11080208 ' CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10934 NORTHVIEW SQ CONTRACTOR:ALERT PLUMBING PERMIT NO: 11080208
OWNER'S NAME: SRIHARI SRIDHARAN&NIVETHITHA KUMAR 2530 BERRYESSA RD DATE ISSUED:08/29/2011
1. 'NER'S PHONE: 4084259257 SAN JOSE,CA 95132 PHONE NO:(408)272-1423
Ld LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class - Lic.# O(0`}1
Air-
RESIDENTIAL COMMERCIAL
Contractor °`Dl f.r1 A Date Pt "k
I hereby affirm that I am license under the provisions of Chapter 9 JOB DESCRIPTION: SFD ADD NEW GASLINE TO NEW KITCHEN GAS STOVE
(commencing with Section 7000)of Division 3 of the Business&Professions TOP
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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$1000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:31636061.00 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
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued by: Date:
Signature 5
�' k, I--- Date �
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
I,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 and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
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
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I Owner ox authorized agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must _Date: 2
forthwith comply with such provisions or this permit shall be deemed revoked. L'
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
;,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
,ting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
Lo (408)777-3228• FAX (408)777-3333• building0guoertino.org MISC
CUPERTINO
LUMBING MECHANICAL ❑ELECTRICAL [-]MISCELLANEOUS j
PROTECT ADDRESS k o q A,``2TA V(C Vj C. U 1►.a i✓= #i2 1
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OWNER NAME S T?(f I�lv� �� PAN
PHONE4�01'4 19-C � E-MAm ��I�Po�t�•� ��M FIIL6
1jjS ET ADDRESS C7 ` I v�/ 1F� n � E CITY, STATE,ZIP ^ ,..�I �Q FAX
CONTACT NAME `t K1 J PHONE �/ (� E-MAM
STREET ADDRESS CITY,STATE, ZEP FAX
0,10'WNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE ER LICENSE TYPE BUS.LIC#
A� E2T �v��t 530 6 �- e . Ca
COMPANY NAME l V�� I N E-MAIL FAX
STREET ADDRESS (� !� CITY,STATE,ZIP PHONE 4-0 14 L>
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
SE OF SFD or DUPLEX 1:1MII-
MULTI-FAY PROJECT IN WILDLAND 1-1YESPROJECT IN ❑YES IS THE BLDG AN El YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
A&&
TOTAL VALUATION: RECEIVED 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 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 buildi g construc' n."I authorize representatives of Cupertino to enter the above-identified property for inspection pudposes.
Signature of Applicant/Agent: Date:
S PLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
OVER-THE-COUNTER
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❑ EXPRESS
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❑ STANDARD
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❑ LARGE
❑ MAJOR
MEPMiscApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
MDDRESS: 10934 north view square. DATE: 08/29/2011 REVIEWED BY:
PN: I BP#: "VALUATION: $1,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPGAS
USE: p PERMIT TYPE:
wORK sfd add new gas line to new kitchen gas stove top.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Piping, Gas <=4 Outlets 1 PGASRES 1 # $65
TOTALS: $65.00
Plumb.Plan Check 0.0 hrs $0.00
Plumb.Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 hrs 1 $44.00Li
NOTE. Thesefees are based on the preliminairTy in ormation available and are only an estimate. Contact the Dept-for addn7 info.
FEE ITEMS (P'ee Resolution 11-0531:,f 1.-'11J FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $65.00
PME Permit Fee: $44.00
Work Without Permit? Yes G No $0.00
Travel Documentation Fee: ITRA VDOC $44.00
Strom Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee
Bldg Stds Commission Fee: IBCBSC $1.00 $41.00 1ADMIN
SUBTOTALS: $154.50 $41.00 TOTAL FEE: $195.50
Revised: 07/04/2011
Gmail - GAS LINE https://mail.google.com/mail/?ui=2&ih6fc057f4bl&view=pt&search...
srihari sridharan <hari.potter.7@gmail.com>
kaC�cic {(
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GAS LINE
Linda Starnes <lindastarne@hotmail.com> Mon, Aug 29, 2011 at 11:27 AM
To: hari.potter.7@gmail.com
There is no approval needed to change your appliances from electric to gas.
The gas line added must have a permit from the City and must be done by a licensed
contractor who is experienced with gas.
Thank you,
Linda Starnes
On Site Manager
1 of 1 8/29/2011 11:32 AM