14050054CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10194 PARISH PL
CONTRACTOR: GREAT AMERICAN
PERMIT NO: 14050054
PLUMBING CO INC
OWNER'S NAME: REKHA R VADDI & VENKAT R MOLUKUTLA
P O BOX 26942
DATE ISSUED: 05/08/2014
OWNER'S PHONE: 4084993596
SAN JOSE, CA 95159
PHONE NO: (408)279 -1515
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
��
License Cl Lic. #
REMOVE AND REPLACE WATER HEATER
r,�,,_,�
A_�L ^ ^`
Contract�V 99 ate.
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
Sq. Ft Floor Area:
Valuation: $1500
performance of the work for which this permit is issued.
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: 31644038 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 1 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 DAY LAST CALLED INSPECyION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Q
Issued by: Date: O
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:
Si ure 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. 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, Secti ns 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or an 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
s
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildinaacupertino.or4
�6 01.
4
L NEW CONSTRUCTION L ADDITION LJ ALTERATION / Ti LJ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS �. (q4 /&'k � ' �/ /APN # - I
OWNER NAME • e ,(4t4 HONE L_1 .vLJ lJ ll/ E-MAIL
STREET ADDRESS A, CITY, STATE, ZIP l FAX
CONTACT NAME J�,q �.1� �4 PHONES J � J� E -MAIL
STREET ADDRESS if { J CITY, STATE, ZIP ( FAX
❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR IWONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ^ CENSE NUMBER ! `v ! (f� plll/ / LICICTEp BUS. LIC #A'-p 8 a4J
COMPANY NAME E -MAIL el f `I FAX
STREET ADDRESS r /P /� ��.�- CITY, STATE, ZIP PHONE Cj � r
ARCHITECT/ENGINEER NAME �J LICENSE NUMBER BUS. LIC # _
COMPANY NAME E -MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
IDESCRIPTION OF WORK I IVT /" ✓ WC-L -/ I
EXISTING USE PROPOSED USE CONSTR. TYPE I # STORIES
USE TYPE OCC. SQ.FT. VALUATION ($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODELAREA REMODELAREA
PORCH AREA I DECK AREA I TOTAL DECK/PORCH AREA I GARAGE AREA: 0 DETACH
TTACH
# DWELLING UNITS: IS A SECOND UNIT U YES SECOND STORY U YES
BEING ADDED? ONO ADDITION? ONO
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES < - ' _ " TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO `
ff t/V
By my signature below, I certify to each of the following: I am the property owner or authorized agent 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 relati ize i epresentatives of Cupertino to enter the abov - identified property for inspection purposes.
Signature o Date: T ^(�A.
SUPPLED INFORMATION REQUIRED
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
B1dgApp_2011.doc revised 06121111
1�,
CITY OF CUPERTINO
V V IP 1V 1QTTM A T"R — RT T11.nTNG DIVNInN
LAIADDRESS: 10194 parish pi
FEE
DATE: 05/08/2014
REVIEWED BY: Mendez
APN:
BP #:
*VALUATION: 1$1,500
*PERMIT TYPE: Building Permit
F J #
$28.00
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
p
Suppl. PC Fee: (F) Reg. () OT
PENTAMATION PRWHEATR
USE:
$0.00
PERMIT TYPE: A
WORK
remove and replace water heater
Permit Fee:
SCOPE
Suppl. Insp. Fee: Reg. C) OT
p,p
;tleo'r. NW? t.''rreck
W,,fJE. F'e,�ruii Fee:
nrh�,F. ;t�� < :h. Inst,
Plumb. Plan Check 1 0.0 1 hrs $0.00 1 1,Wc. P m, C'hack
Plumb. Permit Fee: IPPERMIT�t� - =� e,trr�r t r
Other Plumb Insp. 0.0 hrs $47.00
P;'uriul3.
NOTE: This estimate does not include fees due to other Departments (i.e. rlanning, ruouc moms, rtre, aunuury sewer vwtr/cy 0,_ UV
tlso I)ont /nr nddn'I inin_
FEE ITEMS aW Resolution 11 -053 E . 7111132
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F J #
$28.00
Plumbing
IPRWHEATR Water Heater
Suppl. PC Fee: (F) Reg. () OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. C) OT
p,p
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
CC7ilSj wction T kv.
T-T-_
Administrative Fee:
IADMIN
$44.00
E)
Work Without Permit? ® Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
Travel Documentation Fee: ITRAVDOC
$47.00
Strong Motion Fee:
IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
$139.50
$28.00-1
1 11 TOTAL FEE:
$167.50
Revised: 04/01/2014
CUPERTINO
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building Wcupertino.ora
Address 10 «+. pawl s t'� P1, "1C4h111;Za
PURPOSE
This affidavit is a self - certification for the installation of
compliance with 2013 CRC Section R314,2013 CBC Sect
inspections are required.
GENERAL INFORMATION
Ii$05 OD
required Smoke and Carbon Monoxide Alarms for
s 420.6 and 907.2.11.2 where no interior access for
Existing single - family and multi- family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that
do not have an attached garage. Carbon monoxide alarms combin th smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the S Marshal.
V,
Power Supply: In dwelling units with no commercial r sup ,`��(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be so ely b e� operated where repairs or alterations do
not result in the removal of wall and ceiling finishes c there�no access b eans of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 42 .2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
d")_.. _ _
RE, r- HA
✓ "D I 1 have read and agree to com 1 he terms and conditions of this statement
Owner (o her gents) Name:
Sinature........ :........................................ ............................... Date: ...................
CrAractor Npame:
q6/� tf j
Si nature...... ..... ............................... Lic.# ........ .... Date:..... ...
J
Smoke and COform.doc revised 03118114
:�141-