13070015CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20192 RODRIGUES AVE
CONTRACTOR: MARTI'S PLUMBING
PERMIT NO: 13070015
OWNER'S NAME: SHEKAR PASUMARTHI
171 BRANHAM LN STE 10418
DATE ISSUED: 07/03/2013
OWNER'S PHONE: 4084823420
SAN JOSE, CA 95136
PHONE NO: (408) 375-3190
JOB DESCRIPTION: RESIDENTIAL COMMERCIALE]
❑ LICENSED CONTRACTOR'S DECLARATION
License Classy 3ee Lie. #_7570, 2 d
REPLACE (E) PROPERTY LINE CLEANOUT
Contractor ��7Zf'7T_ Date . 7`
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
SA
Code and that my license is in full force. and effect.
NITARY-
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.
Sq. Ft Floor Area:
Valuation: $1800
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36932047.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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 FRO ALLED 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
ed te: 3
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:
Signa Date " 3 ^
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I 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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
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(x) should I store or handle hazardous
I have 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, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quali"anagement District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino a pal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Section 33, and
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized gent: Date:
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 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
APPLICANT CERTIFICATION
Lender'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
to building construction, and hereby authorize representatives of this city to enter
upon the 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
9.18.
Signature Date
CITY OF CUPERTINO
FORM 1 1V1 1 CTTM A TnR — RITII .IIINf DIVNION
APPLIANCE / EQUIP TYPE
ADDRESS: 20192 RODRIGUES AVE
DATE: 07/03/2013
REVIEWED BY: MELISSA
UNITS
APN: 369 32 047
BP#:
"VALUATION: 1$1,800
%PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
Lp
PENTAMATION 1 RPSS
USE:
Permit Fee:
PERMIT TYPE: A
WORK
REPLACE E PROPERTY LINE CLEANOUT
SCOPE
PME Unit Fee:
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Sewer, Sanitary
1PRSEWER
1
#
$24
Permit Fee:
Suppl. Insp Fee
PME Unit Fee:
$24.00
PME Permit Fee:
$47.00
Construction hctx:
Administrative Fee: IADMIN
$42.00
Work Without Permit? ® Yes (E) No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$24.00
Strong Motion Fee: IBSEISMICR
Ltech. Plan Check Plumb. Plan Check 10.0 1 hrs $0.00 F_lec.. Plan Check
.tech. Permit Fee. Plumb. Permit Fee: IPPERMIT L•'lec. Permit Fee:
Other• :19ech. Inst). Other Plumb Insp. 0.0 hrs $47.00 Other Elec. Insp,
Alech. Insp. Fee: Plumb. hap. Fee: Elec. Insp, fee:
NOTE: This estimate does not inctude fees due to other uepartments ye riamung, ruouc rrorx3, metre, Junituly --f "&at ... ', ---
1. -4
a. —
1.....-4 ,... A. ...,T........o.... is. in. nfinn mrniln6/a and oro nasty nn P.CtlmQte. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
ti5uppl. PCI'ee>
PME Plan Check:
$0.00
Permit Fee:
Suppl. Insp Fee
PME Unit Fee:
$24.00
PME Permit Fee:
$47.00
Construction hctx:
Administrative Fee: IADMIN
$42.00
Work Without Permit? ® Yes (E) No
$0.00
Advunced Phtmzing Fees:
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldiz Stds Commission Fee: 1BCBSC
$1.00
`tet
$159.501
$0.00 OTLEE
$159.50
(b3-5�'\ Revised: 07/0.1/2013