B-2017-1360CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1360
1527 POPPY WAY CUPERTINO, CA 95014-5306 (366 15 029)
MARTI'S PLUMBING
SERVICE
CUPERTINO, CA 95014
OWNER'S NAME: CHATTERJEE NILANJAN AND BIJOYA
DATE ISSUED: 08/16/2017
OWNER'S PHONE: 669-222-9164
PHONE NO: (408) 375-3190
LICENSED CONTRACTOR'S DECLARATION
BUILDING.PERMIT INFO:
License Class CC=36 Lic. #958020
Contractor MARTI'S PLUMBING SERVICE Date 02/28/2019
C BLDG —ELECT 3X PLUMB
MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
REPLACE SEWER MAIN; CLEAN-OUT; PROPERTY LINE
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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.
I have and will maintain Worker's Compensation Insurance, as provided for by
f- Section -3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $4500.00
permit is issued:
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
366 15 029
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,ag'ainst liabilities,, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK ISNOT 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.
L—i
Signatu J Date 08/16/2017
Issued by: Kim Dunbar
OWNER -BUILDER DECLARATION
Date: 08/16/2017
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
t. I, as owner of the' propertyor my employees with wages as their sole
installed without first 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 tlie propeity, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct,the project (Sec.7044, Business & Professions Code).
Date: 08/16/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "All OR BETTER
1. I have and will maintaiti a Certificate of Consent to self -insure for Worker's
Compensation, ,asrprovided 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
'
is issued. ',
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit
I
s. I certify that m the of the work for which this is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
performance permit
shall not employ'any person in anymanner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality' Management District I
Worker 'sCompenkat ion 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 mtist forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agen
APPLICANT CERTIFICATION
Date: 08/16/2017
I certify that I have read this application and state that the above information is
CONSTRU TION'I ENDING 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 corsteuction,I 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 indernnify,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.
I understand my plans shall be used as public records.
Licensed
Signature Date 08/16!2017
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE e CUPERTINO, CA 95014-3255
(408) 777-3228 • building@cupertino.org PEMIT #B -
CUPERTINO
❑ NEW CONSTRUCTION []ADDITION ❑ ALTERATION ❑ T.I: u MEP ` ❑ RE -ROOF [:]SWIMMING POOL/SPA
PROJECT ADD / W
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OWNER NAME PHONE
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NAME ❑ OWNER -BUILDER
CO ANY NAME
LICENSE NUMBER
LICENSE TYPE
STREET DRESSCITY,
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STATE ZIP
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❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTORAGENT C1 ENGINEER ❑ DEVELOPER ❑ TENANT
CONT NAME
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STtEET ADDRESS
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DECRIPT C� W l y
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❑SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
I EXISTING IF
NEW FLOOR IF
PORCH
IF DECK SF
DEMO SF
STORIES #
TOTAL NET SF
REMODEL
REMODEL KITCHEN
REMODEL OTHR GARAGE
❑ ATTACHED
BATHROOM IF
IF
IF IF
❑ DETACHED
EXISING ❑ YES
EICHLER ❑ YES
SECOND STORY ADDITION ❑ YES
FIRE SPRINKLERS ❑ NO
� ❑ NO
❑ NO
DWELLING SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER
UNITS '# UNIT.ADDITON: El NO SF
I
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - IF SPA - IF SPA ATFACHED ❑ YES ❑ NO TOTAL - SF
�
Cmnmercial or Multi-Famihl BuildinV with Public Swimming Pools requires Department of Environmental Heath approval
RE IV TOTj/A�L VALUATION:
i
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES❑ WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE' ❑ NO
IF NO
I
PLYWOOD ❑'h" ❑ 3/8"
PLYWOOD TYPE:
PITCH:
12
ROOF CLASS
E]YES
' n OF LAYERS
THICKNESS 5/8" OTHER
❑
OSB CDX OTHER
❑ ❑
A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES ❑ OTHER
*Provide a signed copy of the Cupertino's Tear-OffPolicy IF not SQUARES
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 read 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 to building construction. I authorize representatives of Cupertino to
enter the above -identified property for inspection purposes. I acknowledge and authorize all information contained on this application form
to be made available for public record.
r(
Signature of Applicant/Agent:. Date: U
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal'of Building Permit application.
*HOA -Provide a letter of approval fiom the Home Owner's Association
BldgApp 2017.doc revised 08/01117
4-��-t_T2
CUPERTINO SANITARY DISTRICT C�
20863 Stevens Creek Blvd #100, Cupertino, CA 95014
Tel (408) 253-7071 Fax (408) 253-5173 mss'+eclseep�9�'�~CVPERTINo
SANITARY DISTRICT PERMIT FETTER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over -the -Counter)
Single Family Project ❑ Multi -Family Project ❑ Commercial Project
Project Address: BTA 'Qly
Permit Number: owirc
Scope of Work:
Owner/Applicant Name: t 9r-�-1 I . (al to m OUo R Phone:
T-
Date: Prepared By:
City Authorized Representative
1, as property owner or authorized agent, acknowledge that all Cupertino Sanitary District requirements
will be met and all required fees will be paid prior to the approval of final inspection for proposed project:
Date: — Signature:
Owner / Authorized Agent
CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
❑ Pre -inspection Required
Date Scheduled:
Final Inspection Required
Date: Conditional Approval By:
Authorized R presentative
Cupertino Sanitary District
District will notify owner of the required fee within 5 days after Pre -Inspection has been completed and cc
City of Cupertino.
'Inspection Fee Paid Date Paid: �%—�--
Connection Permit Fees:
❑ $350/unit - Single Family Residential connecting to existing lateral (CCTV & inspection
included)
❑ $650/unit - Single Family Residential connecting with new lateral (CCN & inspection
included)
❑ $100/unit up to 4 units & $65 above 5 - Housing (Multiple, hotel, condo, living units, etc.)
$500/connection - Commercial & Retail (Permit only. CCTV and inspection not included)
❑ $200/each — Disconnect Permit
Inspection Fees:
$250/unit - Single Family Residential already connected, but new cleanout required
(CCTV & inspection included)
❑ $150/unit - Single Residential already connected w cleanout (CCN & inspection
included)
Date` Final Approval By:
Authorized presentative
Cupertino S nitary District