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11100082 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21025 CLASSIC CT CONTRACTOR:ALLSTAR PLUMBING PERMIT NO: 11100082 OWNER'S NAME: SHITOLE SANJAY D AND SUNITA S 326 PHELAN AVE DATE ISSUED: 10/12/2011 01"'NER'S PHONE: 4082251736 SAN JOSE,CA 95122 PHONE NO:(408)230-5569 Jc� nLICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB (License Class ��_ Lic.# ?4 ! / MECH RESIDENTIAL COMMERCIAL Contractor lZTA!L am b5 PI Date ld ' ( 2--I( I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:WATER HEATER REPLACEMENT (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 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 work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1000 1 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. APN Number:36218051.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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-point source regulations per the Cupertino Municipal Code,Section Issued by: Date•/ -�Z — 9.18. Signature Date RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material berg installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the p Health&Safety Code,Sections 25505,25533,and 25534. 1 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 Owner r authorized - Compensation laws of California. If,after making this certificate of exemption,I Date: 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION r 's,and expenses which may accrue against said City in consequence of the ing of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. �.i.n all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36218051. 00 DATE ISSUED. . . . . . . : 10/12/2011 RECEIPT #. . . . . . . . . BS000015018 REFERENCE ID # . . . : 11100082 SITE ADDRESS 21025 CLASSIC CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SHITOLE SANJAY D AND SUNITA S ADDRESS 21025 CLASSIC CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM JAVIER ESTUDILLO CONTRACTOR DUARTE TADEV LIC # 22189 COMPANY ALLSTAR PLUMBING ADDRESS 326 PHELAN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95122 TELEPHONE (408) 230-5569 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- -------- lADMIN HOURS 1.00 41. 00 0 . 00 41.00 0 .00 1BCBSC VALUATION 1, 000 .00 1. 00 0. 00 1.00 0 . 00 1BSEISMICR VALUATION 1, 000 . 00 0.50 0 . 00 0 .50 0. 00 1PPERMITFE FLAT RATE 1. 00 44 . 00 0 .00 44 . 00 0 . 00 1PRWHEATR UNITS 1 .00 26 . 00 0. 00 26 .00 0 . 00 1TRAVDOC FLAT RATE 1 .00 44 . 00 0. 00 -----44_00 ------0_00 ---------- ---------- TOTAL PERMIT 156 .50 0 . 00 156 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ---------- CREDIT CARD 156 . 50 VISA --------------- TOTAL RECEIPT 156 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- 518 WATER HEATER GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTFNO (408)777-3228• FAX(408)777-3333• buildingC@cupertino.org MISC PLUMBING MECHANICAL ❑ELECTRICAL []MISCELLANEOUS PROTECT ADDRESS C AFN OWNER NAMEu ' 1 L�L� t� 6 E-MAIL STREET ADDRESS ® 1 _ CITY, STATE,C U r�! C cjS-1, I q fFAX CONTACT NAME PHONE E-MAIL STREETADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME ; LICENSE NUMBER r/ L(CETj$E TYl BUS.LIC7MV COMPANY NAME E-MAILY (r FAX STREET ADDRESS :3 �I j„/U n CITY,STATF� /T' C S 1!L PH GI - -2 6 0-10 ARCHITECT/ENGINEER NAME` LICENSE NUMBER c BUS.LIC# COMPANY NAME' E-MAIL. FAX STREET ADDRESS CITY,STATE,ZIP PHONE JSE OF CJW6.r DUPLEX ❑ MULTI-FAMILY PROTECT IN WIIALAND ❑ YES PROTECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION F WORK TOTAL VALUATION: RECEIVED BY: By my signature bl w,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct.j have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the/above-identified prop for inspection pu{poses. Signature of App]icant/Agentr Date: `a UPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY OVER-THE-COUNTER ❑ EXPRESS Y U ❑ STANDARD U ❑ LARGE c ❑ MAJOR AEPMrscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21025 classic ct. DATE: 10/12/2011 REVIEWED BY: bobs. APN: I BP#: "VALUATION: $1,000 Y°PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR USE: PERMIT TYPE: WORK water heater replacement SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1 PRWHEATR 1 # $26 TOTALS: $26.00 Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT F-1 I- Other Plumb Insp. 0.0 hrs $44.00 NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the relimna information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Cee Resolution 11-053 E '1.;11) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $26.00 PME Permit Fee: $44.00 Administrative Fee: (ADMIN $41.00 Work Without Permit? Yes 0 No $0.00 Travel Documentation Fee: 1 TRA VDOC $44.00 Strom Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $156.501 $0.00 TOTAL FEE: $156.50 Revised: 10/01/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: DZS' Ci-ffiS i C s PERMIT# OWNER'S NAME: S 4) CI-6 PHONE# 08 7-S-1 (o opt GENERAL CONTRACTOR: 4it377+0- BUSINESS LICENSE# ADDRESS: A'el n ` � CITY/ZIPCODE: SaYDWt *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 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 Painting / Wallpaper Paving Plastering PlumbingZ Z 181 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date