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10070146 ' CITY OF CUPERTI NO BUILDING PERMIT BUILDING ADDRESS: 21702 LINDY LN CONTRACTOR:NATIONAL ROOTER PERMIT NO: 10070146 OWNER'S NAME: PADMAJA GOGMENI 2911 MONROE ST DATE ISSUED:07/21/2010 VNER'S PHONE: 4082037093 SANTA CALARA,CA 95051 PHONE NO:(408)241-0887 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL 6, License �= w REPIPE HOUSE INCLUDE(6)FIXTURES License Class Lic.# ?C-� Contractor tea,fy,),,key 1AV 2!�c-,<_-Date 7'-2 / —/J 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:$6400 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:35624035.00 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 DA S FRO 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 theZ granting of this permit. Additionally,the applicant understands and will comply Issued by: �� Date: 7- 1 ,/ with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 01 RE-ROOFS: Signature / -c..� c� Date?2(�� 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 I,as owner of the property,or my employees with wages as their sole compensatio i, 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(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 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 mu:t 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 relatin; to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save '-demnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION sts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. ,,ranting 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 O Date n:_w, CITY OF CUPERTINO *` REPIPE/SEWS R/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # C6(-Y n O ` CO1 Date: Building Address: Owner's Name: Phone#: Contractor: .� Phone#: Fax#: Contact: Phone#: Fax#: Contractor License#: 76�-?U 0 Cupertino Business License#: �� Job Description: reprpm A-t- �er Residential Commercial ❑ r Valuation: f , 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: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial bi.ilding P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gis Piping System P 1-4 Outlets 1BCBSC Cal Bldg Stanc.ards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 M.Indoor Air Quality and Finishes 1•Use LovNb-VOC Paad 1 IAO/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes. 0 3.Use Low&VOC Adhesives 3 IAO/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7•Sea!all 5prsed P ebmlorMDF 4IAQ/Health. pts y=yes 0 S.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y-=-yes p 1 1 1 N.Flooring . 1.Select FSC Certified Wood Flooring i Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials i Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs Resource pts y=yes Total Points Available: 1401 1301 57 Total Points Pro'ect Received: 0 0 0 ;7 G:daW gs/gree buildingguidelines/remodelers/greenpointsfinal2.12.D4protected.xls CITY OF CUPERTINO FEE ESTIMATOR-- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: RAPN: BP#: *VALUATION: 1$6,400 rPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY . APPLICATION USE: SFD or Duplex �� ,, TYPE: � W as 00 3 � APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES Re-Pipe Interior 1PRF EPIPE 6 $66 TOTALS: $66.00 Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT Other Plumb Insp 0.0 1 hrs 1 $42.00 NOTE: Thesefees are based on the preliminary information twilable and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 09-051 Ffj' 7/1%29) FEE QTY/FEE MISC ITEMS J , F-71 PME Plan Check: $(1.00 ;F s PME Unit Fee: $66.00 PME Permit Fee: $42.00 Travel Documentation Fee: ITRA VDOC $4':.00 Select an Administrative Item Bldg= Stds Commission Fee: IBCBSC SUBTOTALS: $15' .00 $0.00 TOTAL FEE: $151.00 Revised: 6/30/2( INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: SylviaM Sec: Twp: Rng: Sub: Blk: Lot : APN 35624035 . 00 INVOICE DATE. . . . . . : 07/21/2010 REFERENCE ID # 10070146 SITE ADDRESS 21702 LINDY LN SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PADMAJA GOGINENI ADDRESS 21702 LINDY LN CITY/STATE/ZIP . . . : CU?ERTINO, CA 95014 CONTRACTOR RO:JALD J. PEREIRA LIC # 25124 COMPANY . . . . . . . . . . : NATIONAL ROOTER ADDRESS 2911 MONROE ST CITY/STATE/ZIP . . . : SA14TA CALARA, CA 95051 TELEPHONE (4 )8) 241-0887 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE ------------------ --------- ------- ---------- ---------- ---------- CAL BLDG STAND COMMISSION F PRINTING PERMIT 1 . 00 1. 00 0 . 00 PLUMBNG PERMIT ISSUE PRINTING ]HERMIT 42 . 00 42 . 00 0 .00 RES REPIPE OF FIXTURES PRINTING ]HERMIT 66 . 00 66 . 00 0 . 00 TRAVEL & DOCUMENTATION FEE PRINTING PERMIT 42 . 00 42 . 00 0 . 00 ---------- ---------- ---------- 151 . 00 151. 00 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION --------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING 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/ SL BCONTRACTOR LIST JOB ADDRESS: PERMIT# l 6)0-7 0 `4 OWNER'S NAME: t 2 PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE # %Z ADDRESS: lI Q9057 CITY/ZIPCODE: SU, *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: SUBCONTRACTOR BUSINE iS 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 Owner/Contractor Signature Date