16010010CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20718 GARDEN CREST CT
CONTRACTOR: TRENCHFREE INC PERMIT NO: 16010010
OWNER'S NAME: PENDHARKAR SUMIT AND ERANDE MONIKA
PO BOX U DATE ISSUED: 01/04/2016
OWNER'S PHONE: 4085134753
SAN JOSE, CA 95151 PHONE NO: (408) 726-7926
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REPLACE WATER SERVICE FROM METER TO PROPERTY
License Class / Z Lic. #
Contractor/ eve -ee �✓t-C. 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
Sq. Ft Floor Area:
Valuation: $2350
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: 36230054.00
Occupancy Type:
permit is issued. )_ WA _ I
l/
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 INSP TON.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
&"4�ttujvl" 9
Date:
Issued by: Da
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
RE-ROOFS:
9.18.
�� r
Signature Date !fo
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
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)
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. 1 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 2550 33, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized ag Date: II-q—)
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
CUPERTINO-
ZAP
GENERAL PERMIT APPL[GA►[ON 160IGNO
C0MN)IUNIiY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 05014-3255
(408) 777-3228 • FAX (4,08) 777-3333 • buildino(a)CUDertino.or4
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USE OF ❑SFDorDUPLE: ❑ MULTI-F.4,0LY LN' WTI DLAS� ❑ YEs
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DESCRIPTION OF R'O.kK
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TOTAL VALUATION:
2,71-0
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By my signa«re below, I certify to each of the following: I= the property owner or authorized anent
to act on the rope, ov;,ner's behalf. I have read this
applicztion and the L-iformation I have provided is correct. I have read the Description of )York and verify it is accurate. I agree to comply with all applicable local
ordinances aad st=te lati•s relatir!g to " a` onstruct' �, I authonze representatives of Cupertino to enter the above-identiEed property for inspection purposes.
Si—nature A.pplicant/A
Date:
of gent:
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MEP-AlflscApp_2011.doc remised 06121/11
CITY OF CUPERTINO 16010010
W.'Ma FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20718 Garden Place Ct
Plumb. Plan Check 10.0 1 hrs $0.00
DATE: 01/04/2016
REVIEWED BY: PAUL
APN: 362 30 054
1 BP#:
'VALUATION: 1$2,350
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PME Plan Check:
$0.00
PENTAMATION I RPWS
PERMIT TYPE:
WORK
Re place water service from meter to property
SCOPE
-WeehNon,
Plumb. Plan Check 10.0 1 hrs $0.00
1 1
penw,-' Fee:
Plumb. Permit Fee: IPPERMIT
In
Other Plumb Insp. Rol hrs
.-Vech. 1,,?sp.
jpay. Pei�:
PME Plan Check:
VOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). Thesefiees are based on the preliminary information available and are.only an estimate. Contact the Dept,lor addn'l in
FEE ITEMS (]-'ee Resolution .1.1-053ff 71111.13)
FEE
QTY/FEE
MISC ITEMS
Nan
PME Plan Check:
$0.00
PNM Unit Fee:
$25.00
PME Permit Fee:
$48.00
("0f?S11"R1'f10f 7 7.`CI%,:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
lI.iTlia.T%'.t%i;a
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Suds Commission Fee: IBCBSC
$1.00
SUBTOTAL 8�'
$167.50
$0.00 TOTAL FM,
1$167.501
Revised: 10/01/2015