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11120008 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22597 ROYAL OAK WAY CONTRACTOR: CUPERTINO PERMIT NO: 11120008 PLUMBING OWNER'S NAME: CAMPBELL,CA 95008 PHONE NO: (408)253-0618 ❑ LICENSED CONTRACTOR'S DECLARATION r r ri'- BUILDING PERMITINFO: OLnc ELECT PLUMB License C1ass_L—_%2 Lic.N C�e4 4-,F 05 r r C � ��3t,,, �� ntecu r RESIDENTIALf_. `�`BN'"'� PA.«- Date 11— 1— 11 1 hereby affirm that I am licensed under the provisions of Chapter 9 30B DESCRIPTION: COPPER RE-PIPE WATFR MAIN&WATER HEATER (commencing with Section 7000)of Division 3 of the Business&Professions REPLACEMENT Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to sell'-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. Sq. Ft Floor Area: Valuation:$6000 1 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 MIN Number:34232011.00 Occupancy T)pe: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state Imus relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,mid hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. 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 land will comply Issued b�• -- Date: with all non-point source rcgula' a Cupertino Municipal Code,Section 9.18. �_ 1/ RE-ROOFS: Si nature Date �2' All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,I agree to remove all new materials for mr inspection. ❑ OWNER-BUILD1'R DECLARATION' Signature of Applicant Data I hereby affirm that I um exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVI'RINGS1f0 BE CLASS"A"OR Bl PIER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,mid the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURIi construct lite project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of[he Califnnria lleahth&Safety Code,Sections 25505,25533,and 25534. ],,ill 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices a hick unit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Arca Air Quality.\Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Codb SectionsF5, 3 at 534. Section 3700 of the Labor Code,for the performance of the work for which this r1— permit is issued. Owner or authorized agent: Date: 0— certify that in the performance of die work for which this permit is issued,I shall not employ any person in my manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby aff inn that there is it construction lending agency for the perfmnance of forthwith comply with such provisions or this permit shall be deemed revoked. work's fin which this permit is issued(Sec.3097,Civ C.) Lender's Name APPI,ICANT CERTIFICATION' Lender's Address 1 certify that 1 have read this application and state[hal the above information is correct.1 agree to comply with all city and county ordinances and stole Imus relating an building construction,and hereby authorize representatives ofthis city to enter the above mentioned property for inspection purposes.(We)agree to save unify,and keep harmless the City of Cupertino against liabilities,judgments, ARCIIITEC7"S DIiCLA1tA"PION ts,and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO • 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . 1 . : 34232011 . 00 DATE ISSUED. . . . . . . : 12/01/2011 RECEIPT # . . . . . . . . . : BS000015455 REFERENCE ID # . . . : 11120008 SITE ADDRESS . . . . . : 22597 ROYAL OAK WAY SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BRAHMANANDAM GORTI AND LALITA ADDRESS . . . . . . . . . . : 22597 ROYAL OAK WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : FRANK CARDIA CONTRACTOR . . . . . . . : CARDIA, FRANK L LIC # 612 COMPANY . . . . . . . . . . : CUPERTINO PLUMBING ADDRESS . . . . . . . . . . : 1300 DELL AVE STE C CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 253-0618 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00 1BCBSC VALUATION 6, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BPWSVCS WATER SERVICE 1 . 00 22 . 00 0 . 00 22 . 00 0 . 00 1BSEISMICR VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00 1PPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 1PRREPIPE NO OF FIXTURE 1 . 00 12 . 00 0 . 00 12 . 00 0 . 00 1PRWHEATR UNITS 1 . 00 26 . 00 0 . 00 26 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 190 . 60 0 . 00 190 . 60 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 190 . 60 VISA --------------- TOTAL RECEIPT 190 . 60 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING • CITY OF CUPERTINO •8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 34232011 . 00 DATE ISSUED. . . . . . . : 12/01/2011 RECEIPT # . . . . . . . . . : BS000015455 REFERENCE ID # . . . : 11120008 SITE ADDRESS . . . . . : 22597 ROYAL OAK WAY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BRAHMANANDAM GORTI AND LALITA ADDRESS . . . . . . . . . . : 22597 ROYAL OAK WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : FRANK CARDIA CONTRACTOR . . . . . . . : CARDIA, FRANK L LIC # 612 COMPANY . . . . . . . . . . : CUPERTINO PLUMBING ADDRESS . . . . . . . . . . : 1300 DELL AVE STE C CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 253-0618 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00 1BCBSC VALUATION 6, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BPWSVCS WATER SERVICE 1 . 00 22 . 00 0 . 00 22 . 00 0 . 00 1BSEISMICR VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00 1PPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 1PRREPIPE NO OF FIXTURE 1 . 00 12 . 00 0 . 00 12 . 00 0 . 00 1PRWHEATR UNITS 1 . 00 26 . 00 0 . 00 26 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 190 . 60 0 . 00 190 . 60 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 190 . 60 VISA --------------- TOTAL RECEIPT 190 . 60 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING • GENERAL PERMIT APPLICATION I I M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014.3255 I SC •CUPERTINO (408)777.3228• FAX(408)777-3333• buildinO(ODcuoertino.orn PLUMBING MECHANICAL ELECTRICAL MISCELLANEGUS PROIECT ADD= �� I APNM q n527 /\ OWNERNAME (-•C• 1/Y14_ vlrGlh(Y)ra-t'11N �(D^ 9y E-MAIL lJ STREEI'ADDRESS CITY, STATE,ZIP FAX CONTACT NAME CPHONE 7 7 STREETADDRESS f ,� CRY,STATE, ZIP FAX 13 OWNER 11OWNER-BUBDER 13 OWNER AGENT n�129NiRACTD0. ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENmNSa:I ❑ DEVEIAPER ❑ TENANT CONTRACTOR NAMEn LICENSE l`� LICENSE TYPE BUS.LICA COMPANY NAME( STREET ADDRESS / 00 2-01 CA ,CITY,STATE ffi(,jf�, ba-t) 5'v CX) PHONE �Irj F3 WO—2-5 3^ CSS ARCHII'ECTIEVOINEER NAMUR LICENSE NUMBER BUS.LIC A COMPANYNAME' E-MAIL FAX STREET ADDRESS CITY,STATE.ZIP PHONE E OF orDUPLIX PROJECTINWBDIAND ❑ YES PROIECT IN ❑YS 13 THE BLDG AN ❑ YES TDTE I DING: C3 COMMERCIAL URBAN INTERFACE AREA E3NO FLOOD ZONE C3NO EICHLER HOME? ❑NO SCRIPT10N OF WORK TOTAL VALUATION:/;1000 RECEIVED BY: I' By my signature below,I certify to each of the fallowing: 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 have[ea a Desaipdan of Wor�:wdverify�, it is accurate. I agree to comply with all applicable local ordinances and state laws relaun to building con = tatives of Cupeer the above-itdentified property for inspection poses. Signature of ApplicandAgent, ate: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY u LI OVER-THE-COUNTER 6 ❑ EXPRESS Y U 2 ❑ STANDARD u ❑ LARGE ' 6 ❑ MAJOR ILIEPMiscApp 1011:doc revised 06/11/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION • its ADDRESS: 22597 royal oak way DATE: REVIEWED BY: bobs. APN: BP#: *VALUATION: $6,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1RPWS USE: PERMIT TYPE: WORK co er re-pipe, water main and water heater replacement. SCOPE APPLIANCE/EQUIP TYPELBPWSVCS QTY UNITS BP FEES Water Service 1 # $22 Re-Pipe Interior PE 1 # $12 Water Heater 1 1 # $26 TOTALS: F $60.00 dfe,•h. Plan Check Plumb.Plan Check 0.0 hrs $0.00 E/er.Mail Ch".-(A .Mech. Perma Fee: Plumb.Permit Fee: IPPERMIT 1:7ec. Permit Fee: • <khrr 11"ch.hap. Li I Other Plumb Insp. 0.0 hrs $44.00 Other idea. Insp. El R�ch.Inst'. Fee: Plumb. Insp. Fee: Eley.Insp, Pee: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc.). Thesefees are based on the preliffina information available and are only an estimate. Contact the Dept for addh7 infa FEE ITEMS /Fee Resolution 1/•053 E2 7/1./1!1 FEE QTY/FEE MISC ITEMS Plan Check .Supp). PC'Fee PME Plan Check: $0.00 Permit Fire: Supp[ harp Flee PME Unit Fee: $60.00 PME Permit Fee: $44.00 Con.rtrrnaiun 7hc Administrative Fee: ]ADMIN $41.00 Work Without Permit? 0 Yes (D No $0.00 4,1vanced Plarrning F'ec,�: Travel Documentation Fee: ITRAVDOC $44.00 Strong Motion Fee: IBSEISMICR $0,60 Select an Administrative Item • Blda Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $190.60 $0.00 TOTAL FEE: $180.60 Revised: 10/01/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ' ( PERMIT# C4,9 OWNER'S NAME: car+: �t PHONE# G ' �6 GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *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 SUBCO OR HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractor . Signature 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 Owner/Contractor Signature Date