf gas afPliance to vjr& 6P� aicroo `ti , Y2pv a ,&a i5Tct away.
Pi e w'111 be "e.
• Residential 12/ Commercial ❑
Valuation: $ 150
Project Size: ExpressZ Standard ❑ Largc ❑ Major❑
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set& the sheet index.
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
Q Grou
1 PCSEWER i Commercial building P 1CPSS
sewer/sanitary sewer
1 BPREPIPE Commercial re-pipe per fixture P Gp 1CPRP F
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial P
/ IBSEISMICR Seismic Residential P
• 1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
CITY OF CUPERTINO
SO
RREPIPE/SEWER/MAIN SERVICE
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P ICPWS or
IRPWS
1PPRSEWG Private Sewage Disposal System P
IPCESS Cesspool P
1 BPWATER Install/alter Water Pipe P
IBPFIXTURE Plumbing Fixture P
1 1PGASRES Residential Gas Piping System P
1-4 Outlets
I BPGAS, Gas Piping System 5+Outlets P
IPPERMITFEE Plumbing Permit Fee Issuance P
/ I PLMBLNCK Plumbing Plan Check P
1 PLMBINSP Other Plumbing/gas Insp. P
1TRAVDOC Travel & Documentation Fee B
1BUSLIC Business License B
Revised 6-16-08
•