13030119 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6397 MYRTLEWOOD DR CONTRACTOR:GENMOR PLUMBING PERMIT NO:13030119
OWNER'S NAME: SUDHEER GUNDANN.A 2552 SEABOARD AVE DATE ISSUED:03/22/2013
OWNER'S PHONE: 4084191175 SAN JOSE,CA 95131 PHONE NO:(408)855-8348
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL
/a Q COPPER RE—PIPE THROUGHOUT HOUSE
License Class C 3� Lic.#
Contractor S
I hereby affirm that I am licensed under-the provisions of Chapter 9 r
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
AN !
I hereby affirm under penalty of perjury one of the following two declarations:
I 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 for which this permit is issued. Sq.Ft Floor Area: Valuation:$4000
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 APN Number:36917006.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and;countyordinancesand state laws relating WITHIN 18 F P ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon,the above mentioned propertyfor.inspection purposes. (We)agree to save 180 FROM L CALLED INSPECTION, . .
indemnify,and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses whichmay accrue against said City in consequence of the Issued by: Date 2?'
granting of this. Additionally,the plicant understands and will compl
with all.non- , sur regulations r e Cupe unicipal Code,Sec' n
9 18.
r RE-ROOFS:
Signature Date 5 i All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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)
HAZARDOUS MATERIALS DISCLOSURE
I as ownerof the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations:. Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,'as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
performance of the work for which this permit is issued.
I have and will maintain'Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections O5,25533, 25534. 2r
Section 3700 ofthe Labor Code,for the performance of the work for which this Owner or authorized agent: ate: ✓I Z Z
permit is issued.::
I certify that in the performance of the 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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. It after making this certificate of exemption,I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code,I must work's for which this permit
forthwith comply with such provisions or this permit shall be deemed revoked. t is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify,that I have read this application and state that the above information is
correct.:I agree to comply with oll city an&cour►ty ordinances and state 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 ARCHITECT'S DECLARATION
indemnify and'keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit..Additionally,the applicant understands and will comply
with all non-point source'regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
GENERAL PERMIT APPLICATION o MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION M
.10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228-FAX(408)777-3333• building(d)-cuoer<ino.org \ � MISC
�_L MBING [:]MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRES�7/�q_ \/� 11.L�n �CC& �V- AIN# 1 O !1
OWNER NAME 'V1 r` 6 t` ',G,^ Wu`� PH 1� I 1 y`' !E-MAII
STREET ADDRESS e_ v,�V Y_ , C STATE ZIP - l^ (�^ (,�O ( FAX
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CONTACT NAME w PHONE �Q�V -'E-MAIL
STREET ADDRESS C"Y,STATE,ZIP Q-A
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13 OWNER ❑ O�RdERR--B`UIIDEP ❑.01ANERAGENTf 13TRA
CONCTOR `❑CCONTRACTORAGENT 11ARCHCTTE- 1T ❑ENGINEER ❑ DEVELOPER 11 TENANT
CO CTOR NAME �I �;V, CEVIQ4
LICENSE�1Iy Sq(0) L '3 S BUS.LIC#
COMPANY NAME �1`n ! -„ E``���AVAVV4T /„_TD, y��(070I
STREET N•�` �{/� CTIY IAAL,,ZZI`N, (�1/I/W O ��� Pt S G�3L53
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ARCHTTECT/ENGLNEER NAME V Y, LICENSE NUNMER BUS.LIC q
COMPANNY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF D Dr DUPLEX ❑ MULTI-FAMILY PROJECT IN=LANTD ❑ YES FP�R:0CTIN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO D ZINE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION: �By
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property o1;mer's behalf. I have read this
application and the information I have provided is correct. I have d the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to build' resen struction. I rep 'ves f u ertino to enter the above-id ntified for inspection pu4poses.
Signature of Applicant/Agent: Date:
SUP NTAL INFORMATION REQUIRED OFFICE USE ONLY
OVER-THE-COUNTER
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❑ LARGE
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❑ MAJOR
AffPMisc,4pp 2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 6397 MYRTLEWOOD DR DATE: 03/22/2013 REVIEWED BY: MELISSA
APN: 369 17 006BP#: *VALUATION: $4,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION 1 RPRP
USE:. p PERMIT TYPE:
WORK COPPER RE-PIPE THROUGHOUT HOUSE
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Re-Pipe Interior 1PRREPIPE 1 # $13
TOTALS: $13.00
11ech.Plat Check Plumb.Plan Check 0.0 hrs $0.00 Dec.Plan Check
ilecdt.Pennit Fee: Plumb.Permit Fee: 1PPERAffT Elec,Permit Fee:
Other Alech.Insp.. Other Plumb Insp. 0.0 hrs $45.00 Other Elec.Insp.
Li
Allech.Insp.Fee: Plumb. Insp.Fee, Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District etG). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info,
FEE ITEMS OW Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
sgpp l..PC Fee
PME Plan Check: $0.00
Permit.Fee:
Supp/. Insp Fee
PME Unit Fee: $13.00
PME Permit Fee: $45.00
Cimso"action:Tcax:
'Administrative Fee: IADMIN $42.00
Work Without Permit? 0 Yes (E) No $0.00
Adv,anved Planning Fees:
Travel Documentation,Fee 1TRAVDOC $45.00 i
Strong Motion Fee: 7BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
ffAm $146.501 $0.00 - $146.50
�\ Revised: 01/01/2013