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10100122 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10413 GLENVIEW AVE CO gTRACTOR:NEW STRUCTURE PERMIT NO: 10100122 PLL MBING INC (AVNER'S NAME: PRASAD NALLAMOTHU PO 30X 111143 DATE ISSUED: 10/15/2010 .,NER'S PHONE: 4086152434 CAMPBELL,CA 95011 PHONE NO:(408)364-2143 ❑ LICEN22SED CONTRACTOR'S DECLARATION JOII DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class d Lic. J4`3 / INSTALL HOUSE&CITY CLEAN OUT Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 Ql' (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: I have and will maintain a certificate of consent to self-insure for Worker's _J Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. S Ft Floor Area: Valuation:$2600 I have and will maintain Worker's Compensation Insurance,as provided for b Section 3700 of the Labor Code,for the performance of the work for whic AP14 Number:36911029.00 Occupancy Type: 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.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FRO T CALLED INSPEC ION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, ` costs,and expenses which may accrue against said City in consequence of the U granting of this permit. Additionally,the applicant understands and will comply Iss::ed by: Date: with all non-point source re ns per the o Municipal Code,Section 9.18. Date �`�jn RE-ROOFS: Signature J All -oofs shall be inspected prior to any roofing material being installed.If a roof is instilled without first obtaining an inspection,I agree to remove all new materials for insl ection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I h:ve read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: He:lth&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's mai erial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertif unicio e,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 ,25��25534. Section 3700 of the Labor Code,for the performance of the work for which this �0 �� permit is issued. Owner or authorized agent: Date: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. wo:k's for which this permit is issued(Sec.3097,Civ C.) Ler der's Name APPLICANT CERTIFICATION Let der's Address 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 ••-on the above mentioned property for inspection purposes.(We)agree to save :mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION _ sts,and expenses which may accrue against said City in consequence of the I ur derstand 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 Lionised Professional 9.18. Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RE-'EIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36911029. 00 DATE ISSUED. . . . . . . : 10/15/2010 RECEIPT # . . . . . . . . . BS000011760 REFERENCE ID # . . . : 10100122 SITE ADDRESS . . . . . : 10413 GLENVIEW AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PRASAP NALLAMOTHU ADDRESS 10413 GLENVIEW AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95129 RECEIVED FROM . . . . : PRASAL NALLAMOTHU CONTRACTOR FRIDLIB LEON LIC # 26052 COMPANY NEW STRUCTURE PLUMBING INC ADDRESS PO BOX 111143 CITY/STATE/ZIP . . . : CAMPBELL, CA 95011 TELEPHONE (408) 364-2143 FEE ID UNIT QUANTITY AMOINT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ---------- ---------- ---------- 1BCBSC VALUATION 2, 600 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 2, 600 . 00 0 . 50 0 . 00 0 .50 0. 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00 1PRSEWER UNITS 1 . 00 21. 00 0 . 00 21 . 00 0. 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 .00 42 . 00 0 . 00 ----- ----- ---------- ---------- ---------- TOTAL PERMIT 1.06 . 50 0 . 00 106 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------------ CASH 106 . 50 CILSH --------------- TOTAL RECEIPT 106 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING 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: /00-13 PERMIT# OWNER'S NAME: /'�f•Z�}'S �(2LA- NE# GENERAL CONTRACTOR: 1 egl ,«G i-,« u.� rvlTY/ZIPCODE: SINESS LICENSE# ADDRESS: *Our municipal code requires all businesses working in the i.-ity 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 SUBCONT 'ORS HAV BTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Signatt re Date Please check applicable subcontractors and complete the following information: V 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 CITY OF CUPERTINO FEE ESTIMATOR—BIL ILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: "VALUATION: $2,600 O;:PERMITTYPE: Plumbing Permit PLAN CH ECK TYPE: Alteration/Addition / Repair PRIMARY PENTAMATION 1 RPSS USE: SFD or Duplex �t1: , PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $21 TOTALS: $21.00 t;,�� , 1'lur Uri, Plumb.Plan Check CMIPPERMIT L/ C�Jz�°rtc ���_ t' .„el t'>�_ Plumb.Pe/",s> Other Plumb Insp. C Off'r°1110_Ct�sy3. LiI„/,�F, ii:S!” /`c( 1�Icr7ah 1i;'1� . .. 1,10,h5tp, /'cc' NOTE. Theseees are based on the preliminary information availa,de and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (, ee Resolution 09-051 Eff. T`1/10) FEE QTY/FEE MISC ITEMS P/an 01c, /'c( slf'op/ P( [cc PME Plan Check: $0.00 S111)")[ 117§'af? 1'cv PME Unit Fee: $21.00 PME Permit Fee: $42.00 C oiisirnction Ta.y” F -T ,1<'r�ttstE'c;ctl �t�'r1<�t� 1-c<z: Work Without Permit? 0 Yes E) No $0.00 T'1 lnoitl" l c c . Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $106.50 $0.00 TOTAL FEE: $106.50 Revised: 9/29/2010 Sig- CITY OF CUPERTINO REPIPE/SEWERALAIN SERVICE CUPEkJ1N0 PERMIT APPLICATION FORM APN # (ter /I 00-2—Cl,DU Date�G�" Z©� Building Address: 3 �� �,� © f EA W Owner's Name: Ai Phojae Contracto Phone#: c4 — .2 Aa 3 Contact: Phone#:/ L-� Fax #: .3 .. Contractor License #: 637240 Cupertino Business License#: Job Description: M,41AJ Z I NZ�ep Residential Ccmmercial ❑ Valuation: 2�dd Project Size: Express Standard Large Major Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set& the :sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial buildin; P 1CPSS sewer/sanitary sewer- 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piling System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commissior. . B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercia.. P Revised 01/07/09