14040078 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10231 PARISH PL CONTRACTOR:TB PERMIT NO: 14040078
E &N6 in
OWNER'S NAME: PRAVEEN GHANTA DATE ISSUED:04/14/2014
OWNER'S PHONE: 4088219507 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
f COOPER RE-PIPE,INTERIOR ONLY
License Class C—�6 Lic.# �7-L �'9 �
Contractor ((4OA , Date 1- — Y
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:$6000
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:31644005 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 DA OFITVW 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 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
granting of this permit. Additionally,the applicant understands and will comply Is y: Date:
with all non-poin7souce�pero Municipal Code,Section9 18. RE-ROOFS:
Signature ` Date 1 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)
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 whie it hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Ma gement District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal e,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections ,25533,and
Section 3700 of the Labor Code,for the performance of the work for which this — t
permit is issued. Owner or authorized agent: Date:
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 of exemption,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•CUPERTINO,CA 95014-3255
EUp>`ATCNO (408) 777-3228•FAX(408)777-3333•buildingCa�cupertino.org `
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PROJECT ADDRESS 102-M
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OWNER NAME Pl + J rVAll �n0
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CITY ATE,ZIP_. I FAX
CONTACT NAME A + i ri en PHONE G -'qs E_NLA_II-()A,�1 C 1 ,r/ <
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STREET ADDRESS �- CITY,STATE,ZIP '( ,J FAX
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❑OWNER '❑ o AwER-BUIIAER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHTIECr ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAME � tArn in LICENSETCBUS.LIC#ZVNMC— 7-3,'�
COMPANY NAME E- FAX
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STREET ADDRESS CITy'SIAI
ARCHrrECTIENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E MAII FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SED or DUPLEX ❑ MULTI-FAMILYPROJECT IN WIIALAND ❑ YES PROJECT IN ❑YES rl'SICTILER
THE BLDG AN ❑YES
BUILDING', F1COMMERCW. - TURBAN INTERFACE AREA ❑ NO FLOOD ZONE El NO HOME? ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION: _ _ 4 M _
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' alf. read is
application and the information I have provided is correct. I have read t escription of Work and verify it is accurate. I agree with all applicable local
ordinances and state laws relating toI construction. th0' representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: IT Date:
SUP EMENTAL ORMATION REQUIRED . o> cEus> ori
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10231 PARISH PL DATE: 04/14/2014 REVIEWED BY: MELISSA
APN: 316 44 005 BP#: *VALUATION: 1$6,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPRP
USE: p PERMIT TYPE:
WORK COOPER RE-PIPE INTERIOR ONLY
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Re-Pipe Interior 1PRREPIPE 1 # $14
TOTALS: $14.00
4✓F.,t F�
E
Plumb.Plan Check "00 $0.00 111-1'<";' 1,11lr
loch,Pe rrgit Fee' Plumb.Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 hrs $47.00 (:?if e, 1;;<, .'r;s
Lj
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etG). These fees are based on the prefimina information available and are onl an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 1.1-053F,(. 7/f 1/.13) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $14.00
PME Permit Fee: $47.00
Administrative Fee: IADMIN $44.00
Work Without Permit? 0 Yes (E) No $0.00
Travel Documentation Fee: ITRAVDOC $47.00 i
Strong Motion Fee: IBSEISMICR $0.60 Select an Administrative Item
Bldy,Stds Commission Fee: IBCBSC $1.00
. ., �I; . , $153.60 $0.00 TOTAL FEE': $153.60
Revised: 04/01/2014