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10070141 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19730 MERRITT DR CONTRACTOR:DRAIN DOCTOR PERMIT NO: 10070141 OWNER'S NAME: RAJ TUPLUR 480 ALDO AVE DATE ISSUED:07/20/2010 NER'S PHONE: 4089738244 SANTA CLARA,CA 95054 PHONE NO:(408)370-3082 LICENSED CONTRACTOR'S?DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT r PLUMB r � r License Class Lie.# Cn d 4S!J MECH RESIDENTIAL COMMERCIAL Contractor J)Y-r., DUC Tri'` Date !-7` 2o 'f U JOB DESCRIPTION:REPLACE KITCHEN LINE,INSTALL BUILDING CLEAN- I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions OUT 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 Sq.Ft Floor Area: Valuation:$2500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:31629045.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point sou ce regulations per the Cupertino Municipal Code,Section 9.18. Issued by - Date: Signatu Date �G j� ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I 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 the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I 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 Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air Section 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 permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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,Iw become subject to the Worker's Compensation provisions of the Labor Code,I must n r"rautharjLDater V forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a constriction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter unon the above mentioned property for inspection purposes.(We)agree to save Lender's Address unify and keep harmless the City of Cupertino against liabilities,judgments, s,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIP RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl{: Lot : APN 31629045 .00 DATE ISSUED. . . . . . . : 07/20/2010 RECEIPT #. . . . . . . . . : BS000010914 REFERENCE ID # . • . : 10070141 SITE ADDRESS . . . . . : 19730 MERRITT DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . RAJ TUPLUR ADDRESS 19730 MERRITT DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2440 RECEIVED FROM . . . . : DRAIN DOCTOR, INC CONTRACTOR . . . . . . . : JCHN H. LIM LIC # 24784 COMPANY DRAIN DOCTOR ADDRESS 480 ALDO AVE CITY/STATE/ZIP . . . : SANTA CLARA, CA 95054 TELEPHONE (408) 370-3082 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 500 . 00 1. 00 0 .00 1. 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 1PRSEWER UNITS 1. 00 21 .00 0 . 00 21 . 00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 148 .00 0 . 00 148 . 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 148 . 00 #2455 --------------- TOTAL RECEIPT 148 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CUPERTINO FEE ESTIMATOR-- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: `VALUATION: $2,500 -1 PERMIT TYPE: Plumbing Permit PLEkN CHECK TYPE: Alteration /Addition / Repair APPLPRIMARY SFD or Duplex � TYPE�CATION USE: ttl t E. r v xw ` as 00 3U APPLIANCE/EQUIP TYPE CAPACITY FE E ID QTY BP FEES Piping, Drainage 1PRI IPE 1 $42 Sewer, Sanitary 1 PR:SEWER 1 $21 TOTALS: $63.00 Plumb.Plan Chel:k 0.0 hrs $0.00 Phunb.Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hr $42.00 -T I NOTE. Theseees are based on the preliminary information available and are only an estimate. Contact the Dept-for addn'l info. FEE ITEMS (Hee Resolution 2I-051 Htf' 09) FEE QTY/FEE MISC ITEMS PME Plan Check: $).00 PME Unit Fee: $63.00 PME Permit Fee: $42.00 Travel Documentation Fee: ITRAVD0C $42.00 ;t ='noo ? Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $148.001 $0.00 TOTAL FEE: $148.00 Revised: 6/30/2010 CITY OF CUPERTINO REPIPE/SEWS R/MAIN SERVICE CUPEI�TINO PERMIT APPLICATION FORM APN # .-� �� L . `..�-- Date:_.._._,___t__ .2 0 . Building Address: L 00 Owner's Name: �' � 2 Pho e V7� , 2 N Contractor: I Phone#:,I'o i �'T d �/� v✓► P(Ot/ S G� Fax#: Contac Phone#: Fax#: Contractor License#: c 34 S Cupertino Business License#: Job Description: Residential Commercial ❑ Valuation: Project Size: Express Standard LJ Large Major Green Building: Please complete relevant portio a 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 b iilding P 11CPSS sewer/sanitary sewer 1BPREPIPE Commercial rc-pipe per fixture P 1CPRP 1PGASCOM Commercial Cras Piping System P 1-4 Outlets 1BCBSC Cal Bldg Stan lards Commission B ALL PERMIT Fee TYPES 1 BSEISMICOM Seismic Commercial P Revised 01/07/09 IADIHeafth M.Indoor Air Quaft and Finishes 1.Use LowlNo-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/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.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0 B.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 D 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 t1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 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 4 Resource pts y=yes 0 1 1 1 Total Points Available: 1 1401 1301 57 Total Points Project Received: - 0 0 0 7 -2o f G:data/progs1g•eenbuildngguidelines/remodelers/greenpointsfinal2.12.D4proiected.xls 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: 7 30 PERMIT# aV 7 OWNER'S NAME: U C 1l M PHONE # 465S 73-*2- 4 4- GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working it 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 CONTVC� TORS 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 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 c., ki Roofing Septic Tank Sheet Metal Sheet Rock T'le 2v . lo Owner/Contractor Signature Date