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14060179 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10157 CAMBERLEY LN CONTRACTOR:CONSOLIDATED PERMIT NO: 14060179 PLUMBING INC OWNER'S NAME: ATUL AND VINITA PANDE TRUSTEE 3732 CHARTER PARK DR STE D DATE ISSUED:06/27/2014 OWNER'S PHONE: 4084469412 SAN JOSE,CA 95136 PHONE NO:(408)978-3093 LTJ' LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL El REPLACE(E)SEWER LINE&INSTALL(N)PROPERTY License Class 6 Lie.# j Z` LINE CLEANOUT n ..Y. Contractor(' r1So�i'G�(�q�e� ,��..i Date G � 2 7— L y I hereby affirm that I am licensed under the provisions of Chapter 9 SA 3 " (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:$17500 and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number:34242023 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 DAYS 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 -180 D ' LLED 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 2 / granting of this permit. Additionally,the applicant understands and will co a with all non-point source 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) 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 Ba Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cu ertino icipal de,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio s 255 ,2 33,a ;!Lte: Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 6 2`7- 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 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 [SIE I AL PERMIT APtPLI ATfON O� CO:M•MUNITYDEVELOPMENT DEPARTMENT BUILDING DIVISION EP 0 10500 TOR'RE AVENUE•C'UPE'RTINO,CA 9'50'4-3255 a. mill C'UE� E`T `NO (408) 777=3 28• FAX(4:08)777-3333•build ncMCup•er ino oro Ra. II3G TlFCI4ANlGAL <,.Fj.ECnUCAL MISC£LLA1iEOUS PROJECT ADDRESS APN PAle OWAERI7AME FHON$ _I L E-M4ILl J STREETADDRESS CITY, ATE,ZIP FAX e CONTACT NAME PHONE &MAII STREETADDRESS CITY,STATE, ZIP FAX ❑ OwNint D.:.owr>ER avis DEte ❑ OwTiER AGEi.? ❑ COWMCTOR ❑comACTOR AGENT ❑ ARCHITECT ❑ENaNEER ❑ DEVELOPER ❑.TENANT COT.7 PACTOR71i41XE LICENSE NLJI ffiER ®�/ LICENSE TYPE BUS.LIC K r CO ANY NAMB� E•bihiL 1 / p S 73 .ADDRESS CITY STA P14ONE r ARCHliECT/ENGINEERNAMELICE'SE NUMBER- BUS.LIC 9 COMPANYTAME EMAIL FAX S772ET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ' MULTIFAMILY PROJECT LN WILDL.kND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑y.S BLM.Di lo: ❑:COMJJ�CCIAL; URBAN IN-IMRPACE-AREA ❑ NO FLOOD ZONE ❑NO EICW-ZR HOER ❑NO DESCRIPTION OF WORK RAI, Awle 1/0r- Aw TOTAL VALUATION: ' two By my signature lialow I certify each of the folio �operty o�;mer or n o act on pe er's beh ve read this application and the.infblmatloq I have prov Is co�o! � 'e D ork and verify it is accurate. a r mply with alf applicable local o.*dinances and state'1a��7 relating to mg censwntz. s uporinC to enter the above-identified property for inspection purposes. S i¢nature of Applicatlt/Agent: LISP t�1\t AL lT 2AI'TON REQL>7 • i r -VEPhdiscApp_2011.doc ret'ised 06/11/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10157 CAMBERELY LN DATE: 06/27/2014 REVIEWED BY: MELISSA APN: 342 42 023 BP#: *VALUATION: 1$17,500 RPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPS USE: pPERMIT TYPE: WORK REPLACE E SEWER LINE & INSTALL N PROPERTY LINE CLEANOUT SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $24 TOTALS: $24.00 r u � _ ,LA� h: Prrt Plumb.Plan Check 0.0 hs $0.00 1;;e<'-1'I"an"heck I'.j"m;l Foe,- Plumb.Permit Fee: IPPERMIT I`E,: per ra r}'�< 1rrrE /cc° sr}- Other Plumb Insp. 0.0 hrs $47.00Jrler 1 f 1; >, 11.114nni t CoMIVILJNYTY 1VIANAGEIVIENT SERVICES March 18,2014 To Whom It M�ayConcern Re: De Anza Oaks Homeowners Association Dear Sirs: Consolidated Pl ml.ing, [nc:has the"association's permission to seek permits for the repairs of any domestic water lines otF°: or tines iuwithin the De Anza Oaks comman ity. Since CCCai 1munity Mann x neiat Services, Inc. Bill It u1b' aiA',tAssociation Manager De Ana Oaks Homeowners Association BH/st cc: Board of Directors 1935 Dry Creek Head, Suite 203■Campbell,CA•95008-3631 •voice (408) 559-1977 fax (408)559-1970 Rick Subject: FW: DEANZA OAKS/CITY OF CUPERTINO From: Bill Hubbard [mailto:BHubbard(U)communitymanagement.com] Sent: Thursday, June 26, 2014 10:19 AM To: Rick Subject: RE: DEANZA OAKS/CITY OF CUPERTINO 22900 CHR—Gladys Smith,408-996-7730 10157 CL—Atul an +' , 412 i