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10090236CITY OF CUPERTIP40 BUILDING PERMIT BUILDING ADDRESS: 20818 HANFORD DR OWNER'S NAME: RAVICHANDRAN SITARAMAN 1ER'S PHONE: 4089810650 ❑ LICENSED CONTRACTOR'S DECLARATION License Class C– 3 (O Lic. # 7.3 2 (, 1 i Contractor A( (S7'/4 Z P 1 v wl b, -t� Date -'l 17 k i 0 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. 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. APPLICANT CERTIFICATION I certify that I have read this application and state that the above infonnation 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 pennit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date t -J OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 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 Califomia. 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 lemnify and keep harmless the City of Cupertino against liabilities, judgments, sts, 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. CONTRACTOR: ALLSTAR PLUMBING PERMIT NO: 10090236 326 PHELAN AVE DATE ISSUED: 09/24/2010 SAN JOSE, CA 95122 PHONE NO: (408) 230-5569 BUILDING PERMIT INFO: BLDG r— ELECT [— PLUMB MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: GAS LEAK REPAIR GOING UNDER HOME TO REPAIR A 21 FT SECTION Sq. Ft Floor Area: Valuation: $1100 APN Number: 32630063.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: ;7 Z -LI, & v s 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 compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Ow or authorized HDater r 'l l 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date I Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION DATE: REVIEWED BY: wl ADDRESS: APN: BP#: *VALUATION: $1,100 PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition /Repair PENTAMATION PRIMARY PERMIT TYPE: USE: SFD or Duplex 1100 .�rrt;:,�. WORK SCOPE APPLIANCE / EQUIP TYPE FEE ID Piping, Gas <=4 Outlets 1PGASRES TOTALS: 1RPGAS a.t rt, Iii +, t `t,��. Plumb. Plan Che 0.0 hrs ,a i'rr:ck Plumb. Permit Fee: IPPERMIT fy r Other Plumb Insl�. 0.0 hrs $42.00 NOTE: These fees are based on the preliminary infor FEE ITEMS (Fee Resolution 09-051 Eff. 'iU70j />/tltl C�llt't'k I`C't' ulop1. PC' Fee PME Plan Check: Pcnnii St�1pi" Iris/) l=ee PME Unit Fee: PME Permit Fee: C'c�rastl trcuan Tax "Icou,stical l c:it't1% Work Without Permit? 0 Yes 0 No Travel Documentation Fee: I TRAVDOC Strong, Motion 1� ee: Bldg Stds Commission Fee: IBCBSC SUBTOTALS: tion available and are o. FE E QTY/FEE ;;0.00 $63.00 $42.00 an estimate Contact the Dept for addn'l MISC ITEMS 942.00 $0.50 Select an Administrative Item $1.00 $'48.50 $0.00 TOTAL FEE: $148.50 Revised: 9/22/2010 CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 5 ITEMS OF 5 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32630063.00 DATE ISSUED ....... : 0900001010 RECEIPT #......... 1556 REFERENCE ID # 10090236 SITE ADDRESS .....: 20E18 HANFORD DR SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER RAITICHANDRAN SITARAMAN ADDRESS . 20318 HANFORD DR CITY/STATE/ZIP ...: CU:?ERTINO, CA 95014 RECEIVED FROM JO3E ALVAREZ CONTRACTOR .......: DU.!�RTE TADEV LIC # 22189 COMPANY ALLSTAR PLUMBING ADDRESS ..........: 326 PHELAN AVE CITY/STATE/ZIP SAN JOSE, CA 230-556995122 TELEPHONE ....... METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 148.50 148.50 VOICE ID DESCRIPTION 202 UNDERFLOOR PLUMBING 506 GAS TEST REFERENCE NUMBER --- ---------------- VISA VOICE ID DESCRIPTION 301 ROUGH PLUMBING 507 FINAL PLUMBING QUANTITY AMOUNT PD -TO -DT THIS REC FEE ID UNIT --- ------ ---------- -------- - ---------- 1BCBSC ---------- VALUATION 1,100.00 1.00 0.00 0.00 1.00 0.50 0.0 0.00 1BSEISMICR VALUATION 1,100.00 0.50 63.00 0.00 63.00 0.00 1PGASRES OUTLETS 1.00 1.00 42.00 0.00 42.00 0.00 1PPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 p.00 1TRAVDOC FLAT RATE ---------- --------- ---------- 148.50 0.00 148.50 0.00 TOTAL PERMIT METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 148.50 148.50 VOICE ID DESCRIPTION 202 UNDERFLOOR PLUMBING 506 GAS TEST REFERENCE NUMBER --- ---------------- VISA VOICE ID DESCRIPTION 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPEkTiNO CITY OF CUPERTINO REPIPE/SEWS R/MAIN SERVICE PERMIT APPLICATION FORM APN # Fee ID Date: Building Address: Permit Type 0'10$18 Na��r �R 1PCSEWER Owner's Name: P Phone #: 40f R8� o�so ry ,fay. Contractor: 1BPREPIPE Phone #: ` OV 251-6040 4Z( -ST -AR adv 'bin 1CPRP Fax#: Contact: Commercial Cas Piping System 1-4 Outlets Phone #: &14-,7- yZ_J.S. J...a l Ilii igeZ Fax #: Contractor License* 7LZ 6 i B Cupertino Business License Job Description: G 5 (� u (� e pa , Q go h �; c Q • X10 -t R P PC; iz << P Residential Commercial ❑ Valuation: [ t CSO 00 Project Size: Express Standard Large Major Green Building: Please complete relevant portio :i 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 Group Permit Type 1PCSEWER Commercial building sewer/sanitary sewer P 1CPSS 1BPREPIPE Commercial rc pipe per fixture P 1CPRP 1PGASCOM Commercial Cas Piping System 1-4 Outlets P 1BCBSC Cal Bldg Standards Commission-. Fee B ALL PERNUT TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09