14120054CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7738 OAK MEADOW CT
CONTRACTOR: SOHINI RAJPAL
PERMIT NO: 14120054
OWNER'S NAME: SOHINI RAJPAL
7738 OAK MEADOW CT
DATE ISSUED: 12/10/2014
OWNER'S PHONE: 4087078405
CUPERTINO, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
INSTALLATION OF GAS LINE TO KITCHEN FOR RANGE.
License Class Lic. #
Contractor Date
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: $1300
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36626010 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
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 DAYS FROM LAST CALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
may accrue against said City in consequence of the
/� �1 l , J
�� f� '/
costs, and expenses which
Issued by: /� r�/ �f/ 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:
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.
DECLARATION
Er OWNER -BUILDER
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 25505, 25533, and 25534.
J
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: �,�4.��+'�`^�'`"` Date:
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 14-
j y�2-�5y
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 MISC
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CUPERTINO
141,,,,, ,,. ,- I—l?.XUI,uAKjTr,AT n>TFrTRIrAI. MISCELLANEOUS
(408) 777-3228 •FAX (408) 777-3333 • building(a,cupertmo.or
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PROJECT ADDRESS
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E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME
PHONE
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STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER OWNER -BUILDER
i❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
-
E-MAIL
FAX
"STREETADDRESS
CITY, STATE, ZIP
PHONE
FDo,DUPLEX
❑ MULTI -FAMILY
PROJECT IN WBALAND ❑ YES
PROJECT IN ❑ YES
IS TIM BLDG AN L� YES
STT
COMMERCIAL
URBAN INTERFACE AREA NO
FLOOD ZONE NO
EICHLER HOME? NO
DESCRIPTION OF WORK Ax
L! A _� ,^ n ` (� / C t/ E /� ,I -
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TOTAL VALUATIONS
. (DE.,
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act 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 relating to buf din anstruction. I authorize representatives of Cupertino to enter the above -identified proppe for inspection purposes.
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Signature of Applicant/Agent:
Date: / /I 1�
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE usE,oivLY t s �4 r
OVER THE COULTER ` }
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MEPMiscApp_2011.doe revised 06121111
CITY OF CUPERTINO
1PIPIRi. F.CTTMATOR — RITILDING DIVISION
d
ADDRESS: 7738 oak meadow
DATE: 12/10/2014
REVIEWED BY: Sean
UNITS
APN:
BP#:
*VALUATION: $1,300
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
#
PENTAMATION 1 RPGAS
PERMIT TYPE:
USE:
IPPERMIT
Other Plumb Insp. 0.0 hrs
WORK
Installation of gas line to kitchen for range.
PME Unit Fee:
SCOPE
PME Permit Fee:
APPLIANCE / EQUIP TYPE
FEE ID
QTYIFEE
QTY
UNITS
BP FEES
Piping, Gas <=4 Outlets
1PGASRES
Plumb. Plan Check 0.0 1 hrs
1
#
$72
Plumb. Permit Fee:
IPPERMIT
Other Plumb Insp. 0.0 hrs
$48.00
Odier t'Ic�c. Insp.
PME Unit Fee:
$72.00
PME Permit Fee:
7r;.�p. t :e:
PIU1 , heap.7�ee:
Consloiction Tax:
1"k,( -Inst e<:
Administrative Fee: IADMIN
Sh 1
Work Without Permit? ® Yes (E) No
$0.00
TOTALS:
i
Travel Documentation Fee: ITRAVDOC
$72.00
Strom Motion Fee: 1BSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer Distract, c —
__ - G.-.._,, . sL /; . a%. r:,.., "—Hahlo and are only an estimate. Contact the Dept for addn7 info.
District, eic1. !nese ees are uuaea 011 c..c.�.w...�,W,-
FEE ITEMS (Fee Resolution-] 1-053 Eff. 7/1113)
FEE
QTYIFEE
- - -
MISC ITEMS
Man C77. he ckt: Fue:
Stir
Plumb. Plan Check 0.0 1 hrs
$0.00
PME Plan Check:
1.wfil FCC':
Plumb. Permit Fee:
IPPERMIT
Other Plumb Insp. 0.0 hrs
$48.00
Odier t'Ic�c. Insp.
PME Unit Fee:
$72.00
PME Permit Fee:
7r;.�p. t :e:
PIU1 , heap.7�ee:
Consloiction Tax:
1"k,( -Inst e<:
Administrative Fee: IADMIN
Sh 1
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer Distract, c —
__ - G.-.._,, . sL /; . a%. r:,.., "—Hahlo and are only an estimate. Contact the Dept for addn7 info.
District, eic1. !nese ees are uuaea 011 c..c.�.w...�,W,-
FEE ITEMS (Fee Resolution-] 1-053 Eff. 7/1113)
FEE
QTYIFEE
- - -
MISC ITEMS
Man C77. he ckt: Fue:
Stir
PME Plan Check:
$0.00
�z!?f'#p,'lt l`e't'•
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
Consloiction Tax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? ® Yes (E) No
$0.00
�,�i'£f:1'.'Li' f"t'tfi titi?�<-: ,T•{'tzs:
i
Travel Documentation Fee: ITRAVDOC
$48.00
Strom Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
. - 0�>S
$214.50
$0.00 TOTAL FEE:
$214.50
Revised: 10/01/2014
CUPERTINO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building @cupertino.orci
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS '773C 0"M9,A-D"� �C_, /
McG V
APN
BP#
OWNER NAME Ci���� /K p�J
OWNERADDRESS
DESCRIPTION OF WORK: S L/ N�E 6A2yll M1111\1S 1-0 k i[ IF fS
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.)
1; I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
A'2. I understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
' I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
��
name instead of my own.
A&4. I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
A -K. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer" under state and federal law.
AA r�, I understand if I am considered an "employer" under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
(.understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
OwnerBuilderForm 2010.doc revised 04/14/10
1-9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed
contractors.
_0__10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I
am the party legally and financially responsible for proposed construction activity at the site address listed above.
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
byppall applicable laws and requirements that govern Owner -Builders as well as employers.
.PJ�.12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS: Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name:
Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license,
form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued
to verify the property owner's si nature
Property Owner's Signature: Date: [ZZ acfi T7
------------------------------------------------------------------------------------------------------------------------------------
(NOTE: The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner -Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner -Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note: A copy of the property owner's drivel's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature:
Date:
OwneYBuildeYForm 2010. doe revised 04/14/10
CITY OF CUPERTINO BUILDING PERMIT INSPECTION CARD
BUILDING ADDRESS: 7738 OAK MEADOW CT
CONTRACTOR: SOHINI RAJPAL PERMIT NO: 14120054
OWNER'S NAME: SOHINI RAJPAL
7738 OAK MEADOW CT DATE ISSUED: 12/10/2014
OWNER'S PHONE: 4087078405 CUPERTINO, CA 95014 PHONE NO:
INSPECTIONS DATE INSPECTOR
BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH
FOUNDATION/PIERS/H.D.S.
COMMERCIAL
UFER GROUND
�
RESIDENTIAL
PAD/SET BACK -CERT
JOB DESCRIPTION: INSTALLATION OF GAS LINE TO KITCHD�i F�R GE.
/
GARAGE SLABS/PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
%
UNDERGROUND/SLAB
PLANNING (408) 777-3308
-
UNDERGROUND PLUMBING
_
UNDERGROUND ELECTRICAL
DO NOT POUR FLOOR UNTIL ABOVEHASBEEN SIGNED
UNDERFLOOR PLUMBING
ELECTTRICAL
UNDERFLOOR MECHANICAL
AREA/'rER#
UNDERFLOOR ELECTRICAL
WILDLAND URBAN INTERFACE FIRE
TO ARRANGE SPECTION
IPIa 1717:- i - etween 7:30 am and 3:30 Monday through Friday, at least 24 hours
UNDERFLOOR FRAMING VENTS
UNDERFLOOR INSULATION
before required inspection. Job ad ess and Permit Numbers are needed when
PLACE NO SUBPLOOR`UNTIL ABOVE HAS BEEN SIGNED
reque Ing an inspection.
FINAL: Inspector: Date:
PLUMBING
ROOF SHEATHING
HANDICAP
CUPE INO SANITARY DISTRICT
Closed circuit video in ection of property line cleanout, point of connection
ROUGH PLUMBING
ENERGY
TUBS & SHOWER PAN
* OCCUPANCY OF BUILDING NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY
-
INSPECTOR
and street lateral quired prior to passing FINAL CITY PLUMBING
ROUGH MECHANICAL
INSPECTIO Call the District (408-253-7071) for an appointment.
ROUGH ELECTRICAL/POOL BOND
—
NO BUIL ING FINALS INSPECTIONS UNTIL ALL REQUIRED
FRAMING/STAIRS/E. EGRESS
BUSINESS LICENSES ARE OBTAINED
INSULATION/VENTILATION
COVERNO WORK UN FIL ABOVE HAIN BEEN M.UNLV, PERMIT XPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT
EXTERIOR SHEAR/HOLD DOWN ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION.
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR IMPORTANT
When a permit has expired, a charge totaling one-half the fees to obtain a new permit
EXTERIOR LATH/w-SCREED must be paid in order to reactivate the permit. If a permit has been expired for more
INTERIOR LATH than one year, a charge totaling the full fees to obtain a new permit must be paid
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED to reactivate the permit.
SCRATCH COAT
NOTES:
T-BAR/MECH/ELECT ABOVE CEIL 1 ti
FINALS.,
SPECIAL INSPECTIONS Inspector: Date:
ELECTRIC METER RELEASE
GAS TEST/METER RELEASE
�
ROOF INSPECTIONS
PRE -INSPECTION: Inspector: Date:
TEAR -OFF: Inspector: Date:
PLYWOOD: Inspector: Date:
GRADE - PUBLIC WORKS
FIRE—CALL (408) 378-4010
PLANNING (408) 777-3308
_.
SANITARY (408) 253-7071
BATTENS: Inspector: Date:
ELECTTRICAL
IN PROGRESS: Inspector: Date:
MECHANICAL
FINAL: Inspector: Date:
PLUMBING
HANDICAP
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION.
ENERGY
* OCCUPANCY OF BUILDING NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY
-
INSPECTOR
BUILDING
CERTIFICATE OF OCCUPANCY *
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