B-2018-0054CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0054
10240 STERLING BLVD CUPERTINO, CA 95014-3826 (375 24 024) MOOMAU PLUMBING
SAN JOSE, CA 95118
OWNER'S NAME: MATHU CHANDRAMOHAN AND CHANDRAMOHAN DATE ISSUED: 01/09/2018
SHANMUG
OWNER'S PHONE: 408=861-9456
License Class C_ -H Lic. #Z9-2-821
Contractor MOOMAU PLUMBING Date 08/31/2018
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:
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.
2. 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.
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
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 indemnify and keep harmless the
City of Cupertino against liabilities, judgments, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source reg s per the Cupertino unicipal Code, Section 9.18.
Signature Date 1/9/2018
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
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.
2. 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.
3. 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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 indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 119/2018
PHONE NO: (408) 396-3837
BUILDING PERMIT INFO:
X BLDG —ELECT $ PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPLACE 50 GAL WATER HEATER - SAME LOCATION
Sq. Ft Floor Area: I Valuation: x1950.00
APN Number: Occupancy Type:
375 24 024
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby A ene
Date: 01/09/2018
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without fust obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 1/9/2018
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health &Safety e, tions 25505, 25533, nd 25534.
Owner or authorized agent:
Date: 1/9/2018
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
0 (408) 777-3228 • building@cuper ino.or r PEMIT #B - -
CUPERTINO REV # DEF#
n NEW CONSTRUCTION I -I ADDITION I—I ALTERATION �I T T Fl" 1 A4F.P I—I RE -ROOF I� SWIMMING POOL/SPA
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PROJECT ADDRESSEE
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ONTRACTOR NAME ❑ OWNER -BUILDER COA
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DECRIP'IL
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INGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($}
XISTING USE
EX15TING SF
NEW FLOOR SF
PORCH
SF DECK SF
DEMO SF
I STORIES 9
TOTAL NET SF
REMODEL
REMODEL KITCHEN
REMODELOTHR GARAGE
❑ ATTACHED
'
BATHROOM SF
SF
SF SF
❑ DETACHED
EXISING ❑ YESEICHLER
SECOND STORY ADDITION O
FIRE SPRINKLERS ❑ NO
C3❑YES
NO
NO
DWELLING SECOND DWELLING []YES ❑ATTACHED❑DETACHED OTHER
UNITS # UNIT ADDIInN: ❑ NO S F I
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNFFE ❑ PREFABRICATED
POOL -SF SPA - SF SPA ATTACH ED ❑YES [I NO TOTAL -SF
rRE/�W,i D Y.
TOTAL VALUATION:
Cmnme,dalw Multi-Famda Buildin&s with Public Suamnune Pools require Denariment of Emrirorunenta! Henlh nl rn:+al
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RE -ROOF EXISTING P.00F TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES F] WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE NO
I IF NO
PLYWOOD ❑'� ❑ B/$`
PLYWOOD -TYPE:
PITCH: ROOF CLASS
YES
# OF LAYERS
THICKNESS ❑ 5/8" OTHER
❑ OSB ❑ CDX OTHER
:12 A .
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES ❑ OTHER
*Provide a signed copy of the Cupertino's Tear -Off Policy SF kof 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 identifiedproper p ction pur ses. I acknowledge and authorize all information c main d on this application form
to be made available for publicr card
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION RJIRED
*New SFD/Second Dwelling Units/Multily 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 from the Home Owner's Association.
BidgApp_2017.doc revised 08101/17
9 S- 90