07110014 CITY OF CUPERTINO - '
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BUILDIRG DIVISiJN PERMIT ,���T7R�.�+�?� �������� '
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BUILDING ADDRESS: PERMIT NO.
8111 PRESIDIO DR TOM'S PLUMBING 07110014 .
JER'S NAME: PIItM1T ISSUE DATE
PERUMAL NATARAJAN P O BCX 362 � 11/02/2007
PHONE: SANITARY NO. CON'CROL NO.
ARCHi'IECT/ENGINEER:
BUILDING PERMITINFO
RUNNII�G GAS LINE TO THE B� E� P�� �
� O p LICENSED CONTRACfOR'S DECLARATION
� V� ! hcrcby af(itm that I am licenscd umlcr provisions oC Chaptcr 9(commencing JOb DeSCT1pLI0I1
Z� wiih SccGon 700U) of Division 3 of thc Business and Professians Code, snd my licensc is
�� y in full Co�ce and effect
� � Licenac Clus Lic. X
�'^� F, � Datc Contractor
ARCHITECI'S DECLARATION
�� U I undcrstand my plans shall bc uscd u public records
�
4 O ,F Liccnsed Ptufcssional
n y � OW NER-BUILDER DECI.ARATION
� e� I hcrcby alTirm Ihat I am cxcmp� Crom thc Comractor's Liccnso Law for U�c
p O foliowing rcason. (Scc6on 7031.5, Business and Profcssions Cafc: My city or county
K,°, Pi which rcqui�cs a permit w conswc4 a�tcr, improvc, dcmolish, or mpair any swnure
y Z y prior tn i�s issuancc, alsu rcquircs �hc applicanl Cor such pertnit to filc a signed siaicmcn�
_< ihat Ne is licenscd pucsuanl to thc pmvisions o[ thc Conuactor's Li��cnsc Law (Chapter 9 Sq. Ft. Floor Area Valuation
y F$ (commencing wi�h Sccdon 7000) of Division 3 0( Ihc Busincss and Prokssions Codc) or
y �.. that he ia exempt theretrom and the buu for U�e allcgcd exempdon. Any violarion of
Sectioa 7031.5 by arry applicant for a pecmit subjecu Uu applicant w a civil penalty of APN Number Oeeupancy Type
not moro �han fiw hund�ed dollars (5500).
❑ I. u owner of ttie property. or my employces with wages az the'v sok compensadon,
will do the work, and ihe stcucwm is not intendcd or offeted for sa� (Sec. 7044, Business
snd Pro[essions Cade: The Conuxtor's License Law doet not spply to an owner of Required Inspections
propeny who builds a improves thercon, and who das such work himulf or through his
own employccs, providcd that such improvements ue not intended or oRued for sala 1t,
hawever, �he building or improvement is wid wiihin one yeu oC completion, ihe owner-
buildu wiil have �he burden of proving �hat he did not build or improvc for puryose of
saleJ.
0 I, u awner of �he propeny, am exclusively conuuting wiW Gaased rnnuactors w
COnEWM IhC projeM (StC. 7044 Businas and Professions Code:) The Coatnemr's Li- . .
cease Law docs aot apply to an owner o( propcny who huilds ar improves ihereon, and ,
who conuacts Cor such projects with a contruwr(s) licensed purswnt to �hc Convacars
Licenae I.aw.
r'j 1 am uempt under Sec. . B dc P C for �his �eaton
nv [�' � H� 1 V Date _1t1L�1��.
WORKER'S COMPENSAT[ON D TION � ' � (
1 hcrcby affirm under penalty of perjury one of the follawing dectantions:
❑ I hsve and will mainuin a Cenifiple of Consenl to self-inswe for Workcrs Compen-
sation. u providcd for by Secdon 3700 of the Labor Code. for the performance oC thc
wark for which Ihis permit is issucd.
❑ I dave and will maintain Worker's CompensaUon insurancc, u mquired by Scction
3700 0[ �he Labor Codc, Cor tAc pcdormantt o( the work for which this pecmit is issued. '
My Worke�s Campenaation Insurancc carticr and Policy number aie:
Cartier: Polity Na.:
CERTIFICATE OF EXEMPITON FROM WORKERS'
COMPENSATION INSURANCE •
(7Lis section necd not bc complcted it the permit is for anc hundred doliars (S I00)
or Icss.) •
i cenify ihet in thc performance of lhc work (or wAich �his pertnit is iuucd, l shall not
employ any pecson in any r� r so u ta 6ccomf Workcrs' CompcnsaGan
Laws of Califomia. Dstc �
Applicam
N077CE TO APPLICANT: If, atYcr making U�is CcniGcatc of Excmp on, you shoulJ
baome subjcct to thc Worker'a Compensation provisions of thc LaDor Codc, yau must
� O forthwi� comply wiih such provisians or this permit shall be dcemcd revoked.
'� �"'� CONSTRUCf10N LENDING AGENCY
[- � I hereby a�rtn ilut there is s consuuction knding agency Cor the perfurtnance uf
p: � ihc wuric fur which this permit is iuued (Scc. 3097. Civ. CJ '
� Q Lendcr's Namc .
� z C.ender's Address
V 0 1 cenifY U�at 1 havc read �his application and sutc ths� ihc abovc informaliun is
w� camct. 1 agrce w comply wiih all city and counry onlinances and state laws cclaung to
0 U building consuucUon, and hereby authori�e ecprcsentaGvcs of this ciiy to cntcr upon ihc
w aAove-mcntioned pmpeny for inspecuon purposes.
(Wc) agiee to save, indcmnify and kecp humless the Ciry of Cupertino against
�„� � lisbiliues, judgments, costs and expensea which may in any way accruc against said City
V z in conaequence oC 1hc granting of lhis permiL /)� j� Li�
�"� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by Date /
SO REGULATIONS.
� 1 1 Re-roofs y r �/
Signuurc of ApplianUContractor 1c
HAZARDOUS MA7'EitIALS CLOSURE Type of Roof �
Will ihe applicant or futurc building acupant storc or handlc harardous matcrial
defincd by �lrc Cupertino Municipal Codc. Chaptcr 9.12, and thc Heal�h and Safcty
k. 5cction 25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
❑ Ycs ❑ No
WiII thc applicant or future building occupant usc cyuipmcnt or deviccs which
If a roof i;; installed without first obtaining an inspection, I agree to remove
emi� har�rdous air coniaminan�s aa defined by the Bay Area Air Quality Managcmenl all new m aterials for inspection.
Disvict?
❑ Ycs � Nu
1 havc reaii the hvsrdous ma�crials �cquircmcnLS undcr Chap�cr 6.95 of Ihc Cali(or-
nia Flcal�h & Safcry Codc, Sixtiions 25505, 25533 aiu125534.1 undcrsmnd �haz iC ihc building
does no� curten�y havc a �cnan4 that it is my responsibility to notify thc occupant of �hc
ms which mutt bc mel prior �u�� or a c�r�� ar o��, . S ignature of Appl icant Date
�� � All roof coverings to be Class "B" or better
Owncr or autharixcd agcnl ��
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT , OPER.ATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 35611080.00
DATE ISSUED.......: 11/02/2007
RECEIPT #.......... B�000003151
REFERENCE ID # . ..: 07110014
SITE ADDRESS .....: 8111 PRESIDIO DR
SUBDIVISION .......
CITY .............. CLPERTINO
IMPACT AREA .......
OVJNER ............: PERUMAL NATARAJAN
ADDRESS ..........: 8111 PRESIDIO DR
CITY/STATE/ZIP ...: CL:PERTINO CA, 95014-4027
RECEIVED FROM ....: R�NI NATARAJAN
CONTRACTOR .......: CI�ARKE, JOSEPH M. LIC # 10044
COMPANY . . . . . . . . . . : TC�M' S PLLTMBING
ADDRESS ........... P O BOX 362
CITY/STATE/ZIP ...: S�.R.ATOGA, CA 95071
'PELEPHONE ........: (�08)867
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPGAS OULETS 1.00 5.40 0.00 5.40 0.00
PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 46.19 0.00 46.19 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 46.19 VISA
---------------
TOTAL RECEIPT : 46.19
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------------------- -------- ----------------------------
202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
o� �� o o I�
�= x � CITY OF t�UPERTINO
� � � REPIPE/����Y��_�/MAIN SERVICE
CUPEl�TINO PERMIT APPL�ICATION FORM
APN # Date:
Building Address:
Owner's Name: Phone #: ��0�'f' � � �L�.L�.(Y
a Y�
Contractor: Phone: License #: �,� �
�O �� "� �
Contact: � Phone: l Cupertino Business License #:
D�,wz� � �o��t �
Building Permit Info:
Bldg ❑ Elect Plumb �
Job Description:
� t� �
Residential Lef Commercial ❑
Cost of Project:
�
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE ftldg. Permit Fees BUILDING
BPGAS (Jas Pi ing System Fee PLUMBING
PPERMITFEE f'lumbing Permit Issuance PLUMBING
BPREPIPE �;e ipe of Fixtures PLUMBING
BPFIXTURE �'blg. Fixture PLUMBING
BPWSVCS 1`dain Water Service PLUMBING
BPSEWER :�ewers PLUMBING
BPSEWAGE :�ewage Disposal PLUMBING
BUSLIC �3usiness License BUILDING
_ Community Development
`� `'�,; . ' 10300 Torre Avenue
�" ? :; '�' � Cupertino CA 95014
Telephone (408) 777-3228
��N � Fax (408) 777-3333
cuPE�,TiNo
Buildi:n De artment
JOB ADDRESS: PERMIT #
� l'�~��.51 i c� r D� L h n"D � � 01 �
OWNER'S NAME: PHONE # q�o �S — --a
GENERAL CONTRACTOR: (� � FAX #
I am not using any subcontractors:
Si�;nature Date
Please check a licable subcontractors and com �lete the followin information:
SUBCONTRACTOR BUSIr�ESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
� �
Owner/Contra r Signature ate