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11080227CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10348 S TANTAU AVE I CONTREACTOR: PENNINGTON PLUMBING I PERMIT NO: 11080227 I SERVIC ( 8R'S PHONE: 4087450345 LJ LICENSED CONTRACTOR'S DECLARATION n License Class �'� Lic. # G Contractor` Date I hereby affirm that m licensed under th provisions of Chapter 9 (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: 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. 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. APPLICANT CERTIFICATION I certify that 1 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 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. Additi nally, the applicant understands and will comply with all non -points ce regions per the Cupertino Municipal Code, Section 9.18. �\ Signature Date V� �� L OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 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 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 Compensation laws of California. 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 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 upon the above mentioned property for inspection purposes. (We) agree to save it nify and keep harmless the City of Cupertino against liabilities, judgments, 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 9.18. Signature Date SUNNYVALE, CA 94087 1 PHONE NO: (408) 738-8115 BUILDING PERMIT INFO: BLDG r ELECT I— PLUMB f— MECH 1— RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: INSTALL NEW GAS SHUT OFF VALVE AT METER LOCATION Sq. Ft Floor Area: I Valuation: $400 APN Number: 37508034.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued Date: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I 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 I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain comceplianith the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety C90c, Sections 25505, 25533, and 25534. Owner utho a a (� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit 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 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37508034.00 DATE ISSUED.......: 08/31/2011 RECEIPT #......... BS000014631 REFERENCE ID # ...: 11080227 SITE ADDRESS .....: 10348 S TANTAU AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER PAI RAGHUNANDAN K AND SAHANA ADDRESS 10348 S TANTAU AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: RONALD M PENNINGTON CONTRACTOR RON PENNINGTON LIC # 31352 COMPANY PENNINGTON PLUMBING SERVICE ADDRESS 118 E FREMONT AVE CITY/STATE/ZIP ...: SUNNYVALE, CA 94087 TELEPHONE (408) 738-8115 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 400.00 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 400.00 0.50 0.00 0.50 0.00 1PGASRES OUTLETS 1.00 65.00 0.00 65.00 0.00 1PPERMITFE FLAT RATE 1.00 44.00 0.00 44.00 0.00 1TRAVDOC FLAT RATE 1.00 44.00 0.00 44.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 195.50 ---------- 0.00 195.50 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 195.50 --------------- 195.50 VOICE ID DESCRIPTION -------- ---------------------------- 202 UNDERFLOOR PLUMBING REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING 506 GAS TEST 507 FINAL PLUMBING OE U --2- -Z--7 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 MISC CUPERTINO 4 I �f PLUMBING I 1 N>EC�MCAL ❑ELECTRICAL ❑MISCELLANEOUS (408) 777-3228 •FAX (408) 777-3333 • buildincl(c cu�ertino.or PROJECT ADDRESS 1 t , 1 OWNER NAME [7 _ � ' APN # .� 7/^ f PHONE "'-) � � s E-MAIL STREET ADDRESS 1 f t V 1 CITY, STATE, ZIP 2� n C C I FAX -, CONTACT NAME `• � V PHONE /`_ E-MAIL j� � (eo eQ' r S EI' ADD SS / i /1 1Le CITY, STATE, ZIP i I , A� � ` C, �t FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO CTOR NA14E , er C -a LICENSE N� 2 �� L LICENSE TZ ' n BUS. LIC # COMPANY N VO C�Vkn E-MAIL � FAX STREET ADDRESS (d 2 e�C CITI ,STATE, ZIP f ��C,z 1 PHO - c (-, Z I� ^ / zC G TJ l9 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAII. FAX STREET ADDRESS CITY, TATE, ZIP P NE ;SE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK 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.,,11 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 buildin struction- I au ze representatives of Cupertino to enter the above -identified property for inspection pu{poses. Signature of Applicant/Agent: Date: SUPPLE NTAL INFO TION REQUIRED OFFI E USE ONLY OVER-THE-COUNTER U U ❑ EXPRESS ❑ STANDARD r ❑ LARGE ❑ MAJOR AEPMiscApp_2011.doc revised 06121111 CITY OF CUPERTINO ffift7 FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10348 s. tantau DATE: 08/31/2011 REVIEWED BY: bobs. UNITS APN: BP#: 'VALUATION: $400 "PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition./ Repair PRIMARY SFD or Duplex USE: # PENTAMATION 1 RPGAS PERMIT TYPE: WORK install new gas shut off valve at meter location. SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Piping, Gas <=4 Outlets 1PGASRES 1 # $65 PME Unit Fee: $65.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes No $0.00 TOTALS: A Travel Documentation Fee: 1TRA VDOC $65.00 Strong Motion Fee: IBSEISMICR NOTF. - These fees are hated an the nreliminary inlarmatinn availahle and are nnly an e.ctimata Cnntart the Dent far addn'l info_ FEE ITEMS (fee Resolution 1.1-053 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $65.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes No $0.00 A Travel Documentation Fee: 1TRA VDOC $44.00 Strong Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee $41.00 1ADMIN Bldg St s Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $154.50 $41.00 TOTAL FEE.T $195.50 Revised: 07/04/2011 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS:V&Sq _ PERMIT # ' Z �— OWNER'S NAME: rG PHONE # -2kci— 20 GENERAL CONTRACTOR: (;60(m BUSINESS LICENSE # ADDRESS: 2U2 Ga CITY/ZIPCODE: ,N16 *Our municipal code requires all businesses working in the city to have a City of Uupertmo business ncense. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAV OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. / i^ I am not using any subcontractors: Signat a Date Please check applicable subcontractors and complete the following information: Iq b8 -3/,I( Date 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile b8 -3/,I( Date