11010045 CITY OF CUPERTINO BUILDING PERMIT
BUILDI[NG ADDRESS: 20220 LYNTON CT CONTRACTOR:ACE PLUMBING PERMIT NO: 11010045
OWNER'S NAME: ANURAG JAIN 565 N CENTRAL AVE DATE ISSUED:01/07/2011
VNER'S PHONE: 4084464214 CAMPBELL,CA 95008 PHONE NO:(408)605-9754
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class C ?Lb Lic.# 5k 6 REPLACE WATER HEATER
Contractor Anc p Im Date
I hereby affirm that I am licensed under the 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:
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:$1100
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:36935019.00 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 county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY +ROM LA T CALLED INSPE TIO
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. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
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. 1 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
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this _�o/S�t D
Owner or authorized agent: r f Date:
permit is issued. �9
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit 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 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 ARCHITECT'S DECLARATION
;ndemnify and keep harmless the City of Cupertino against liabilities,judgments,
ts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
,,,anting 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
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36935019. 00
DATE ISSUED. . . . . . . : 01/07/2011
RECEIPT #. . . . . . . . . : BS000012422
REFERENCE ID # . . . : 11010045
SITE ADDRESS . . . . . : 20220 LYNTON CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . . ANURAG JAIN
ADDRESS . . . . . . . . . . : 20220 LYNTON CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ACE PLUMBING
CONTRACTOR . . . . . . . : TAEK SONG LIC # 24542
COMPANY . . . . . . . . . . : ACE PLUMBING
ADDRESS . . . . . . . . . . : 565 N CENTRAL AVE
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 605-9754
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 1, 100 .00 1. 00 0 .00 1. 00 0 . 00
1BSEISMICR VALUATION 1, 100 . 00 0 .50 0 .00 0. 50 0. 00
1PPERMITFE FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0. 00
1PRWHEATR UNITS 1.00 25. 00 0 . 00 25 . 00 0. 00
1TRAVDOC FLAT RATE 1.00 42 . 00 0 . 00 42 . 00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 110 .50 0 .00 110.50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 110. 50 3207
---------------
TOTAL RECEIPT 110 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: zb�,,Z,() L e PERMIT#
OWNER'S NAME: %jai PHONE# �Lj 44
GENERAL CONTRACTOR: BUSINESS LICENSE# 2
ADDRESS: S&t" , C'ookT /M, CITY/ZIPCODE: f pD
*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.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V 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
Owder/Contractor Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20220 lynton ct. DATE: 01/07/2011 REVIEWED BY: bobs.
APN: BP#: *VALUATION: 1$1,100
PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION PRWHEATR
USE: PERMIT TYPE:
WORK replace water heater
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1 PRWHEATR 1 # $25
TOTALS: $25.00
Medi_ %'lon t'ta��c k Plumb.Plan Check 0.0 hrs $0.00 t r��. i'�tr�(h��eh
Plumb.Permit Fee: IPPERMIT I::'t:c T'axmif bl'c.
Ot/tc�r ,11c-c l�.Irasr>_ Other Plumb Insp. 0.0 hrs $42.00 Ont l'!C( iMPsL1
alcof. ln'Np. FCC lisp. 1"'v'
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info.
FEE ITEMS (Fee Resohition 09-051 Ef. T%
CITY OF CUPERTINO
WATER HEATER
CUPERTINO PERMIT APPLICATION FORM
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APN# Date:
250 35- 61q. W tl 4zlf
Building Address:
z o 2 i 0 1, v1 CIT . C �` �� t� .f'0!
Owner's Name: Phone #:
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Contractor: Phone #: 1109) 6 e-9 7,1*
Fax #: p
Cupertino Business License #: Contractor State License #:
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Contact: Phone #: 448) 6,0t_ 7-&,fq
Ta. eK ste.j Fax #: 4ol3 - 9,818
Building Permit Info-
Bldg �__ Elect Plumb Mech
Residential W Commercial ❑
Job Description:
Re p l ace- W a-e r heaiey-
Strapped
On Platform ❑ Bonded ❑ New Location ❑ Replacement 21
Valuation (cost of project): # I I UD ,
Project Size: Express ❑ Standard [ Large ❑ Major
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to
the application or if applicable, include in plan set & the sheet index.
Green Building Points achieved:
Revised 03/10/10