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B-2016-1848 CITY OF CUPERTINO BUILDING PERMIT BUIMINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-1848 10335 FINCH AVE CUPERTINO,CA 95014-3412(375 43 010) QUALITY PLUS PLUMBING SANTA CLARA,CA 95051 OWNER'S NAME: SREEKANTHAM SREENATH AND SHAILAJA DATE ISSUED:04/28/2016 OWNER'S PHONE:408-896-5742 PHONE NO:(408)219-4655 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC36 Lic.#873636 Contractor QUALITY PLUS PLUMBING Date 03/31/2018 X BLDG —ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing. MECH X RESIDENTIAL COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: INSTALL(I)GAS LINE FROM METER TO KITCHEN 12%N I hereby affirm under penalty of perjury one of the following two declarations: ELECTRICAL OUTLET 1. 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 p ormance 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 permit is issued. Sq.Ft Floor Area: Valuation:$650.00 APPLICANT CERTIFICATION 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 75 Number: Occupancy Type: 3 and state laws relating to building construction,and hereby authorize 375 43 010 representatives of this city to enter 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ` ignature/^ Date 4/28/2016 Issued by:Abby Ayende Date:04/28/2016 V►1l/Vl OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without fust obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:4/28/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall .00 be deemed revoked. I ner or authorized agenic APPLICANT CERTIFICATION ate:4/28/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 4/28/2016 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 +uUPERT[NO (408)777-3228-;FAX(408)777-3333• building(cDcupertino.org m I .'B Z01 1- LUMBING ❑MECHANICAL LECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS I G�� C� APN# OWNER NAME E-MAIL 5 5n h_rH 5a,L--,�A-Y7T�lr42— PHONE6a Z yZe )-.4 jz STREET ADDRESSCITY, STATE,ZIP FAX ((_)5!)_j5_ ff/"61-t A//L_ C_0715 i r?U LA CONTACT NAME PHONE E-MAIL A-n, /)-1-16HCIL-� STREET ADDRESS 2 n 1�C �l^ CITY,STATE, ZIP �J c,4rJ� 5-1 1 FAX ❑ OwNER ❑ OWNER-BUILDER ❑ OWNERAGENTT ❑ CONTRACTOR ;WONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBERLICENSE T E BUS.LIC#4®�L.y P)1_ I U✓�� eA '92363a G COMPANY NAME E-MAIL FAX A- PL-V'-'310�, �, G��QI'7" STREET ADDRESS CITY,STATE,ZIP PHONE ��-2 ��-�n� 'q-3v ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE.AREA NO FLOOD ZONE "El NO EICHLER HOME? 14n_90 DESCRIPTION OF 1VO RK1)V1` LLtnC, L} rnj,_-t,_V 3/41 G,JrL(r✓fi,iZ%3� �A-5 i–i 0 Pn� i i-QVI,/'l L TOTAL VALUATION: RECEIVED BY By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property o ner's be If. I have read this application and the infonnation I have provided is correct. I have read the Description of Rork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building struct. I authorize represe tatives of Cupertino to enter the abov o ntified p pertyJfor inspection purposes. Signature of Applicant/Agent: _ 1� 8/ SUPPLEMENTAL INFORMATION REQUIRED oFizcE osE`bnL� c� ❑ O\rER THE-COUNTER ❑ EXPRESS U 0."STANDARDt� e," U ❑ LARGE:5 ❑ AIAJOR A1EPA1iscApp_2011.doc revised 06/21/11