15040005 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21647 RAINBOW DR CONTRACTOR:NEW PIPES INC PERMIT NO:15040005
OWNER'S NAME: PATIL SUHAS S AND JAYASHREE S 1515 MERIDIAN AVE STE 203 DATE ISSUED:04/01/2015
OWNER'S PHONE: 4083072310 SAN JOSE,CA 95125 PHONE NO:(408)269-1969
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
INSTALL NEW GAS LINE TO OUTDOOR PATIO.
License Class Lic.#
Contractor-----'46 Date 1
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:$10000
1 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:36637002.00 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 D 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 DAYS AST CALLED 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 Issued by Date:
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.
��,�, J� ROOFS:
Signature Date All roofs shall be inspected prior to any r
"`yy 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
f
Health&S
H
he eaSafety Code,Sections 25505,25533,and 25534.
I have and will maintain Worker's Compensation Insurance,as provided for by tc
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent:92, 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
918.
Signature Date
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION off'
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 U
CUPERTtNf3
(408).777-3228• FAX(408)777-3333•building(ftypertino.or4 misc�
PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS I � 1 ?I O \ APN# '] (/` p o
OWI�ERNAME ("� _ J,�/ir OTTE P E-/MAIL
STREET ADDRESS ( / / 41 )Y)&Q ®, CITY ST Far A FAX
CONTACT NAME �'��/ D P �/ j l '7/ `lE MAIL
STREET ' uck�� CITY T TE, ��- �/� FAX
❑ OWNER ❑ OWNER-BUJLDER ❑ OWNER AGENT yrCONTRACTOR - ❑CONTRACTOR AGENT ❑ ARCHTTECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORA'AME I`k4'WOE"7
LICKS BUS(! l J4. C / 1
L
COMPANY NAIAF ` /J, MAILC - Z6 cF (q "4
-
STREET ADDRESS ( �� 1�l CI S �TF�QIP11
C
41
ARCIETECT/ENGINEER NAME LICENSE NUMBER/ BUS.LIC#b
12k
COMPANY NAME E-MAIL FAX r I
STREET ADDRESS CITY,STATE,ZIP P ONE V
USE OF or DUPLEX ❑ MULTI-FAMILY PROJECT IN'WI DLAND ❑ YES. PROJECT IN El THE BI AN EI YES
BUILDING: COMMERCIAL URBAN INTERFACE AREA " " O FLOOD ZONE 'O EI HOME? NO
DESCRIPTION OF WORK
�yz-
TOTAL VALUATION: RECE�DBYt �
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prope 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 build' nstru=tautbo e esentatives of Cupertino to enter the above en fled/pro for inspection purposes.
Signature of Applicant/Agent: Date: ^ ^(U
SUPPLEMENTAL INFORMATION REQUIRED ` `�' ` x'
r OFIGEat7SEO1�LY, ;
n� ,O,YER- I�-COUjViER �;;
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MEPMiscApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 21647 Rainbow Dr. DATE: 04/01/2015 REVIEWED BY: Sean
APN: BP#: *VALUATION: 1$10,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION 1 RPGAS
USE: p PERMIT TYPE:
WORK Install new gas line to outdoor patio.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Piping, Gas <=4 Outlets 1 PGASRES 1 # $72
TOTALS: $72.00
:I1ech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check
tfech. !'erwit Fees Plumb.Permit Fee: IPPERMIT Elec Permit Pee:
cher Hoch.Jnsp. Other Plumb Insp. 0.0 hrs $48.00 Oche'I-Am Insp.
Lh:ch.Imp. Fee: Plumb. Insp. Fee: Lslec.Insp. Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These&es are based on the prefindna information available and are only an estimate. Contact the Dept-for addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
.5uppl. P(, Fee
PME Plan Check: $0.00
Permit Fee:
suppl. Insp Pee
PME Unit Fee: $72.00
PME Permit Fee: $48.00
Construct.on Tax:
Administrative Fee: ]ADMIN $45.00
Work Without Permit? ® Yes (F) No $0.00
I)dvanced Plunning lees:
Travel Documentation Fee: 1TRAVDOC $48.00
Strong Motion Fee: 1BSEISMICR $1.30 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
s $215.301 $0.00 METoAI.FEEsY' $215.30
h
Revised: 02/14/2015
lfiAt Gip /,6i#T owe
lfT K gAlu $t'OF-kxua
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the_ OC#T tAmfI 3� 14C)0-4:1196
job site during construction. It is unlawful to make any, _ ';`� �.•U� X13,00
changes or alterations on same, or to deviate! ��t)� ��W�leslsi ooh
therefrom, without approval from the Building Official. APR 0201`�
The Stamping of this plan and specifications SHALL NOT 45T "WE
be held to permit or to be an approval of the violation x= '� ----- 9&T fiT ya;pD°
of any pro .i ns of any City rdinance or State Law.
BY �A�v / � 323joo
DATE
PERMIT
'-�UPERTINI
t3uildirtq D,-oartm9nt
=- 0 1 2015
i�f h N�tT t vIBVVEL r-UK GUMPLIACE
COPY rZevlewea ByMEI�4 TO
SCALE: N' S APPROVED BY: DRAWN HY t-k
DATE:'-H S REVISED
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% ^ � � I� 6DO ^„ ' DRAWING NUMBER
8X 11 PRINTED ON NO.1000H CLEARPRINT• Q'J� GF9 YI,//�J{(1 'l/T