The URL can be used to link to this page

09010007 CITY OF CUPERTINO L�n,�T BUILDING DIVISION Plri'1�1v11T VI , BUILDING ADDRESS: PERMIT NO. 1130 S STELLING ED SPEEDY OWNER'S NAME: PERMIT ISSUE DATE 3eNKATESH B141-PIAGHAR 701 A1=199 AVE SIPE 43 A CONTROL NO. 408) 234-8134 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 O p LICENSED CONTRACTOR'S DECLARATION m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is =y in full force and effect. INSTL CITY CLEAN OUT . t2Z License Class �`3 Lic.g —a Dale % Contractor gg ARCHr1ECPS DECLARATION fir 1 understand my plans shall be used as public records :),u O y Licensed Professional a y 3 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the %p O following reason.(Section 7031.5,Business and Professions Code:Any city or county K$ which requires a permit to construct.alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement _C that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation yt- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or tu that he is exempt therefrom and the basis for the alleged exemption.Any violation of $2600 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than ere hundred dollars(35M). 36226006 . 00 ❑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 forsale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P 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- i builder will have the burden of proving that he did not build or improve for purpose of sale.). f IJ❑I,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. " 'j �: '44 cense Law does not apply to an owner of property who builds or improves thereon,and. = a who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's oy`„P� \a. 1°� to License Law. ❑I am exempt under Sec B&P C for this reason Owner Date WORKER'S COMPENSATION 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 Worker's Compen- .,ation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's 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 am: Cartier. G7/Z/4�j 0 �� Policy No.: 3 'r 9 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(S 100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workeri Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must 0 forthwith comply with such provisions or this permit shall be deemed revoked. Z m CONSTRUCTION LENDING AGENCY (.~-m rA I hereby affirm that there is a construction lending agency for the performance of fx> the work for which this permit is issued(Sec.3097,Civ.C.) ALender's Name a z Lender's Address U C) I certify that I have read this application and state that the above information is correct I agree to comply with all city and county ordinances and state laws relating to Vbuilding constmction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. CL (We)agree to save,indemnify and keep harmless the City of Cupertino against omm rA liabilities,judgments,toss and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. �+ APPLICANT UND STAMDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SREGILL. R . ONS US "�` Re-roofs -Signature of Applicant/Contractor 0 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. C3 Yes ❑No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Jistrict? ❑Yes ❑No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Code,Sections 25505.25533 and 25534,l understand that if the building docs not currently have a ten that it is my responsibility to notify the occupant of the re r mens which t be or conte of a Cc ate of Occu an rW' �' P `' Signature of Applicant ate All roof coverings to be Class';."or better Owner or authorized agent Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 36226006 . 00 DATE ISSUED. . . . . . . : 01/05/2009 RECEIPT #. . . . . . . . . . BS000006899 REFERENCE ID # . . . : 09010007 SITE ADDRESS . . . . . : 1130 S STELLING RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER VENKATESH BHIMACHAR ADDRESS 1130 S STELLING RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SPEEDY ROOTER & PLM CONTRACTOR . . . . . . . : SPEEDY ROOTER PLUMBING LIC # 23086 COMPANY SPEEDY ROOTER PLUMBING ADDRESS . . . . . . . . . . : 701 ALDO AVE STE 43 CITY/STATE/ZIP . . . : SANTA CLARA, CA 95054 TELEPHONE (408) 234-8134 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 2, 600 . 00 0 . 50 0 . 00 0 . 50 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 102 .48 0 . 00 102 .48 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 102 .48 #1636 --------------- TOTAL RECEIPT 102 .48 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING � oIQoc-1 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPER`TINO PERMIT APPLICATION FORM APN# Date: Building Address: Owner's Name: Phone#: Contractor: Phone#: Fax #: �'P Contact: Phone#: 114?4�L 2 1,e Ca�� f— Fax #: Contractor License#: � / Cupertino Business License#: Job Description: Residential ( Commercial ❑ Valuation: Project Size: Express ❑ Standard p 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 ` 1PRSEWER Residential building P 1RPSS / sewer/sanitary sewer CITY OF. CUPERTINO 0 REPIPE/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 1CPWS or 1PPRSEWG Private Sewage Disposal System P 1RPWS 1PCESS Cesspool p 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P 1PPERMTTFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1 TRAVDOC Travel &Documentation Fee B 1BUSLIC Business License B Revised 6-16-08 M.Indoor Air Quality and Finishes 1.Use iowWVOC Palet 1 IAQ/Health pts y--yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes. 0 3.Use Loaft VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood'for Interior Uses 1 IAQ/Health pts y=yes 0 7,5ea!4 PaftlaboaidorMDF 4IAQ/Health pts y=yes 0 6.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 i 1 Total Points Available: 1 1401 130 57 Total Points Project Received: 1 01 01 01 G:data/progs/greenbuildingguidelineslremodel9rs/greenpoints5na12.12.04protected.xls Community Development 10300 Torre Avenue st'll Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ''UPEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: //V•i PHONE # 3- 8 GENERAL CONTRACTOR:� e:tWy o�JZF& # 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 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