11060052CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10771 S BLANEY AVE
CONTRACTOR: WATER QUALITY
PERMIT NO: 11060052
PLUMBING
OWNER'S NAME: PAVIT BRAR
1860 ALMADEN RD
DATE ISSUED: 06/06/2011
ER'S PHONE: 4154252835
SAN JOSE, CA 95123
PHONE NO: (408)267-9330
❑ LICE N ED CONTRACTOR'S DECLARATION
'
n
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# C51 Q
MECH F RESIDENTIAL r
I
COMMERCIAL
Contractor I Date
T
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: COPPER RE -PIPE
(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 declar'o
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.
f have and will maintain Worker's Compensation Insurance, as provided for by.
Sq. Ft Floor Area:
Valuation: $7000
lection 3700 of the Labor Code, for the performance of the work for which this
APN Number: 36934049.00
Occupancy Type:
)ermit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information is
oo built. 1 agree comply with all city and county ordinances and state laws relating
building construction,
uction, and hereby authorize representatives of this city to enter
PERMIT EXPIRES IF WORK IS NOT STARTED
ipon the above mentioned property for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
ndemnify and keep harmless the City of Cupertino against liabilities, judgments,
:osts, and expenses which may accrue against said City in consequence of the
180 DAYS FROM LAST CALLED INSPECTION.
;ranting of this permit. Additionally, thelwplicant understands and will comply
vi[h all no oint source regu ti r the Cupertino Municipal Code, Se tion
S
// j
Issued by Date (I'--
x.18.
�\ c
>ignature -Date—
RE-ROOFS:
OWNER -BUILDER DECLARATION
All roofs shall be inspected prior to any roofing material being installed. If a roof is
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
he following two reasons:
inspection.
, as owner of the property, or my employees with wages as their sole compensation,
Signature of Applicant: Date:
vill do the work, and the structure is not intended or offered for sale (Sec.7044,
lusiness & Professions Code)
, as owner of the property, am exclusively contracting with licensed contractors to
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
onstruct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
leclarations:
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
'ompensation, as provided for by Section 3700 of the Labor Code, for 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 &
erformance of the work for which this permit is issued.
Safety Code, Section 25532(a) should I store or handle hazardous material.
have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should I use equipment or devices which emit hazardous air
ection 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
ermit is issued.
mai aim compliance with the ertino Municipal Code, Chapter 9.12 and the
certify that in the performance of the work for which this permit is issued, I shall
He t &Safety de ions 25505, 25533, and 25534.
of employ any person in any manner so as to become subject to the Worker's
'ompensation laws of California. If,
Ow a ori nt•
after making this certificate of exemption, I
Date•
ecome subject to the Worker's Compensation provisions of the Labor Code, I must
xthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I h eby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION
for hich this permit is issued (Sec. 3097, Civ C.)
certify that I have read this application and state that the above information is
Lender's Name
)rrect. I agree to comply with all city and county ordinances and state laws relating
building construction, and hereby authorize representatives of this city to enter
Lender's Address
pon the above mentioned property for inspection purposes. (We) agree to save
idemnify 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
..mg of this permit. Additionally, the applicant understands and will comply
I understand my plans shall be used as public records.
itn all non -point source regulations per the Cupertino Municipal Code, Section
18.
Licensed Professional
ignature Date
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36934049.00
DATE ISSUED.......: 06/06/2011
RECEIPT #.........: BS000013679
REFERENCE ID # ...: 11060052
SITE ADDRESS .....: 10771 S BLANEY AVE
SUBDIVISION ......:
CITY .............. CUPERTINO
IMPACT AREA ......
OWNER PAVIT BRAR
ADDRESS 10771 S BLANEY AVE
CITY/STATE/ZIP ...: CUEPRTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: JASON SATALINO
CONTRACTOR SATALINO, MARTY LIC # 21526
COMPANY WATER QUALITY PLUMBING
ADDRESS 1860 ALMADEN RD
CITY/STATE/ZIP SAN JOSE, CA 95123
TELEPHONE (408)267-9330
FEE ID
----------
UNIT
-------------
QUANTITY
----------
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
-ADMIN
HOURS
0.50
----------
39.00
---------------------
0.00
39.00
----------
0.00
1BCBSC
VALUATION
7,000.00
1.00
0.00
1.00
0.00
1BSEISMICR
VALUATION
7,000.00
0.70
0.00
0.70
0.00
1PPERMITFE
FLAT RATE
1.00
42.00
0.00
42.00
0.00
1PREPPIPE
FLAT RATE
1.00
42.00
0.00
42.00
0.00
1TRAVDOC
FLAT RATE
1.00
42.00
0.00
42.00
0.00
TOTAL PERMIT
----------
166.70
----------
0.00
----------
166.70
----------
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
166.70
---------------
166.70
VOICE ID DESCRIPTION
-------- ----------------------------
106 SEWER & WATER
REFERENCE NUMBER
--------------------
AMEX
VOICE ID DESCRIPTION
-------- ----------------------------
202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302
506 GAS TEST 507
TUB & OR SHOWER
FINAL PLUMBING
=UPERTINO
CONTRACTOR / SUBCONTRACTOR LIT
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:, , ' " }= , I PERMIT # I ` v U U '4
OWNER'S NAME: PHONE # (, -
GENERAL CONTRACTOR: BUSINESS LIC SE #
ADDRESS: CITY/ZIPCODE:
*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 ALLBCONT jTPIIS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: 4
Signature Date
Please check applicable subcontractor and complete the following information:
Owner / Contractor Signature
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
71
Tile
Owner / Contractor Signature
Date
CITY OF CUPERTINO
W -w FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE
DRESS: 10771 blaney ave.
F
DATE: 06/06/2011
REVIEWED BY: bobs.
UNITS
N:
BP#:
"VALUATION: $7,000
°PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION 1 RPDP
PERMIT TYPE: 19
WORK
sfd copper re -pipe
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Piping, Area
1PREPPIPE
1
#
$42
PME Unit Fee:
$42.00
PME Permit Fee:
$42.00
Work Without Permit? C Yes 0 No
$0.00
TOTALS:
i
Travel Documentation Fee: ITRA VDOC
$42.00
Strom Motion Fee: IBSEISMICR
NOTF. These fees are hnced an thv nrolirninnry infinrm"Aa" avnilnhlo and oro - t — �N,, " !',..,r . Oti„ nes r .
FEE ITEMS (Fee Resolution 09-05I 1_ ff' ?%1; "IOC
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
PME Unit Fee:
$42.00
PME Permit Fee:
$42.00
Work Without Permit? C Yes 0 No
$0.00
i
Travel Documentation Fee: ITRA VDOC
$42.00
Strom Motion Fee: IBSEISMICR
$0.70
0.5 hrs Admin./Clerical Fee
$39.00 1ADMIN
Bldg) Stds Commission Fee: IBCBSC
$1.00
F- SUBTOTALS:
$127.70
$39.00 TOTAL FEE:
$166.70
Revised: 04/29/2011
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
,CUPERTINO ( q
M I _q r_
�LUMBIN ❑ NIECHANIC ❑ELECTRICAL ❑ MISCELLANEOUS
J
PROJECT ADDRESS
408) 777-3228 •FAX (408) 777-3333 • building(a.cupertino.Or
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{ �'' *-~ a
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APN li }n' lJ
OWNERNAME /(I, n / �; n
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PHONE { ��
STREET ADDRESS I t I
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�S
!
FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
�WNER ❑ OWNER -BUILDER
❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �j _ y
' �, 1
LICENSE NUMEER (
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LI 1 BUS. LIC N
COMPANY NAME'
)
STREET ADDRESS 1 �'
V� �j
s
CITY. ATE ZIP .� t -t �� PHONE
ARC=CVENGINIM NAME
LICENSE NUMBER BUS. LIC !!
COMPANY NAME
E-MAIL FAX
STREET' ADDRESS
CTIY, STATE, ZIP PHONE
-'SE OF Or Duplex
MUCTURE; ❑ Commercial
❑ Multi -Family
PROJECT IN WM DLAND
URBAN INTERFACE AREA ❑ Yes ❑ No
PROJECT IN
FLOOD ZONE ❑ Yes ❑ NO
DESCRIFTION OF WORK
1
TOTAL VALUATION: :71ii.
ave-.�"1 -
a CELB"'�`�
By my signature below, I certify to eac f the following: I the prop wner or authorized agent to act on die property owner's behalf. I have read this
application and the inform ation I have r vided is correct I ha r e Description of Work and verify it is accurate. I agree to c mply with all applicable local
ordinances and state laws relating to b '1 Ing cons ction. I a representatives of Cupertino to enter the oho-ideLKpfied ro arty for inspection purposes.
Signature of ApplicanUAgent: Date:
SUPT MENTAL INFORMATION REQUIRED
MEPMucApp_1011.doc revised 03116111