14030101 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7648 NEWCASTLE DR CONTRACTOR:ACE PLUMBING PERMIT NO: 14030101
OWNER'S NAME: MOKKAPATI SUBRAHMANYAM V AND ANUPAM 565 N CENTRAL AVE DATE ISSUED:03/17/2014
OWNER'S PHONE: 4089967721 CAMPBELL,CA 95008 PHONE NO:(408)605-9754
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
�y / REPLACE WATER SUPPLY MAIN FROM METER TO
License Class_ Lic.# Oi7 HOUSE
Contractor C , Date
I hereby affirm that I am licensed under ge 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:$1500
1 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:36617083 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 �7r,7ITI 80 DAY gOF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter A
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST 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:J ��
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 Date_ e/ 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
1,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)
1,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,Sectio s 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater
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
GENERAL PERMIT APPLICATION Mm E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION lU
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildina(ftupertino.org I S C
GU0!`kT'IHO
PLUMBING^ ❑MECHANICAL ❑ELECTRICAL ❑/MISCELLANEOUS
//��
PROSECT ADDRESS ^ APN# %'P w t / G D".
OWNER NAME Q� ' l� PHONE �� E-MAIL
STREET ADDRESS CITY, STATE,�ZIP. I FAX
CONTACT NAME PHONE EMAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWITR -[IowNE .BUILDER E301ANERAGENf CONTRACTOR 11CON RACfORAGEN'r ❑ ARCHITECT ❑ENGA'EER E] DEVELOPER ❑ TENANT
CONTRACTOR NAME LICEI`'S�ENUMBEIt LICFt�SE TYPE BUS.LIC#
COMPANY NAMEy� (� E MAIL FAX
STREET ADDRES /S�'7 ^ �\� CITY,STATE ZIPCwk b F"0 >,,P-
"-j
ARCHITECT/ENG�INEERdNrAME LICENSE NUMBER BUS.LIC# ( l7
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ M'ULM FAMILY PROTECT INWIIALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: []C kL 'URBAN WTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOTS? ❑ NO
DESCRIPTION OF WORK
C a- r S
Al
UNIONS � i
TOTAL VALUATION: RECEEDB•_ v ;
.'a'+ ra �f, �' "-•c
'
By my signature below,I certfify to each of the following: I am the property owner or authorized agent to act on the property ownei's behalf. I have read this
application and the information I have pro ided is correct. I have read the Description of Vdork and verify it is accurate. I agree to comply v✓ith all applicable local
ordinances and state laws relating to W rng construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
SignatureofApplicant/Agent: Date:
21
SUPPLEMENTAL INFORMATION REQUIRED`MMU-5
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rAnnAx� .
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7648 newcastle dr DATE: 03/17/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$1,500
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Du lex PENTAMATION 1 RPWS
USE: p PERMIT TYPE:
WORK �re lace water supply main from meter to house
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Service 1BPWSVCS 1 # $24
TOTALS: $24.00
b cc,'. i"'arr k Plumb.Plan Check 0.0 hrs $0.00 77ee. Plon C'6z rc;t
Lfecl,. F'c�r if Fee: Plumb.Permit Fee: IPPERMIT Elea �T��ii I"Ge
7?,sp, Other Plumb Insp. 0.0 Ins $47.00 oflh,�,k,,c,Insp.
llhoiih. T2sp.F'ea�
NOTE:This estimate does not includefees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the prelimina information available and are only an estimate Contact the Dept-for addn'l info.
FEE ITEMS (Fee Resolution 11-053 a.* 711113) FEE QTY/FEE MISC ITEMS
S7fppl. PC f,e,4.,
PME Plan Check: $0.00
PME Unit Fee: $24.00
PME Permit Fee: $47.00
(,'0nVr7a't1 on K Ix., F-1
Administrative Fee: IADMIN $44.00
Work Without Permit? ® Yes 0 No $0.00
Jdvollc cep f'(<rr�rrrl�ht�cs:
Travel Documentation Fee: 1TRAVDOC $47.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
$163.50 $0.00 TOTAL FEE: $163.50
Revised: 01/15/2014