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B-2016-2264 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2264 10375 HENEY CREEK PL CUPERTINO,CA 95014-0829(342 48 026) ALLSTAR PLUMBING CORPORATION SAN JOSE,CA 45112 OWNER'S NAME: RATTAYYA JASTI V TRUSTEE&ET AL DATE ISSUED:07/05/201 OWNER'S PHONE: PRONE NO:(408)282-7020 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic.#732611 Contractor ALLSTAR PLUMBING CORPORATION Date 02/28/2017 X BLDG _ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERC with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: REPLACE WATER LINE COPPER TIPE M TO IPE L s. 1 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. 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 permit is issued. Sq.Ft Floor Area: Valuation:$5841.88 APPLICANT CERTIFI ATIOIV 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 342 48 026 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 all 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. Signature l Date 7/5/2016_ Issued by:AbbyAyende Date:07/05/2016 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 first obtaining an inspection,I agree to i emove 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:7/5/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"All OR BETTER 2. 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 DISC O URE 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 ode,Chapter 9.12 and the 3. 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 shall not employ material. Additionally,should I use equipment or devices which emit hazardous p y an y person in any manner so as to become subject to the air contaminants as deflued 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 et-y-Eode-Seetiens-255-Q5 2 5533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall J be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION �Date:7/5/2016 certify that I have read this application and state that the above information is CONSTRI F,?AW]N- EN–C—y ., 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 T' DE A ON Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 7/5/2016 Professional r v: GENERAL PERMIT APPLICATION EP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO,CA 95014-3255 CUPERTtlw O (408)777-3228•FAX(408)777-3333•building(cDcupertino.org Isc vt(P -22 dPLUMBING [:1 MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN# Liq OWNERNAME ' a PHONE t� E-MAIL _! 2aiEq�y STREET ADDRESS +�,y�2 - � �� CITY,STATE,ZIP� f I FAX CONTACT NAME Q1 © PHONE j j j a - J�j_ qo E-MAIL, STREET ADDRESS y r_ � A O'Ip s CITY,STATE,,ZIP 5CA 6t tt FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 11CONTRACTOR AGENT ElARCHITECT `I—]ENGINEER ❑ DEVELC PER ❑ TENANT ,r CONTRACTOR NAME LICENSE NUMBER 2 y LICENSE TYPE 3 6 BUS.LIC# : COMPANY NAME 1 t\S+CkW 'V 1 E-MAIL c J j FAX STREET ADDRESS y � CITY,STATE,ZIP_ .. e PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER G BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SED or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK � ` p aj �� 1 4& l TOTAL VALUATION: AEC&IVED BY: c r- v v By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have re d 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 A build g construction. I authorize representatives of Cupertino to enter the above-identified property for inspectior purposes. Signature of Applicant/Agen: , Date: 16 SU EmE-WAt INFO'RMAT'ION REQUIRED U£FICE vSB ONLi; sc� '�. OVER.-TI3E-rOI3NTEIL �" �,.EXP72ESS i� �❑^STANAARD . CJ a ❑ LARGL� 0." Q.l?AJOK,' MEPMiscApp_2011.docre ised 03/16/11