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15120075CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10721 CULBERTSON DR CONTRACTOR: RELIABLE ENTERPRISES PERMIT NO: 15120075 INC OWNER'S NAME: MAREPALLY RAJESH & LAKKARAJU 324 COOGAN WAY DATE ISSUED: 12/08/2015 OWNER'S PHONE: 4085059611 EL CAJON, CA 92020 PHONE NO: (858) 699-0033 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ /' /' kicense ��D�� REMOVE AND REPLACE 50 GALLON WATER HEATER IN Lic. # Class Com,, SAME ��f/ e-1 z � e 4,/b Date �Z J 2_ei1Zj — LOCATION. ontractor 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 Sq. Ft Floor Area: Valuation: $1200 performance of the work for which this permit is issued. 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: 37536036.00 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 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 FROM LAST 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 v ��%�� % G granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source reg at' ns per the Cupertino Municipal Code, Section 9.18. �Z 2 2XJ RE -ROOFS: Signature Date All roofs sliall 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) 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(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 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 caner or authorized agent: Date: � 01__ Z 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 GENERAL PERMH T APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 T ORP.E AVENUE • CUPERTINO, CA 015014-3255 - (408) 777-3228 • FAX (408) 777-3333 • bui1dlno(Q cuDer'ilno.Orq ®U CUPERTINO- l� �� M I � PLUA LAG [:1 MECHANICAL ❑ELECTRIC& L ❑l,,,'ISCELLaNEOUS PROJECT ADDRESS it n 2 APN t g;7 O OCv-1�T RNf?✓��e- /�_/ /7� �0l I PHOl\��0��✓ '%��L I E-IJ�1.�� S 1S`l�T/�e FAX .0T &1 ��roAl CONTACT N.� l✓E % [f PHO��'®�� E-?✓mak L �`L /� ^ / �D �i SS Mf C% S/U ❑ Oti L ❑ OR3:':P-B=m ❑ Ow1,�t AGENT 6'-CO1`7RgCTOR ❑ CONrTP.ACTOR AGE1:•T ❑ ARC=CT ❑=?7GiT= ❑ DEVELOPER ❑ MK,,.I:Z' CONTRACTOR NP.l,E �J /e� � �q I LICENSE'NUM 3ER /�yD3 r� I LIC SE T 1Y - n I BUS. LIC 1 CO?JrP.AhY NA? E-NLSIL I FAX STMO �'VK�4/CITY, s ARCHITECT) TGiNEERTATE LICENSENU,M—P. I DUS.LIC R C0113A_>vY NAME E-24AIL I FAY STREET ADDRESS I CITY, STATE, ZIP I PHONE USE OF MorDL'PLFX ❑ MULTI-FAI,ffi.Y PROi_CT IN Wn DLA -KD ❑ YFS PROY-ECT IN ❑ YES 1S THE BLDG AN ❑ -ns Bu-LT-rjD.G:❑ COI,G,=', LJRA ,CLAL I BLN1T=R?.CF ARZA Rw l.'O FLOOD ZONE NO EICELER$ON E7 NO DESCP,TTION OF WORK " Geer i��a 1�� r� �'�� r TOTAL VALUATION: 2 OO RrC�I1 D�a1 r`? y x3 y v .4 By my signatu-e below, I certify to each of the following: Ian the property owner or authorized agent to act on the proper owner's behalf. I have read this - application and the Lnfornation 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 crd»ances and smote laws relating to bu ]ding construction. I Z413thorizce representatives of Cupertino to enter the above-ide• ti5ed propel y for inspection purposes. SigyatureofApplicani/Agent: Date: =� SUPP_El\TEItIALLt\TFORv1ATI0N REQLIP.rD M. OFFSCELSEOLI`n,,-� F-2: OV£R,TIiE CO[d�TrR " VA. A-HR,s.� ' j "E�.RE�SI I� f k rrr ✓ ,f "M -"W. AIEPArfsc.gpp_2011.doc revised 06121/11 CITY OF CUPERTINO FFF, F.,PftTIMATOR —RITIT .DING DIVISION im� ADDRESS: 10721 Culbertson Dr DATE: 12/08/2015 REVIEWED BY: Sean APN: I BP#: *VALUATION: 1$1,200 '-PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex A,fec,fi. lnsv. 1'"'..'e: PENTAMATION PRWHEATR I USE: $0.00 PERMIT TYPE: A WORK Remove and replace 50 gallon water heater in same location. SCOPE A,fech Pllrs Plumb. Plan Check 1 0.0 1 hrs $0.00 QTY/FEE A,Iech, P, -,r r,�it Plumb. Permit Fee: IPPERMIT I ce: Other Plumb insp. 0.0 hrs $48.00 F A,fec,fi. lnsv. 1'"'..'e: lnsv� PME Plan Check: TOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These.fees are based on the preliminary information available and are only an estimate. Contact the Dept lor addn'l in/o. FEE ITEMS (Fee Resolution .11-053 Lff._711113) FEE QTY/FEE MISC ITEMS Alan ("'hecy" F PME Plan Check: $0.00 P00: PME Unit Fee: $29.00 PNIE Permit Fee: $48.00 M"s INRCROH 1.0..d. Administrative F 1ADMIN $45.00 Work Without Permit? 0 Yes (E) No $0.00 Travel Documentation Fee: ITR,4VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 131d.g Stds Commission Fee: IBCBSC $1.00 �sZUBTOTALS-$171.50 $000111 TOTAL FEE: $171.50 Revised: 10/01/2015