13040129 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6390 MYRTLEWOOI)DR CONTRACTOR:GENMOR PLUMBING PERMIT NO:13040129
OWNER'S NAME' SRIIZAIvI NATARAJAM 2552 SEABOARD AVE DATE ISSUED:04/17/2013
OWNER'S PHONE: 408692.5526. SAN JOSE,CA 95131 PHONE NO:(408)855-8348
17 .
❑ . LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lia D COPPER RE-PIPE FROM FROM MAIN TO HOUSE AND
_1n `` THROUGHOUT HOUSE
Contractor' n 10 M IV to
I hereby affirm that I am licensed and r the provisions of Chapter 9 11A
(commencing with,Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect., RY .
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 $4500
performance of the work for which this permit is issued. Sq.Ft Floor Area:
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 13700 of the Labor Code,for the performance of the work for which this APN Number:36919008.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above in
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 FRO 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 Issu Da e•
granting:of this permit.'Additionally,the applicant understands and will comply
with all non-point rce'regula per the pertino Municipal Code,Section
9.18.
(,� t ` RE-ROOFS:
Signature Date l 1� All roofs shall be inspected prior to any roofing material being installed.If a roof is
t first obtaining an in spection,I agree to remove all new materials,for
installed withou
inspection.
❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date:
I hereby affirm'that'l.am exempt from the Contractor's License Law for one of
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 isnot 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 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 bane 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;v , '!;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 Munic al Code,Chapter 912 and
I have and will maintain Worker Cpupensation Insurance,as provided for by {
the Health&Safety Code,Section 5,25533 n 553
Section 3700 of the�Lapor Code,for the performance of the work for which this Owner or authorized agent: ate: 1
pemvt�s:issued
I certify;thati in the 0e66rniance of the work for which this permit is issued,I shall
not employ any person mi any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY
Compe�►satron!lawsof Califomta If?after making this certificate of exemption,I
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
k.
APPLICANT CERTIFICATION Lender's Address
I certify:that I have read this application and state that the above information is
correct:l agree to comply with all city and county ordinances and state laws relating
to building cons'' tion,'and hereby authorize representatives of this city to enter
upon tl}e above'mentioned property for inspection.purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the,City of Cupertino against liabilities,judgments,
costs,-and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.',Additionally;the applicant understands and will comply
with all;non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
918
Date.
Signature
� I!
GENERAL PERMIT APPLICATION v
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
o MEP
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228.•FAX(408)777-3333•buildinga-cupertino.org
misc
C'UPERTINO
�P'CUMBING EIMECHANICAL ❑ELECTRICAL EIMISCELLANEOUS
PROJECT ADDRESS 'rye ew
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OWNERNAMI - PHONE &qg JEMAIL
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STREET ADDRESS
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CONTACT NAMEPHO E-MAIL
STREET D S wA, Aw CITY,STATE,ZI �J �'FV �-7
❑OWNER ❑ OWNER-BUILDER ❑OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER 11 TENANT
-CO R �4M$_ / �� LICENSE NUMB LIEN2I TYPE BUS.LIC#
COMP ., .NAME, Y. UM k� EM'LICENSE
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ST REE �SLV1 Y/ WI V C STATE, �� PH J
ARCHITECT/ENGINEER NAME LICENSE NUMBER / BUS.LIC#
.COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE-OF ❑SFD or DUPLEX ❑ MULTI-FAME,Y PROJECT IN WBALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
_. BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION: ...By my signature below,I certify to each of the following: I am the property owner or authoriz d a ent to act on the property,owner's behalf I have read this
application and the,information I have provided is correct. I have read th ription of or an verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to build' c tru ti n. I th rize r s taf s to enter the above-identified prope for inspection purposes.
S"Ignature.of.Applicant/Agent: Date:
fill 11 Nk
SUPPL .KENTAL INFORMATION REQUIRED
��y 411 t, kl
MEPMiscApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 6.390 MYRTLEWOOD DR DATE: 04/17/2013 REVIEWED BY: MELISSA
APN:
3691 008 BP#: "VALUATION: $4,500
*PERMIT TYPE: Plunibing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PENTAMATION
PRIMARY SFD or Duplex PERMIT TYPE: 1 RPR
WORK COPPER RE-PIPE FROM MAIN TO HOUSE AND THROUGHOUT HOUSE
SCOPE
APPLIANCE/EQUIP TYPE; FEE ID QTY UNITSBP FEES
Re-Pipe Interior 1PRREPIPE 1 # $13
TOTALS: Gf $13.00
;11tzc%.Plan(:'heck 7OtherP
lan Check 0.0 hrs $0.00 EW.Plan{;heck
7
M11ech.Permit Fc e: Plumb.Permit Fee: IPPER71
MIT L'tec. Permit f at::
Othet ;ttech.In.rp. mb Insp. 0.0 hrs $45.00 Other F,lec.Insp.
Rlech.Insp. Fee., Plumb. Inst.Fee: Elec,Insp.Fee:
NOTE:This estimate does not include fees.due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are.based on the prehiMina information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E . 7�f L12) FEE QTY/FEE MISC ITEMS
Plein Check Fee:
Sitplrl. PC Fee
PME P1an.Cheek: $0.00
Permit.Fee:
SuP�pl.Imp Fee
PME Unit Fee: $13.00
PME Permit Fee: $45.00
Constrztction :Tax: -T-T
Administrative:Fee: IADMIN $42.00
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning fees:
Travel Documentation Fee: ITRAVDOC $45.00
Strome Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Blde Stds'Commission Fee: IBCBSC $1.00
$146.50 $0.00 $146.50
Revised4/01/2013 .