15040060 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10080 IMPERIAL AVE CONTRACTOR:ALLSTAR PLUMBING PERMIT NO: 15040060
OWNER'S NAME: RAJ JAKKANPUDI 326 PHELAN AVE DATE ISSUED:04/08/2015
O 'S PHONE: 4083662641 SAN JOSE,CA 95122 PHONE NO:(408)230-5569
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL Ej
REPLACE(E)WATER HEATER,SAME LOCATION
License Class Lic.#
Contractor—
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 Valuation:$2350
performance of the work for which this permit is issued. Sq.Ft Floor Area:
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:35722012.00 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 WIT D T ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter OM L ED INSPEC IO
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ate:
granting of this permit. Additionally,the applicant understands and will c Issued by:
with all non-point source regulations p e Cupertino Municipal Code, ection
918.
RE-ROOFS:
Si y 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-B LDER DECLARATION Date:
Signature of Applicant:
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
1,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) HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to
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(x)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
the Health&Safety Code,Sections 2550 55 ,and 25534.
1 have and will maintain Worker's Compensation Insurance,as provided for by r
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 o MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O
CA 95014-3255
(408) TORRE AVENUE•CUPERTINO Ca.c
CUPERTINO� (408)777-3228•FAX(408)777-3333•buildinaupertino.ora MISC
PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS I 01MO APN#
OWNERNAME E-MAIL
STREET ADDRESS �� f ,�„ CTI'Y, ATE,ZIP FAX
CONTACT NAME PHONE e E-MAIL
STREET ADDRESS WkA A-is A V-D 4t A D CITY,STATE,ZIP No
FAX
St CA at504 1❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAM LICENSENUMBER.4 LICENSE TYPE BUS.LIC# �..p
COMPANY NAME E-MAIL FAX
STREET ADDRESS n r�o CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMII.Y PROJECT IN WILDLAND ❑ YES7PR'0ECT IN ❑YES IS THE BLDG AN El YES
BUILDING: ❑COMMERCIAL - URBAN INTERFACE AREA ❑ NOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WO 0G ` /n„,„�„�/D/ (1 -P—
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TOTAL VALUATION:
By my Signature below,I certify to each of the following: I am the pro erty owner or authorized agent to act on the property ehalf I have read this
application and the information I have provided is correct. I haver a Description of Work and verify it is accurate a to comply with all applicable local
ordinances and state laws relating to building con c' n. I au rize representatives of Cupertino to enter the abov-i entified operty for inspection purposes.
Signature of Applicant/ en` Date:
SUPPL RMATION REQUIRED
Q � OFFICE USEONI.X ' °'
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revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10080 IMPERIAL AVE DATE: 04/08/2015 REVIEWED BY: MELISSA
APN: 357 22 012 BP#: "VALUATION: $2,350
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/Repair
PRIMARY PENTAMATION PRWHEATR
USE: SFD or Duplex PERMIT TYPE:
WORK REPLACE E WATER HEATER SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $29
' $29.00
TOTALS: ix, �.
777,7 7
WN
Mech. t'lrrn Check Plumb.Plan Check 0.0 hrs $0.00 L1c-�' t'tizn£`heck
me6h. Perinit Fee;
Plumb.Permit Fee: IPPERMIT !>lec. Permit Pee:
Orhe� -lleckr.Irs,}. Other Plumb Insp. 0.0 1us $48.00 Qrker like.Ina 7.
_,facer. Insp.Fee:
P7samb. Trap. Fee: Eslcc.Imp.Fee:
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fees are based on the preliminaryin ormation available and are onlyan estimate Contact the De t or addn'l in o.
FFEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE
MISC ITEMS
C:"heck Fee:
pl. Pt`I°ee
PME Plan Check: $0.00
Permit Fee:
Supp/, Insp P'ee
PME Unit Fee: $29.00
PME Permit Fee: $48.00
Construction Tax:
Administrative Fee: IADMIN $45.00
Work Without Permit? ®Yes (E) No $0.00
Advanced 111cxr1r"iing Fee's:
Travel Documentation Fee: ITRA VDOC $48.00
Strong Motion.Fee: 1BSEISMICR $0.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
$171.50 TALEEE: $171.50
r
Revised: 04/01/2015