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13120033 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 8155 PARK VILLA CIR CONTRACTOR-Y'B -` eHH E PERMIT NO:13120033 .10ETEIZOMD OWNER'S NAME: SUNEEL INDUPURN , DATE ISSUED: 12/03/2013 OWNER'S PHONE: 4082306655 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALU License Class _ Lic.# INSTALL GAS LINE TO COOKING GAS RANGE Contractor \W fS�• CCJv��"Date I hereby affirm 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$880 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:35610041.00 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 DAYSLAST 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: Signature SV�CSG` s V Date 127-0)-12> 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(a)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 Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent 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 Compensation laws of California. If,after making this certificate ofexemption,I CONSTRUCTION LENDING AGENCY 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 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•j UPERTINO,CA 95014-3255 ,^_��,» MISC (408)777-3228•FAX 408 777-3333•buildin4Ca�cupertino.org l"!/� CUPERTINO ❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESSI APN# 3 S/ _ /Q I OWNERNAME 5IJNCCL I/UVU UrV PHONE D- X30 �66� SUNCCt-T-Kco) mGr�' Cow STREET ADDRESS l CITY,STATE,ZIP FAX 1 1� LL 'Y1 CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME C n L W E S T &n�)r,4 c`.}I LICENSE NUMBER LICENSE TYPE BUS.LIC# S COMPANY NAME !'1 E-MAIL FAX C L l s T COV-1kA40k STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WIDLAND ❑ YES PROJECT IN ❑YES FEICHLER THE BLDG AN YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO HOME? ❑ NO - DESCRIPTION OF WORK (2 C6 Y),P,Ck TOTAL VALUATION: g 0. 110,131,000, ,' ,tui''�, , ~ a � By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is.correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: &3) 20 * mg SUPPLEMEINFORMATION REQUIRED OWAC t r�oira", t a, AVER TTS �R MEPMiscApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 8155 park villa cir DATE: 12/03/2013 REVIEWED BY: Mendez APN: BP#: "VALUATION: 1880 'PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY s PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 RPGA WORK install gas line to cookinq range SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Gas <=4 Outlets 1PGASRES 1 # $70 TOTALS: $70.00012 fill W IN Y� kfe(A Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec. Plan Check ;tech.Perwit Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit Fee: Ether Afech.Insp. Other Plumb Insp. 0.0 hrs $47.00 Oiher Elec.Insp. :Rech.Insp.Fire: Pluinh. Insp.Fee: Elec.Insp.Fee: NOTE:This estimate does not mcludefees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc). Theseees are based on the prefintina information available and are only an estimate Contact the Dept for addn'1 info, FEE ITEMS (Fee Resolution 11-053 E�..' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. 117sp Fee PME Unit Fee: $70.00 PME Permit Fee: $47.00 Cont-action 1 ax. Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes (j) No $0.00 Advanced Manning Nees: Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 OEM $209.50 $0.00 °�£ ' $209.50 � . w= . Revised: 10/01/2013