14050023 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22893 LONG DOWN RD CONTRACTOR:CONSOLIDATED PERMIT NO: 14050023
PLUMBING INC
OWNER'S NAME: ANIL PAI AND SHANTI 3732 CHARTER PARK DR STE D DATE ISSUED:05/02/2014
O—WNNEER'S PHONE: 4082554532 SAN JOSE,CA 95136 PHONE NO:(408)978-3093
C3� LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL 0
REPAIR&REPLACE AS NEEDED(E)SEWER LINE.
License Class 0-36 Lic.# SDS 1 6 2 INSTALL
Contractor
0—(C-7( PL U PV1 P Date .5--1 W (N)PROPERTY LINE CLEANOUT(HOA LETTER REC'VD)
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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$20000
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:34240003 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 WITHIN180 ��T
RMIT 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 18 FALLED 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 Z
e:
granting of this permit. Additionally,the applicant understands and will comply t
with all non-point so rce regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature Date 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. [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 255q5-,4,5533,an 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:S-- �
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 fhe 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
918.
Signature Date
n , l
GENERAL PERMIT APPLICATION 0 �/ MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 v�0
(408) 777-3228•FAX(408)777-3333•buildinaCcDcupertino.org \
MISC
®PLUMBING [:]MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS I APN# 3 q Z- — L(0
— 00
OWT\'ERhAME ' A
STREET ADDRESS 9'i CITY, STATE,ZIP I FAX
CONTACT NAN!E -r, 7
PHO /
STREETADD "Iw -'5- .
. 1 e CITY,STATE.ZIP / F /�r
13 OWNER 13oN;w R-Bu.DER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGII.'EER ❑ DEYELoPER ❑TENANT
CONTRACTOR NAME es LICENSE NUMBER LICENSE TYPE v BUS.LIC 4 alS
COMPANY N. t n - E FAX..
STREET ADDRESS CITY,STATE Z PHONE
A732- 9 37
ARCHrTBCT/ENGWEERNAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAM FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULn FAMII-Y PROIECT IN WIIALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICIILER HOME? ❑NO
DESCRIPTION OF WORK
r
®.
4we 41nzdWE
S >
TOTAL VALUATION:._ 4
By my signature below,I Jertify to each of the following: I am the property or au orized agent to act on the o o er's have read this
application and the information I have provided is corn ave rea escripti ork and verify it is e. I ee to ply v ith all applicable local
ordinances and state laws relating to building co ction. I author' repr Ives pertino to enter the above-id&iEva property for inspection purposes.
S i gnature of Applicant/Agent: Date:
S LE ION UIRED
gem RN
'.ERT'E�COL3�'ZZ
IB - y; _ _
� J�PILEBS�
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MEPMisa4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 22893 LONGDOWN RD DATE: 05/02/2014 REVIEWED BY: MELISSA
AP342 40-003 BP#: EVALUATION: $20,000
'PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
-------[PRIMARY PENTAMATION 1 RPSS
USE: SFD or Duplex PERMIT TYPE:
WORK REPAIR& REPLACE AS NEEDED E SEWER LINE. INSTALL N PROPERTY LINE CLEANOUT
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $24
` $24.00 ;
TOTALS: .' �<
r
-
it +-bit
'
L9-<:h. i'tarn t:` cr- Plumb.Plan Check 0.0 hrs $0.00 'i-�'.
tf>c:r. Per;aait Fee. Plumb.Permit Fee: IPPERMIT
Otfic, Af(,-CA Iras,.= Other Plumb Insp. 0.0 hrs $47.00 oi/te r fslec.I s/.
Li
�fuvk t ec. 9'.7hallb. hi p,I ee, i'17('--L'Insp
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc . These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 L . 711113? FEE QTY/FEE MISC ITEMS
Plan ('hrrek Fee:
5uppl. PC
PME Plan Check: $0.00
Satpt,)/, Irisp P'ee
PME Unit Fee: $24.00
PME Permit Fee: $47.00
(,'onstruc ion Tax:
Administrative Fee: 1ADNIIN $44.00
Work Without Permit? 0 Yes 0 No $0.00
�Jdvar cad Planning Fee.':
Travel Documentation Fee: ITRAVDOC $47.00 i
Strong Motion.Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
ti $165.00 $0.00 TOALFEE: $165.00
u
Revised: 04/01/2014
o S#tcrr,,�y 20STEVENS CREEK BOULEVARD,SUITE 100
4��~�� CUPEKTINO,CALIFORNIA 95014-2154
w '. PHONE(408)253-7071.FAX(408)253-5173
m
www.cMoertinosanitarydistrict.com
RECEIPT OF:FEES
Receipt NO 4929 Received from: consolidated Plumbing
Date: 5/1/2014 ... Address: 3732-D Charter Park Dr,San Jose 95136
Check No: 14277 ABA NO: 90-78/1211 � - Bank Name: jBank of the Westg
Amount of: one Thousa ,Two HundredDollars&00/100xxxx dollars
Property Location: APN: Tract No: Other: 408-978-3093
Address: 22913/22903i22893J22946 Lahgdown Road,Cupertino(De Anza Oaks) Job No: �,_
RECEIVED FOR THE PURPOStOF: (Account No) AMOU
1. Connection Fees Zone No ,, Reimbursement Agreement:
a. Acreage
Acres at'$ ..._,;/Ac, (31031)
b. Front Footage
Front Ftr at$ /Ft. (31032)
c. Additional Dwelling Unit
Unit at$ /Ea. (31033)
d. Additional Commercial/;Industrial
Gallons at--$ /Gal. (31034)
e. Special Benefit Zone: � )
2. Checking Inspection Processing Deposit (31040) 1$1,200.00
Sewer Inspection Fee()es 4)(new P/L-c/O)
3.
( )
TOTAL 1$1,200.00
MARK THOMAS AND COMPANY,INC.
bit District Engineer Manager by:
Page 1 of 1
COIMYMUNTTY MANAGEMENT SERVICES
March 18,2014
To Whom It May Concern
Re: De Anza Oaks Homeowners Association
Dear Sirs:
Consolidated Plumbing,Inc.has the association's permission to seek permits for the repairs of any domestic
waterlines or sewer lines located within the De Anza Oaks communiIv.
Since'
Co n1unity Mann neat Services, Inc.
Bill 1 ubbarcLt Association Manager
De At,
n Oak's Homeowners Association
BH1st
cc: Board of Directors
1935 Dry Creek Road, Suite 203■`Campbell,CA■95008-3631 ■voice (408) 559-1977■fax(408) 559-1970