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10120101 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7625 WEST HILL LN CONTRACTO - PERMIT NO: 10120101 +)ETERMINED OWNER'S NAME: KANAN VAIRAVAN DATE ISSUED: 12/15/2010 'NER'S PHONE: 4082100653 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class C Licr.# �6 7 c1 Z REPLACE WATER MAIN LINE RE-PIPE SHOWER VALVE Contractor L V o w A JPLV"4,y N U t,, Date [ 2 V(// 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:$5200 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:36227027.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION AIC 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 DAYS FROM LAST CALLED INSPECTION. 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. " f — RE-ROOFS: Signature V�v L v v Date b 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) 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. I 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(x)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,Sectio s 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this j permit is issued. Owner or authorized agent: —` Date:/? 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 �lemnify 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. r,fanting 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 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36227027. 00 DATE ISSUED. . . . . . . : 12/15/2010 RECEIPT #. . . . . . . . . : BS000012255 REFERENCE ID # . . . : 10120101 SITE ADDRESS . . . . . : 7625 WEST HILL LN SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER KANAN VAIRAVAN ADDRESS 7625 W HILL LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ABRAN CHANDLER CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 200 . 00 1. 00 0 . 00 1. 00 0. 00 1BPFIXTURE NO OF FIXTURE 1. 00 8 . 00 0 . 00 8 . 00 0 . 00 1BSEISMICR VALUATION 5, 200 . 00 0. 52 0 .00 0 . 52 0. 00 1BUSLIC FLAT RATE 1. 00 115. 00 0 . 00 115. 00 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 250 . 52 0 . 00 250 .52 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 250.52 VISA --------------- TOTAL RECEIPT 250 . 52 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING 512 FINAL HANDI-CAP CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 7625 westhill In. DATE: 12/15/2010 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$5,200 ;PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex lex PENTAMATION 1RPFIX USE: -t-�� -�a``='' t- PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixture or Trap 1 BPFIXTURE 1 # $8 Piping, Area 1 PREPPIPE 1 # $42 TOTALS: $50.00 Plumb.Plan Check 0.0 hrs $0.00 °„ Plumb.Permit Fee: IPPERMIT Irz r'c,�Frx 1: Other Plumb Insp. EEhrs $42.00 F-1 L W"'h jlos), 1"v 111l't, ;" e J,1,", h� p [Iv NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 09-051 Eff '%7:70) FEE QTY/FEE MISC ITEMS Plug Chc4 [PME Plan Check: $0.00 t jt fI YIIc` 1,i:{• PME Unit Fee: $50.00 PME Permit Fee: $42.00 � ;7irt r,t'r�jil7 cla. Work Without Permit? 0 Yes No $0.00 Pt'471:aiiig [cf": Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: 1BSEISA17CR $0.52 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: 1 $135.521 $0.00 TOTAL FEE: $135.52 Revised: 12/07/20 nq CITY OF �Wlz CITY OF CUPERTINO REPIPE/SEWERIMAIN SERVICE C U P E RT I N O PERMIT APPLICATION FORM (D12blUI APN# �� O Date: / Z Building Address: � e Owner's Name: q Act V1 �� ,d, ✓ Phone #: .� r (51 - 0(01�5 Contractor: Phone #: t ld x - 2 10 00 f 6-W U) vtk Z V\- Fax #: Contact: Ly-(---t VVlC rrti 0 r Phone#: C/O cq O� Fax/e-mail: Contractor License #: 5 -7- Cupertino Cu ertino Business License#: Job Description: t&p1G eW�,k4 0 uvG1 v ��, ��✓" e i L1 r, rcv'I wee e V 4 fi Ae' �1-1 pt ioj�rj '44V �r i S r vc Gi�G l Residential [7] Commercial ❑ Valuation: �1J 2 00 Project Size: Counter ❑ 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: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES IBSEISMICOM Seismic Commercial P Revised 12/06/10 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: �-2 UV PERMIT# Z� OWNER'S NAME: ci w PHONE# GENERAL CONTRACTOR: r pt, 1 U i o- 6� BUSINESS LICENSE# ADDRESS: 1 c0*1 VAA � C; 5 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 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 FTTile Owner/Contractor Signature Date