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12040044CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 8159 PRESIDIO DR CONTRACTOR:I A L PLUMBING PERMIT NO: 12040044 OWNER'S NAIVE: SHENOY KUMUDA P TRUSTEE & ETAL P O BOX 6147 DATE ISSUED: 04/09/2012 OWNER'S PHONE: 4083145908 SAN JOSE, CA 95150 PHONE NO: (408)224-3691 ❑ LICENSED CONTRACTOR'S DECLARATION, License Class Lie. H 91 Contractor Yt Date N —C/— �Z I hereby affi Ilia, I am licensed under the provisions of Chapter 9 (commenciilh Section 7000) of Division 3 of the Business & Professions Code rind Ih t m}• license is in full force and effect. I hereby affrm under penally of perjury one of the following two declarations: 1 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for One performance of the work for which this permit is issued. n^ APPLICANT CERTIFICATION'. • r ` I certify that I have read this application and slate that the above ormation is correct. I agree to comply with all city and county ordinances an tate laws relating to building construction, and hereby authorize representatives of is city to enter upon the 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -pint source regulations per the Cupertino Municipal Code, Section 9.18. f/pI� /_ /— ... 1 I DA IV 14 a/KtT ❑ fl OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 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 & Professions Code) I, as owner of the property, am exclusively contracting with licensed eontmetors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penally of perjury one of the following three declarations: I have and will maintain a Ceniftcatc of Consent to self -insure for Worker's Compensation, 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 Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of die work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of Califomia. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accme against said City in consequence of the granting of this remit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: COPPER REPIPE EXISTING RESIDENCE Sq. F1 Floor Area: I Valuation: $6700 APN Number: 35611087.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ��/� i>!%lif� Date: 'Y- / RF. -ROOFS: All roofs shall be inspected prior to any roofing material berg installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District l will maintain compliance with the C rtino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 5 O�5',"'2�55533, an Owner or authorized agent: ff Date: i 7 CONSTRUCTION LENDING AGENCY I hereby atBr that there is a construction lending agency for the performance of work's for which this peril is issued (Sec 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed 7 ITEMS OF 7 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ......: 35611087.00 DATE ISSUED.......: 04/09/2012 RECEIPT #.........: BS000016488 REFERENCE ID # ...: 12040044 SITE ADDRESS .....: 8159 PRESIDIO DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 261.67 --------------- 261.67 REFERENCE NUMBER -------------------- #2194 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING OWNER ............: SHENOY KUMUDA P TRUSTEE & ET A ADDRESS ..........: 8159 PRESIDIO DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: JA PLUMBING CONTRACTOR .......: JOE LOVE LIC # 25774 COMPANY ..........: J A L PLUMBING ADDRESS ..........: P O BOX 6147 CITY/STATE/ZIP ...: SAN JOSE, CA 95150 TELEPHONE ........: (408)224-3691 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 6,700.00 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 6,700.00 0.67 0.00 0..67 0.00 1BUSLIC FLAT RATE 1.00 119.00 0.00 119.00 0.00 1PPERMITFE FLAT RATE 1.00 44.00 0.00 44.00 0.00 1PRREPIPE NO OF FIXTURE 1.00 12.00 0.00 12.00 0.00 1TRAVDOC FLAT RATE 1.00 44.00 0.00 44.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- ---------- 261.67 0.00 261.67 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 261.67 --------------- 261.67 REFERENCE NUMBER -------------------- #2194 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 950143255 rn M' A CUPERTINl�O,�y (v' CALMBING ❑MECHANICAL ❑1-3.ECfRICAL ❑MLSCEfr ANCOUS (408) 777-3228 •FAX (40B) 777-3333 • buildine(o)cuoerono.o PAOIECC ADDRESS ,KFS _Dso APN# J/✓`P— OWNER NAME 1 / G / ,g NO 1/ �'t t PHONE CJI �l�r -,d-G` 7 s/O J I E-MAIL A'�/J /J� 4TRFfTADDRESS� IyZ' V & e S I `/�� SLATE. ,t}I l� C FAX CONTACr NAME PHONE E-MAIL STREET ADDRESS ,' CrTY, STATE, ZD' FAX ❑ OWNER ❑ OWNER-UUIDFA ❑ OWNER AGENT ❑ CDNrRACMR ❑CONrRACMRAGN ❑ AROM= ❑E24ON pt ❑ DEVELOPER ❑ TENANT CONRUCTOR NAME1 Qu, -,6' u,-, L r to LICENSE ,Z� lJCETInCrfPE--,/ C-.�JE7 SUS. LIC# COMPANY NAME '.,1 . �IL� o E� 1 E-MAIL FAX STREET ADDRESS 7e. �s ' CITY, STATE, ZIP s � PHO d ro 6 � iz ARCHrrECTIENGINEER NAME LICENSE NUMBER BUS LIC # COMPANY NAME ' E-MAIL FAX STREET ADDRESS CITY, STATE ZIP PHONE USE OF SFDmDUM= ❑ MULTLFAMMY RUDDnrO: cmAma&L PROTECTRTWEDEAND ❑YES. URRANENTE/REAAC/EAA�REA NO PROTECTN ❑YES FLOODZONE 0 UTHERIDGAN ❑ Y6 EEHLER HoM NO {� DESCRIPTION OF WORK C �/ oL=�,/J (/` ri t/ zPe TOTAL VALUATION: (% O RECETVEO BY: By DrysigoaDae below, certify to each of the followmr. I am the property novo= or anthorked agent to act w rhe property owner's behalf I have read dus appliradom and rhe information I have provided is correct j have read the Description. of Work Rod verify it is accurate. I agree m comply With 4 applicable local ordmm ces and sate laws relator building constmemaa representatives of Capertmo to enter the above-idcuti5ed property for mspectiort pu@oses. Signahne ofApplieamUAgeat Date: PI MA=AL INFORMATION REQU= OFFJCE USE ONLY u OVER-THE-COUNTER Y ❑ EXPRESS u u ❑ STANDARD ❑ URGE ❑ MAJOR AEPMucApp_2011.dac revised 06121111