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11080080 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1464 JAMES TOWN DR CONTRACTOR:BAYSHORE PLUMBERS PERMIT NO: 11080080 OWNER'S NAME: KISHORE PANKAJ AND SANGEETA PO BOX 2579 DATE ISSUED:08/10/2011 �'�`"VER'S PHONE: 4082023485 MENLO PARK,CA 94025 PHONE NO:(650)323-6464 [i LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 3(O Lic.# MECH f— RESIDENTIAL COMMERCIAL Contractor� hc> P-- B&� JOB DESCRIPTION:REPLACE SEWER LINE&ADD PROPERTY LINE CLEAN I hereby affirm that I am licensed under the provisions of Chapter 9 OUT (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 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. Valuation:$5700 1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36610080.00 Occupancy Type: 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 T STARTED to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF,W(�RK' S upon the above mentioned property for inspection purposes. (We)agree to save I I UANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST C�►L INSPECTION. costs,and expenses which may accrue against said City in consequence WITHIN 180 DAYS OF PERM quence of the granting of this permit. Additionally,the applicant understands and will comply ,� c with all non-point source regulations per the Cupertino Municipal Code,Section .. Date•& -le,_ `? 9.18. n _ Iss by Signatu J y� Date RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,as owner of the property,or my employees with wages as their sole compensation, Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: [have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 o the e,Sections Compensation,as provided for by Section 3700 of the Labor Code,for the compliance Californiawdith the CupertinoChapter Code, maintain Compensation, ,Chapr 9 1h 2 and the Health& ) performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's T=ya= 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 hereby affirm that there is a construction lending agency for the performance of Hork's __Zstate that the above information is for which this permit is issued(Sec.3097,Civ C.) [certify that I have read this application a correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ng of this permit.Additionally,the applicant understands and will comply wmi all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18• Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1464 jamestown dr. DATE: 08/10/2011 REVIEWED BY: bobs. Its I APN: BP#: "VALUATION: $5,700 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPSS USE: p PERMIT TYPE: WORK replace sewer line add property line clean out SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Building 1PRSEWER 1 # $22 TOTALS: $22.00 Plumb.Plan Check0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $44.00 NOTE. These fees are based on the preliminary in ormation available and are onl an estimate. Contact the Dept for addn7 info. FEE ITEMS (Cee Resolution ll-053 F..,'tf. l.'"11) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $22.00 PME Permit Fee: $44.00 Work Without Permit? Yes (F) No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: IBSEISMICR $0.57 0.5 hrs Admin./Clerical Fee Bldg Stds Commission Fee: IBCBSC $1.00 $41.00 ]ADMIN SUBTOTALS: $111.57 $41.00 TOTAL FEE: $152.57 Revised: 07/04/2011 GENERAL PERMIT ,APPLICATION __- COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION MEP 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408)777-3228 • FAX (408)777-3333 • budding(-.cuoertino.org MISC CUPERTINO PLUIv1B JNG ❑ELECTRICAL ❑NESCELLANEOUS PROJECT ADDRESSAPN �(�� c�n��sev�h Dr. OWNER NAME 2 r . 1j (� E MAII 1 -��i Y'�i�ISP S��1 C�►/� C).C C?M�` STREET ADDRESS CC-Ya STATE; r � / FAX CONTACT NAME P�5t, 32 3 rc y E-MAIL STREET ADDRESS1 S26- S f / S+ U o IJ ,S A w 1 ! A F iJt�'2 1 C-! / ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR XCCN77ACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME PC V `l eA �' r LICENSE NUMBER LICENSE E BUS.LIC# C 1j coMPANYNAME ,5LU'% Z eV E Y�Ci c2' 1," 5 �C J�v STREET ADDRESSQ , CITY,STA ,IIP PHONE L i p_ 1 X J C' S ARCHITECT/ENGINEER NATME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-CAM FAX STREET ADDRESS CITY,STATE,ZIP PHONE SE OF or DUPLEX ❑ MULTI-FANm"Y PROTECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK :S e WC?� KA- "A- r UL • --!2i , Wet-t- A I 1 vvi-thirl ( (?)12 1�h, il k22 -t- s, L TOTAL VALUATION: ✓ RECEIVED BY: 4L�jl By a y signature below,I certlfy to each of the following: I am the property owner or authorized agent to act on the prop rty 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 buildin construe• n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: ®� �C S PLEMENT INFOMVLATION REQUMED 2E SE ONLY Tf"O-IFR-THE-COUNTER ❑ EXPRESS :E U ❑ STANDARD U ❑ LARGE ❑ MAJOR i11EPM1scApp_2011.doc revised 00/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: y 761 Mee-,S ft vv✓1 D r• PERMIT# OWNER'S NAME: K PHONE# GENERAL CONTRACTOR: pre. I l,t 111'toe r S BUSINESS LICENSE# ADDRESS: N1 ebl 1 G g Y CITY/ZIPCODE: C Z 5 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: , Sig ature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 1 �i C Owne /Contractor Signature Date DISTRICT MANAGER-ENGINEER `�'t��O%Ei BOARD OF DIRECTORS MARK THOMAS&COMPANY.INC. r� WILLIAM A.BOSWORTH RICHARD K.TANAKA JOHN M.GATTO YI ACUR'TIS B.HARRISON DISTRICTCOUNSEL ;L Wt.NOELL H.K6RR,JR. ATKINSON•FARASYN,LLP. �P-0481tfeEo % CHRISTOPHER C.LEE HAROLD S.TOPPEL 20833 STEVENS CREEK BOULEVARD.SUITE 104 CUPERTINO,CALIFORNIA 05014-2154 ' (408)2637071 PHONE • (408)253-5173 FAX 1/ www.cup ettinosanitarydistricI.ccm ,t1Z-'7 File: CuSD — MOP Building Dept. —Cupertino11� City of Cupertino Atta.: Building Department 10300 Torre Ave. Cupertino, CA 95014-3202 Subject: Install Property Line Cleun Out. Name: Pankaj Residence Address: 1464 Jamestown Dr. APN: 366-10-080 Permit No. 11080080 Videotape and Property Line Cleanout inspected. No additional conditions/requirements by the District. Inspector: Tony M Soares/Tony J Soares/Joe Pressn ........I................ •• Date:...08/30/2011................... Sanitary SewerLocation: cc: Property Owner 24' Lt P/L 38' Long 5' Deep SUPPLYING SANITARY SEYvERAGE SERVICES FOR:CITY OF CUPERTINO,PORTIONS OF THE CITIES OF SARA'roGA,SUNNYVALE,LOS ALTOS AND SURROUNDING UNINCORPORATED AREAS