14050153CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7574 ERIN WAY
CONTRACTOR: PLUMBING TECH INC
PERMIT NO: 14050153
OWNER'S NAME: RAVI NYALAKONDA
278 E GISH RD
DATE ISSUED: 05/27/2014
OWNER'S PHONE: 4084208979
SAN JOSE, CA 95112
PHONE NO: (408) 437 -6207
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E]
PROPERTY LINE CLEAN OUT
License Class "56 C-4 L. # 0� 2 / 3 S
Contractor 61�V`n't,Nj�� -1 Date IT Z c (5�--
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: $2800
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35921026.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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
WITITIN 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 DA FROM LAST CALLED INSPE TION.
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: 7 /
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:
Signatur 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)
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, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: _!�,2 Date: I
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 E P
is COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255
1. - _ (408) 777 -3228 - FAX (408) 777 -3333 • buildino(a)cuperiino.org {� M I S
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STREET ADDRESS
CITY, STATE, ZIP
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❑ OVil"a ❑ OIANER- BUMDER ❑ OMI- RAGENS ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCtIITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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COMPANY NAME
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CITY, STATE, ZIP
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USE OF ❑ SFD or DUPLEX ❑ MULTI - FAMILY PROJECT IN WII.DLAND ❑ YES PROJECT IN ❑ YES
BUJ Wa. ❑ CON•MERCIAL URBAN INTERFACE AREA ❑ NO I FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ vEs
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
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TOTAL VALUATION:
By my signature below, I certify to each of the following: I am the property ovmer or authorized agent to act on ovmerIs behalf. e 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 vrith all applicable local
ordinances and state la,,vs relating to building construct . I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Si--natureofApplicant'Agent: Date:
SUPPLE?! NTAL INFORI - iATION REQU=D
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AdEP1 isc,4pp_MLdoc revised 06121111
CITY OF CUPERTINO
FN-W-W IPV'P F QT11%4 A TnR —R1 T11 ,DING Y)IVIqION
ka,ADDRESS:
7674 erwin way
QTY/FEE
DATE: 05127/2014
REVIEWED BY: Mendez
6421��--' -
APN:
I BP#:
*VALUATION: 1$2,800
*PERMIT TYPE: Plumbing Permit
$0.00
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
[Plumb. Permit Fee:
PENTAMATION 1 RPSS
PERMIT TYPE:
WORK
ro eft y line clean out
Other Plumb Insp. 0.0 hrs
SCOPE
011a 1.1cc h7sjl:
Weo3 h?'ip'
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $24
TOTALS: $24.00
NOTE: This estimate does not include fees due to other Departments (ie. Planning, rutplic works, rire, aamiary aewer'u1strict, aunuut
--- --- --- L-- -I -- 'L- —d— —1., .. ea—nto (n"tartthp 1)Pntfnraddn'1 info.
FEE ITEMS (6m Resolution 11-053 ff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Che(:A
6421��--' -
P( , ""C"'
F
Plumb. Plan Check 1 0.0 hrs
$0.00
PME Plan Check:
F7�h
[Plumb. Permit Fee:
IPPERMIT
Other Plumb Insp. 0.0 hrs
$47.00
011a 1.1cc h7sjl:
Weo3 h?'ip'
111wO. hisp. Vee:
$24.00
I'lec, insy), 1",(::
NOTE: This estimate does not include fees due to other Departments (ie. Planning, rutplic works, rire, aamiary aewer'u1strict, aunuut
--- --- --- L-- -I -- 'L- —d— —1., .. ea—nto (n"tartthp 1)Pntfnraddn'1 info.
FEE ITEMS (6m Resolution 11-053 ff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Che(:A
P( , ""C"'
F
PME Plan Check:
$0.00
Permit Fe��:
-
PME Unit Fee:
$24.00
PME Permit Fee:
$47.00
("onsirl'101 oil 7'ax'-
�—1
Administrative Fee: IADMIN
$44.00
Work Without Permit? 0 Yes 0 No
$0.00
Travel Documentation Fee: I TRA VDOC
$47.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldp, Stds Commission Fee: IBCBSC
$1.00
$163.50
$0.00 TOTAL FEE:
$163.50
Revised: 04/01/2014
CUPERTI[NO
Address
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(c)-cupertino.org
osbf5 -3
)xide: Z_
PURPOSE
This affidavit is a self- certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
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 induding 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 combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no .commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. 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.
1 have read and agree to comply with the terms and conditions of this statement
Owner (or Owne Agent's) Name:
At et r h
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V i
Si nature ..... ............................. ........................................................... .............. Date:
Contractor Name:
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Signature ....... ............................. ..........................Lic.# ...a3�S 2 ......... Date: 4; . .. .....
Smoke and CO form.doc revised 03118114
1