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10050208 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18660 PRING CT CON"RACTOR:ABLE UNDERGROUND PERMIT NO: 10050208 CONS TR INC WNER'S NAME: FRANCIS SHANKAR PO BOX 24819 DATE ISSUED:05/28/2010 OWNER'S PHONE: 4082571026 SAN.OSE,CA 951544819 PHONE NO:(408)377-9990 JOB I)ESCRIPTION: RESIDENTIAL LJ COMMERCIAL 13 LICENSED CONTRACTOR'S DECLARATION License Class Lic.# REPAIR GAS LEAK OUTSIDE Contractor Date I hereby af'f'irm 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 Valuation:$1300 performance of the work for which this permit is issued. Sq.F t Floor Area: 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:37525040.00 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 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 Issued by: Date: 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. RE-ROOFS: gnature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is insu lied without first obtaining an inspection,I agree to remove all new materials for insp action. 53- OWNER-BUILDER DECLARATION Date: Sigr ature of Applicant: 1 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) HAZARDOUS MATERIALS DISCLOSURE I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). I ha ve read the hazardous materials requirements under Chapter 6.95 of the Cal fornix 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: Hes Ith&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 mal erial. 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 Cuper' o nici al Code,Chapter 9 2 and the Health&Safety Code,Sec 33,a 25534. 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 Date permit OH ner or authorized agent: 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I ht reby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. wo Vs for which this permit is issued(Sec.3097,Civ C.) Le rder's Name APPLICANT CERTIFICATION Le rder'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 �building construction,and hereby authorize representatives of this city to enter _)n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION ,.,demnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I u tderstand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point sourc regulat/ioo per the C ertino Municipal Code,Section Licensed Professional 9.18. 71:� Signatur Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 91 CUPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCC NTRACTOR LIST Id JOB ADDRESS: fJ� PERMIT# 44- OWNER'S NAME: - /f P # � s GENERAL CONTRACTOR: 4,25:—� BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. EULED UNTIL THE NO BUILDING FINAL OR FINAL OCCUPANCYION(S) WILL BE HAVE OBTAINED AHCITY OF CUPERTINO GENERAL CONTRACTOR AND ALL SUBCONTRACTC RS BUSINESS LICENSE. I am not using any subcontractors: Signatur: Date Please check applicable subcontractors and complete thu 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile �A ti d4lle"�7r Owner/Contractor Signature Date CITY OF CUPE:2TINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37525040 . 00 DATE ISSUED. . . . . . . : 05/28/2010 RECEIPT # . . . . . . . . . BS000010507 REFERENCE ID # 10050208 SITE ADDRESS 18660 ERING CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER FRANCIS SHANKAR ADDRESS 18660 PRING CT CITY/STATE/ZIP CUPERT-NO, CA 95014 RECEIVED FROM . . . . : FRANCIS SHANKAR CONTRACTOR MARSHA M. MILLER LIC # 29014 COMPANY ABLE UNDERGROUND CONSTR INC ADDRESS PO BOX 24819 CITY/STATE/ZIP SAN J0,3E, CA 95154-4819 TELEPHONE (408) 377-9990 FEE ID UNIT QUANTITY AMOUVT PD-TO-DT THIS REC - NEW-BAL ---------- ------------- ---------- ---------- ---------- ---- 1BCBSC VALUATION 1, 300 .00 1. 00 0 .00 1 . 00 0 . 0 1BSEISMICR VALUATION 1, 300 . 00 0 . 50 0 .00 0 . 50 0 . 00 1PLMBINSP HOURS 1 . 00 126 . 00 0 .00 126 . 00 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 --- -- - ---------- ---------- ---------- TOTAL PERMIT 211.50 0 . 00 211 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- --------------- CREDIT CARD 211. 50 visa --------------- TOTAL RECEIPT 211 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION _ -------- --------------------------- ------- 106_-- - SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEY TING PERMIT APPLICATION FORM 11�� bG Date: APN # Building Address:�� .�� Phone#: Owner's Name: Phone#: Contractor: f� Fax#: 7 �� 74 L� Phone#: Contact: Fax#: Contractor License#: �4 X5— Cupertino Business License#: Job Description: Residential ( Commercial ❑ ValE �j Proze: xpress Standard Large Major Green Building: Please complete relevant portion of t 1e Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points: Fee Permit Type Fee Description Quantity Fee ID p Grou 1PCSEWER Commercial building P 1CPSS sewer/sanitary seW(T 1BPREPIPE Commercial re-pips per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg StandardE Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPFRTINO +C REPIPE/5EN ER/MAIN SERVICE CITY Of FEE SCHEDULE CUPERTINO Fee Description Fee Permit Type Quantity Fee ID Grou 1BCBSC Cal Bldg Standards Comnission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P P 1RPSS 1 PRSEWER Residential building sewer/sanitary sewer P 1RPRP 1pRREpIpE Residential re-pipe per f.xture Water Service P ICPWS or 1BPWSVCS 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Jutlets P 1 PPERMITFEE Plumbing Permit Fee I;suance P 1 PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel &Documentat�on Fee B 1BUSLIC Business License B