07110018 CITY OF CUPERTINO < '
BU(LL'i;VG DIVf:iION PERMIT ���P.,t��CT�: ��l���I�� ::
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BUILDING ADDRESS: PERMIT NO.
945 COTTONWOOD DR TBD — ��0 BE DETERMINED 07110018 .
JER'S NAME: pERMl ISSUE DA
RAHUL RASTOGI � 11/05/2007
PHONE: SANITARY NO. CON'I'ROL NO.
ARCHITECi/ENGINEER: BUILDING PERMIT INFO
BLDC ELECf' pLUMB MECH
� � � Q
° o O LICENSED CON7RACCOR'S DECLARATION Job Descri t10I1
r� V� 1 hcrcby afGcm that I am liccnscd undcr pmvisions of CAaptcr 9(commencing P
_z�� wiihSccGon7o(x))o(Division3ofthcBusinestandProfcssionsCodc.andmyliccnscis REPLACf: PIPING FM GALVANIZED TO COPPER
?� y in full force and effce�
,� ? Licenac Class Lic. M
� �;, ❑ Datc Con�ractor
" ARCHI7EC1'S DECLARATION
�� U I undcrstanJ my plans shall bc used as public records
n.
� O y Liccnsed RuCcssional
� y � OWNER-BUILDER DECLARATION
y� <� I hercby atTirm U�at I am ucmpt frum thc Conuactor's Licensc Law for thc
i O O following reason. (Sccuon 7031.5, Busincss and Pmfcssions Ca1c: Any city ar county
e m �i which rcquims s permit to consuuc4 altcr, improvc, dcmolixh, cu �epair any struclurc
y Z y prior ta ils issuance, alsu tequims Ihe applicant for such pertnit to file a signed slalemenl
�_ � that hc is liccnscd pucsuanl to �hc pmvisions of thc Conuactur's liccnsc I�w (Chaptcr 9 Sq. Ft. Floor Area Valuation
y F� (commcncing wi�h Sccdon 7000) o( Division 3 of ihc Busincss and Profcssions Codc) or $ 5 4 0 0
y�.. �hat he ia exempt thetefrom and the buia for �he allcgcd exemption. Any violation ot
SecGo� 7031.3 by a�ry applicant [or a permit subjccu the applicant w a civil pcnaity of Number Oceupaney Type
not moie �han fiw hundicd dollars (5500� 3 6 917 0 9 5`.��
❑ I, u owner o( tlie prnpvty, or my employces with wages u the'v solc compensaUon,
will do the work, and �he swctuce is not intendcd or oRered for sale (Sec. 7044, Husiness
and Ptofessions Cade: Ihe Conuactors License Law does not spply w an owner of Required Inspections
property who builds or improves thereon, and who does such wurk himael[or th�nugh his
own employccs, providcd ihat such improvements are not intended or of[emd for sale. If,
however, the building or improvanent is sald wi�hin oro yeu oC compledon, the owner-
builder will have ihe burden of proving that he did not build or improvc for pmpose of
saleJ.
�,I, as awner of the propeny, am exclusively conlracting wi�h licensed rnnVactors w
wnstruct the p�oject (Sec. 7044, Business and Professions Cade:) The Coatracmr's Li-
cenae Law dacs oot apply W an owner of propeny who builds or improves Ihereon, and ,
who c c�s for suc4 projects wiW a contrxtor(s) licensed pursusnt to ihe Convactor's
Lice
'�'� I am ex pt du See. , B& P for is reuon
O,
�er � Date l � �
WORKEIt'S C MPEt ATION DECLARA110N
1 dereby �rm under penalty o[ perjury onc o[ the following dalarations:
❑ I hsve and will mainuin a Cutificam of Consent to self-insure for Worker's Compen-
sation, u provided for by Section 3700 0[ �he Labor Code, for �he pe�ormanoc ot thc
woric for whicd Nis pertnit is issucd.
❑ I have and wil! muntain Workers CompensaUon Insurana, u �cquired by Scction
3700 of the Labor Code, Cor the pedormance of �he work for which this permit is issued '
My Worke�s Compensation lnsurance carticr and Policy number are:
Cartiu: Policy No.:
CER'I'IF7CATE OF EXIINPIION FROM WORKERS'
COMPENSAT[ON INSURANCE
(ihis sectian necd not bc completed i( �he permit is for onc hundrcd dollsrs (5100)
or Icss.)
i cenify thm � performancc of ork (or which �his pertnit is issucd, ! shall not
employ any perso in any an�mr w w me subject w the W rkcrs' Compensadon
Laws o! Califomi Da1c
Applican�
NOTICE TO AP CAM: If, aftcr making Ui�Cenilicam of Faccmpuon, you should
become subjcct w ihc Worker'n Compcnsation pmvisions o( ihc Ialwr Codc, you muu
, O forthwith comply with such provisiont w this permi� shall be dccmcd awokcd.
z "'" CONSfRUCTION LENDWG AGENCY
� �
[� � I hcrcby affirm Uut there is a conswctlon knding agcncy for �hc perCormance of
G�i � �hc work for which ihis permit is iuued (Scc. 7097. Civ. CJ
�W A Lendcr's Nunc �
� Z Lender's Address
V Q I cenify Ihat 1 havc rcad lhis application and sta�c �hu the above information is
w'" cortcc�t. I agrce to comply wiih all city and county orefinances and sute laws reladng w
� U building consuuction, and hcrcby authori�t mprescntadvcs of ihis cily to cntcr u�n ihc
� W atwve-mcnGoned property for inspection purposes I
E,,,� a (Wc) ag�ee to save, indcmnify and keep hermless ihe Ciry of Cupertino against
�„� � liebiliva, judgmcnLS, costs and expenscs which may in any wsy acaue againsl said City
V,'Z �o uencc of thc g ' g of ihis permi4
"" AP LI NT UNDER A DS AND WILI. COMPLY WITH ALL NON-POINT Issued by: Date /
SO C RE ULATIONS. � �
r p � °� Re-roofs
Signuuro o(Applicant/Conuacwr Da1e ��_
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WiII �he applicant or fuuuc building occupant storc or handlc ha•rardous msicrial
'^ftned by Ihe Cupertino Municipal Codc. Chapmr 9.12, and the Hcahh and Safcty
:. Secuon 25532(a)? All roofs sliall be ins ected nor to an roofin material bein
❑Y� �No P P� y g g installed.
If a roof is installed without first obtainin an ins ection, I a ree to remove
wll thc applicant or futurc building occupant usc cquipmcnt or dcvices which g P g
emit hazazdous air contaminan�v u dcGncd hy the Bay Area Air Quslily Managemem all new ma� erials for inspection.
District?
Q Ycs �J Nu
havc rcad ihe ha� amrials icquircmcnls undcrChaplr.r6.95 of ihc Califor-
niaHcal &SafciyCodc, 'ons 505,25533and25534.1unticrst�ndthatiCdubuilding
daes not u �y havc a tcnan4 it is my ponsibility w nodfy occupant M thc
reyuire n�s hich muu � or i u�of a Ccrtifica�c �f � Signature o.' Applicant Date
U`� �
All roof coverin s to be Class "B" or better
Owner or au�homcd agcnt v Datc g
CITY OF CUPERTINO
2 ITEMS OF 2 PERMI'.� RECEIPT OPER.ATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Bl]c: Lot:
APN ... ...... 36!�17045.00
DATE ISSUED.......: 11,'05/2007
RECEIPT #.........: BS�)00003157
REFERENCE ID # ...: 07:_10018
SITE ADDRESS .....: 94!i COTTONWOOD DR
SUBDIVISION .......
CITY .............. CU]?ERTINO
IMPACT AREA .......
OWNER ............. RAI�UL R.ASTOGI
ADDRESS ........... 94'i COTTONWOOD DR
CITY/STATE/ZIP ...: CU]?ERTINO CA, 95014-4666
RECEIVED FROM ....: RA:iTOGI R.AHUL
CONTRACTOR .......: TBI) - TO BE DETERMINED LIC # 00096
COMPANY ..........: TB]) - TO BE DETERMINED
ADDRESS ...........
CITY/STATE/ZIP ...: ,
TELEPHONE .........
FEE ID UNIT QUANTITY i�MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- ----------
BPREPIPE NO OF FIXTURE 4.00 36.00 0.00 36.00 0.00
PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
----------- ---------- ---------- ----------
TOTAL PERMIT : 76.79 0.00 76.79 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 76.79 MC
---------------
TOTAL RECEIPT : 76.79
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
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CITY OF CUPERTINO
� REPIPE/��:���"� ��.�/MAIN SERViCE
CI F
CUPEl�TlNO PERMIT APP:LICATION FORM
APN #
� Date:
�9/� o �� � Z�v d► �' �`�
Building Address: .� �
� � � � `�'�� a�a,�p,� '� �i �
Owner's Name: � � � � S ,�� � � Phone #:
4�a--�o�.� �6�
Contractor: ���' � �� �� Phone: License #: �� � � � �
Contact: �� t � � � � �,�� phone: � Cupertino Business License #:
d � � � — � �1-8 `�—�
Building Permit Info:
Bldg ❑ Elect ❑ Plumb �
Job Description: �� � � � P � `�� .
���� � ��
Residential � Commercial �
Cost of Project: ����•��� �. 4 � �
0 �
Qty. if
Applicable Fee ID Fee Descri tion Fee Group
BPERMFEE E ldg. Permit Fees BUILDING
BPGAS C�as Piping System Fee PLUMBING
� PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFIXTURE P �l . Fixture PLUMBING
BPWSVCS 1�[ain Water Service PLUMBING
BPSEWER S�;wers PLUMBING
BPSEWAGE S�;wage Disposal PLUMBING
BUSLIC B �siness License BUILDING