14040066 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10394 S BLANEY AVE CONTRACTOR:ALLSTAR PLUMBING PERMIT NO: 14040066
OWNER'S NAME: PRANDNESH DANGE 326 PHELAN AVE DATE ISSUED:04/11/2014
OWNER'S PHONE: 4088630759 SAN JOSE,CA 95122 PHONE NO:(408)230-5569
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
2 n/�/ REPLACE+/-5 FT OF DRAIN LINE FOR KITCHEN&
License Class C Lic.# 339611 LAUNDRY RM
Contractor Dater
I hereby affirm that I am licensed uW 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:$2000
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:36911052.00 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 WO OT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D 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 DA O 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. dditionally,the applicant understands and will comply suedE Date:
with all non-point sour e r ulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature Date % I` 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 2 25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this I
Owner or authorized agent: Date:
permit is issued. I
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
t ^�W
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O
10300 TORRE AVENUE•CUPERTING CA 95014-3255 O
CU4*IrA`I INO (408) 777-3228•FAX(408)777-3333•building(CDCUDertino.org MISC
PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑`MISCELLANEOUS
PROJECT ADDRESS 163q4 &, RA �g APN#
OWIVTERNAME W�N Y7�'v1 'J' PHONED_ 6I -flSq E-MAIL
STREET ADDRESS r `iCJ�(Il 4 7 f� CITY,STATE,ZIP (� �� �1� G I FAX
CONTACT NAME V J �[7V lM�T !� PHONE x/��-^93q,o"I, E-MAILJM *b dI U
STREET ADDRESS �Q„p "T CITY,STATE`,CZII�P/9,10
1 _/�jn (A'
A �''1 Z FAX
❑O� '❑ ONNT7ER-BUILDER ❑ OWNER,RAGENT CONTRACTOR ❑CONTRACTOR AGENT 11 �ARICHITECT �i❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAME �jA 5vw- LICENSENUMBER LICENSETyP BUS.LIC#
COMPANY NAME /(�n��{�n�T t,- �lJl�^ E-MAIL FAX
STREET ADDRESS T�1 I�n'�^ r�n CTTY,STATE ZIP /e A L �) PHONE 44
ARCHITECT/ENGINEER NAME 1� LICENSE NUMBER vYJ� 7I c' BUS.LIC# ,/U
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMII.Y PROJECT IN WIIDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUII.DING• ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK _. / �^ n
`Y/A ✓f r u
TOTAL VALUATION: _ " - #
Y s,,' _ fs .i._ .a's.sas
By my signature below,I certify to each of the following: I am the property owner o authorized aeact on operty ownegpr
r' atf. I hav Is
application and the information I have 15Qvided is"correct. I have read the Description of Work anff verify it is accurate. I agree to a I applicable local
ordinances and state laws relating to builds g construction. I authorize representatives of Cupertino to enter the above-id tied property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLE AL INFORMATION REQUIRED , s
�.: sOENTCETJSE011ZsY'�r���_-sem ':
3
� I� OVERTH)<COUNTER' '
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7
MEPMisc,4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10394 S BLANEY AVE DATE: 04/11/2014 REVIEWED BY: MELISSA
APN: 369 11 052 BP#: *VALUATION: $2,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION 1 RPDP
USE: SFD or Duplex PERMIT TYPE:
WORKREPLACE +/-5 FT OF DRAIN LINE FOR KITCHEN & LAUNDRY RM
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Piping, Drainage 1PREPPIPE 1 # $47
TOTALS: $47.00
f
Plumb.Plan Check 0.0 hrs $0.00 1,lec. Man
Plumb.Permit Fee: 1PPERMIT
C)lircr' {�;�• .Irts ,. Other Plumb Insp. E7rs 1 $47.00 Urhet f"ltrc.Inst.
h;-yP. Fee: ELL
I:iec.
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prefinddna information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E(f. 7/1/13) FEE QTY/FEE MISC ITEMS
Phin Check
Slippy p( /'C1-1
:1
PME Plan Check: $0.00
PME Unit Fee: $47.00
PME Permit Fee: $47.00
Co;;5tf uclion Tax:
Administrative Fee: IADMIN $44.00
Work Without Permit? 0 Yes (E) No $0.00
�l cf°ca,rc'ec�Plarmi;'7'g Fees:
Travel Documentation Fee: ITRAVDOC $47.00 A
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
USS $186.50 $0.00 . -11 TOTAL FEE: $186.50
Revised: 04/01/2014