08120068 CITY OF CUPERTINOt"!BU:¢BINO DIVISION PERMIT � Ta,Qpn RtJ�xNmFgP+Q:T•°-RY I2MIts CT.6s"Iy�'
BUILDING ADDRESS: PERMIT NO.
10420 LANSDALE AVE ULTRAPURE WATER '
NET'S NAME: PERMIT ISSUE DATE
W
ONE: CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
REPLACE EXISTING SEWER O O 0 0
u p G LICENSED CONTRACTOR'S DECLARATION
0
1 hereby affirm Net 1 son licenced under provisions of Chapter 9(commencing Job Description
Mwith Section 70010 of Division 3 of the,Beat.and Profcssme,Cade,and my Ill..is
in full force and erlM. - ,
j va z Lice Clsu lieu r ' .
Eg Date —Contraciar -
E
'1 —ARCHITECTS DECLARATION
as O I undemund my plans shall M tend a public mcords
s
k G Licensed Pnsfessional
OWNER-BUILDER DECLARATION
.� I hemby aflrm that 1 am exempt from the Contractors License Law for to
00 following mama(Section 7831.5.Buuness>M Pm(cssmon Code:My city or county
$ which requires a permit to cmuuuct,cher,maprom,demolish,or repair any structure
prior W its issuance.also mquines We appdianl for such Permit to lleasigned iusment
s< Nal heis licensed pursusntus the pmvisionsoftheConnectoM1lJttm
nLaw(Chapter9 Sq.Ft. Floor Area Valuation
140 (commencing with Section 70D0)of division 3 of the Business and Pmfassions Coca)or
e5 dru be is eanmpt thuefrom and the basis for the alleged exemption Any violation of
Section, manbya"artCRdantfarape It subjects the applicant macivil penalty of APN Number � Occupancy Type
❑I.as owner or the property.or my employes wit wgas as Neo sole compnsadon.
will do the wort,and thesuomum is notmuubil or offered for sale(Sec.7040 Business Required Inspections
and Profeuns loCode The Canuactor.La+•••Law aces rot appy to in owner.r q P
property who builds or Improves Naeon.and who does such work himself or through his
own employer,provided dor such imprommenta are not intended car offered rm sale B.
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 WW or improve for purpose of
ale.).
O 1.u ewer of the propeny,am eadmively compacting with licensed contractors to
construct the project(See 7614.Busmea,ad Profesdans Cade:)The Committees Li.
cense Law does trot apply to m owner of property who builds or informs shemon.sand.
who conmcls for such pmjecu wit a con a mor(a)liccn%d pursuant to the Compactors
License law.
C]1 oro exempt undo Sec. .B&P C for Nis won
wner Date
WORKER'S COMPENSATION DECLARATION
1 hereby aQitm under penslly of perjury one of the following declarations
s
I him am will maintain acmdreme of consent o self-insum for wmines Compen.
an,as provided for by Socuon 3780 of the Labor Cade.for the performance of the
wort for which this Permit is issued.
❑1 have and will maintain Workers Compensation Indi u im imd by Bodian
3700.1'she LaborCade.for the performance of the wont for which tris permit is issmd.
My Warier.Campic samat bsmnnce artier and Policy number tee:
Canmr, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This mcllon reed not W Completed if tee Permit Isfaronc hundred dollars(510)
or leu)
I cmufy that W the performance of the wart for which this permit Is issued,I"I an,
employ,nypumn in my mamlormubbecome mbject to the Workca'CC 62; "
Laws of Celifyrya.Data
Applicant
NOTCE'T'OStPPIICANT:Iff An II t p this Ccrdfius of Exemption,you should
become subject W the Workers Compensation prarommu of the labor Code,you mute
.J O faMwish comply wish such provisions or this permit shall be decreed revoked.
„'zy CONST'RUCTONL.ENDINGAGENCY
(—"141 hm shall afflNeu is a Construction,tion,lending agency for performance of
> the work fur which this Permit is issued(Sec.3097,Civ.C.)
W�0 Lenders Name ,
z Lenders Addles,
U C) I onnify that I have teed We applicadoa and sate Net the above information I, .
ty P COMM 1 agree W comply with all City and county anlmancn and sus laws painting to
� U Wilding comuntion,and hcmby authariu mpramutims ofthis city W Color upon die
above-menu and property for inspection purposes.
C (We)agree 1.ave,indemnify and keep hasmaless the City of Cupertino against
y liabilities.judgments,costa and expersa which may W my way aecmc againslsnid City
U Z in couequeroe of the gandng of Nu pmmiL
^r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2
SOUR TIONS.
Re-roofs
Striation of ApplicanVConumor D
HAZARDOUS MATERIALS DISCLOSURE Type of Roof ,gam
Will the applicant or forum Wilding occupant or handle heallou materiai ✓/
u daRncd by the Cupertino Municipal Code.Chapter 9.1;and the Health and Safety
ewe.Securer 23132(,)7All roofs shall be inspected prior to any roofing material being Installed.
Cy.Yes m
Will the applicant or future building occupant uta equlpmcm or device,which If a roof is installed without first obtaining an inspection,I agree to remove
.it hauNons air co ouninunts u defined by the Bay Arta Air Quality M....covert, all new materials for inspection.
District?
Oyes MWO
1ham peal ate basaodoumaterub mquvemcnumukr pard.95ofthe Califer.
nia Health&SafciyCode,SecdonsnM5.25533md25534.1undeaund NuifNe Wilding
does rot currently have a lonanL that is u my responsibility te notify do=Want or the
requi muuhmet priertat omen 0aCuuEcasofOc fancy. Signature of Applicant Date
Ow�mshomed.gcm 'Dow
h� All roof coverings to be Class'N'or better
Date"
Community Development
�y J 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS:/DL(a0 Zjc-,*-,�,/E A,/,P- PERMIT# G06 �—
OWNER'S NAME: PHONE / a6 S OCeZ�
GENERAL CONTRACTOR ,�, FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Floorutg: Carpeting
• Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
o� Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
• Tile
Owner/Contractor Signature ate
CITY OF CUPERTINO
• 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36912005 . 00
DATE ISSUED. . . . . . . : 12/05/2008
RECEIPT # . . . . . . . . . : BS000006770
REFERENCE ID # . . . : 08120068
SITE ADDRESS . . . . . : 10420 LANSDALE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ABHIJIT & JUI PANDIT
ADDRESS . . . . . . . . . . : 10420 LANSDALE AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95015
RECEIVED FROM . . . . : ULTRAPIPE WATER SER
CONTRACTOR . . . . . . . : BRIAN CASTRO LIC # 27512
COMPANY . . . . . . . . . . : ULTRAPURE WATER SYSTEMS
ADDRESS . . . . . . . . . . : 1420 SOLANO DR
CITY/STATE/ZIP . . . : BRENTWOOD, CA 94513
• TELEPHONE . . . . . . . . : (925) 516-0401
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
1BSEISMICR VALUATION 2, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00
1PPERMITFE FLAT RATE 1. 00 40 . 79 0 . 00 40 .79 0 . 00
1PRSEWER UNITS 1 . 00 20 .40 0 . 00 20 .40 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 .79 0 . 00 40 .79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 216 .48 0 . 00 216 .48 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 216.48 2490
---------------
TOTAL RECEIPT 216.48
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
•
CITY OF CUPERTINO
��. REPIPE/SEWER/MAIN SERVICE
CITY OF
• CUPEkTINO PERMIT APPLICATION FORM
$72 ooca-
APN # / 79Q )2 �16� Date:
Building Address:
Owner's Name: Phone #:
l4 C� c�dl r— rl'7—
Contractor: C�C,�&o Phone#:,OJa 5-SKP aL1 01
0 A Uak t Fax #: �l(Q ()q() /
Contact: /3Q�pa ,�a Phone #: ��5 -595 -u1213
Fax #:
Contractor License #:
Cupertino Business License#: W)a.
Job Description: �Epl�c6 �x sLrwFZ
lei
Residential Commercial ❑
Valuation:��a.
Project Size: Express � Standard ❑ Large ❑ 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
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial P
/ 1BSEISMICR Seismic Residential P
I / IPRSEWER Residential building P 1RPSS
sewer/sanitary sewer
a�,Onciuu, CITY OF CUPERTINO
REPIPE/SEWERIMAIN 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 1CPWS or
IR-PWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
IBPGAS Gas Piping System 5+ Outlets P
f 1PPERMITFEE Plumbing Permit Fee Issuance P
/ 1PLMBLNCK Plumbing Plan Check P •
IPLMBINSP Other Plumbing/gas Insp. P
( 1TRAVDOC Travel & Documentation Fee B
I 1BUSLIC Business License B
Revised 6-16-08
•