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07110042 CITY OF CUPERTINO �� BUILDINC DIVISF�iV • PE1<1�11T �� ; : < ::: _ _ _ .,:- . :....,.,. _ ... . .._ .: PERMIT NO. BUILD(NG ADDRESS: 22782 MAJESTIC OAK WAY GENMOR PLUMBING 07110042 . PERMIT LSSUE DATE �ER'S NAME: KRISHNASAMY BALASUBRAMANIAN 3560 H�.IG ST � 11/08/2007 SANI7'ARY NO. CONTROL NO. PHONE: . (408)855-8348 BUILDING PERMIT INFO ARCHI'IECT/ENGiNEER: BLDC EI,ECT PLUMB MECH 0 0 0 0 u O p LICENSED CONTRACTOR'S DECLARATION JOb DeSCiIpClOI1 ;� v C I hcreyy afGrm that I sm liccnscd undcr provisions o[ Chaptcr 9(commcncing z � wiih Scction 7000) o[ Diviaon 3 of ihc Business and Profcssions Codc, and my licensc is C 0 P P ER RE - P I P E ENT I RE HOME �� y in fuU fo¢e and effx6 �� Z Licenac ass t� Lic.11 �'-� F, � Dam CC��'� ��^^'Q° ��^ �� `5�L ARCHITECi'S DECLARATION ��< 1 undcrsunJ my plans shall be used as puAlic rcrnrda �yU � � y Liccnscd Pcufessional y � OW NBR-BUILDER DECLARATION qq y I hereby utTirm that 1 am exempt Crom �he Contnctors License Law far U�e i p O (ollowing reuon. (Scction 7031.5, Busincss and Pro[cuions Cafc: Any ci�y or county �^� which mquiros a pcmiit to wnsuuc4 alter. imProve, dcmalich, or �epair my swcwro prior W i�s issuancc, also rcquims ihc applicant for such pertnit to filc a signed s�a�cmcni F t. F l o o r Area Valuation � _ � that hc is liccnscd putsuant �o l hc provisions o f i h c Con u s c t o r' s L i�� c n s c L a w ( C h a p t c r 9 S 9• $ 5 5 0 0 y I- �(commencing wi�h Sccdon 7000) of Division 3 of dic Busincss and Profcssiona Codc) or y �... �hat he ia exempt Uu�acfrom and the buia fw the allcgcd exemption. Any violation of SecGon 7031.5 by a�ry app►icant for a pamit subjecu the applicant to a civil penalry a[ Number Occupancy Type not more �han five hund�ed dollars (5500). 3 4 2 3 21: _ 4�� ❑ I, u owner of tl�e property, or my cmployces with wages u �he'v sole compensation, wiA do the wock, end ihe sttucw�e is not intended or ofiered for sale (Sec. 7tY14. Husiness Re uired Ins ections and Professions Code: The Contcactors License Law doca not spplY m an owner of 9 P property who builds or impmves �hercon, and who does such wwk himself or �hrougA his own employccs, providcd that such improvements are not intended ar olCercd Cor sale. IC. havever, the building or improvement is w1d wi�hin one year oC wmplction, the owner- builder will have the burden of proving Wat he did nat build or improvc for pu�pose of sala). Q I, u owner of �he property, uo exelusively conuacting with lianxd rnnuscwrs to conswct the penjea (Sec. 7044. Businas and PcoCessions Cade:) The Contractnr's Li- cense Law docs not apply to an m�mer of propeny who builds or improves themon. and , wha contncts tor such projecu wieh a conuacwr(s) licensed pursuant to Ihe Convaccor's License Law. r'1 I am e�cempc undu See. . B& P C for ihis nea.wn nv Date WORKEIt'S COMPENSAT70N DECLARATION I Gueby �rm under penalty o( perjury one of the following declanGons: ❑ I hs+e and will maintain a Cenifinte of Conaent to xlf-insure far Worker's Compen- sation, u providcd far by Section 3700 of the [abor Code, for the performancc oC thc woric (or which �his pertnit is issced. I pave and will maintain Workers Compensation Insurana, u �cquired by Scction 3700 of the Labor Code, Cor the performance of �he work for which ihis peemit is issued My Workers Compensa[ion Insunna articr snd Policy numbu ue: Cartier. �r+Ga (� 9 Policy No.:.A�'Qb `�2 ( � �c�! 'G y CFR'17FICA7'E OF EXEMP!'ION FROM WORKERS' COMPENSAT[ON INSURANCE � (72�is scction need not bc completed i( the permit is for onc hundred dollus (S I00) or Icu) I cenify that in Wc performancc of Ihe work far which this permit is issucd, l shall not employ any person in any manncr w u w bcrnmc subject a Ihe Workets' Compcnsadan Laws of Califomia Datc Applicant NOTICE TO APPLICANT: If, aMr making ihis CeniCca�c of Exemp�ion, you shouW become subject to the Worker's Compensddon ptovisions of �e Lalwr Cade, you muu � O foMwith comply wi�h such provisiaas or ehis pecmi� shall 6e deemed eevoked. Z '"'' CONSTRUC[70N LENDING AGENCY (-~.� � I hcrcby alT'irm that there is a consuucdan kndine agcncy Cor thc perfortnancc uC . . p; � ihc work for which ihis permit is iuued (Scc. 3097, Civ. C.) W A Lendcr's Namc a � L.cnder's Addresa (� � � certifY thrt 1 have read lhis appiication and staic thu thc s6ovc informatiun is w �-+ corten. I agree W comply wiih all city and counry onlinances and sute Iaws reladng w � U building consuuction, and hereby authoriae mprescnutivcs of ihis city to cn�cr opan ihc w aAove-mendoned p�opcnyforinspccUon purpaus a (Wc) a�ee to save, indcmnify and kecp humless the City of Cupertino against �,,,� � Iiabiiitia, judgmcnLS, cosls and expenscs which may in any way acctuc against aaid City V z in conuquence oC U�c granting of ihis permi� Date .�'*� / �"� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b '�: SOUR��NS. � � �� N' Re-roofs Signaturc of ApplianUConvac�or �8� T of ] toof HAZARDOUS MATERIALS D[SCLOSURE J�]� Wil1 Ihe applicant or Cutwc building occupant storc or handlc ha•rardaus mamrial icftncd by the Cupenino Municipal Code. CLaptcr 9.12, md t6e Heal�h and Safc�y k. Scction 25532(a)? All roof: shall be inspected prior to any roofing material being installed. ❑ Ycs t�o Will thc applicant or fuwre building occupant usc cquipmcnl or dcvices which If a roof is installed without first obtaining an inspection, I agree to remove emit haracdous air conlaminan�s u etefined by �he Bay Area Air Quality Managemen� all new r naterials for inspection. District? ❑ Ycs � Nu 1 havc rcad ihe ha�ard�ws matcrials requiremen�s undcr Chap�cr 6.95 of U�e GliCor- nia Hcal�h & Safcty Cadc. Scaions 25505, Z5533 and 25534.1 undcrs�v+d ihu iCthe ha��dmB does not curtently have a tenan4 � it is my responsibility ta notity the occupant of Ihe ��;�,,,��Wn��hm�,x,,,«�;o�w;u,�onc�r��ora� Signatur�;ofApplicant Date � a �� p��' All roof coverings to be Class "B" or better Owncr or authari�ed agcnt CITY OF CUPERTINO 3 ITEMS OF 3 PERMI�' RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: B1J:: Lot: APN ......... 34;?32114.00 DATE ISSUED.......: 11,'08/2007 RECEIPT #.......... BS�)00003196 REFERENCE ID # ...: 07:L10042 SITE ADDRESS .....: 22'782 MAJESTIC OAK WAY SUBDIVISION ....... CITY .............. CU.?ERTINO IMPACT AREA ....... OWNER ............: KRLSHNASAMY BALASUBRAMANIAN ADDRESS ..........: 227$2 MAJESTIC OAK WY CITY/STATE/ZIP ...: CU°ERTINO CA, 95014-0131 RECEIVED FROM ....: GEVMOR PLUMBING CO CONTRACTOR .......: GEVARO MOR.ALS LIC # 27101 COMPANY ..........: GEVMOR PLUMBING ADDRESS ........... 3550 HAIG ST CITY/STATE/ZIP ...: SAVTA CLAR.A, CA 95054 TELEPHONE ........: (408)855 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- --- BPERMFEE VALUATION 5,500.00 126.36 0.00 126.36 0.00 BUSLIC FLAT R.ATE 1.00 107.00 0.00 107.00 0.00 PPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 274.15 0.00 274.15 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 274.15 #5668 --------------- TOTAL RECEIPT : 274.15 VOICE ID DESCRIPTION 'UOICE ID DESCRIPTION -------- ---------------------------=. -------- ---------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING ��1� �� CITY OF CUPERTINO � a :Y REPIPE/��:�r��.�/MAIN SER��C� CUPEt�TINO PERMIT APPLICATION FORM APN # Dat : " o� I'-�' � O C� �� I �-� Building Address: - " 2 � z. �� S�i C(�a k' i�u , Owner's Name: Phone #: r�� S1� r�q Sc�'n'1 �.�' � G S�t �✓G�'Y1G•-� � av� C`� a)�`�Co � v Z Co � Co tractor: Phone: License #: -��/1✓Ylc.v tUvNbin ' �� ds�'-�3�'�' ��CP / Co�ntact: Phone: Cupertino Business License #: �� SS'— �'�t� !O� Building Pe it Info: Bldg ❑ Elect 0 Plumb '�' Job Description: �� P � t a ., e ��, � �a �•� �-t- r �•� Residential � Commercial ❑ Cost of Project: � S�S�O Qty. if Applicable Fee ID Fee Descri tion Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS ias Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE (Zepipe of Fixtures PLUMBING BPFIXTURE P$lg. Fixture PLUMBING BPWSVCS Vlain Water Service PLUMBING BPSEWER 3ewers PLUMBING BPSEWAGE 3ewage Disposal PLUMBING BUSLIC Business License BUILDING �;' - , Community Development `t 10300 Torre Avenue '� ��' ' Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPEI�TINO Build�in De artment jOB ADDRESS: . PERMIT # �ZZ"1 g 2!� ct -Q S�i C O�t � 1�+. � `� (� o v�"t-- OWNER'S NAME r ��1n ✓�GtSG n� �� t S�r �� PHONE # � 5 ��(.o-� GENERAL CONTRACTOR: Q,�vV�� y J t,i•,., 5;�, � - FAX #�a� �2`7 —c�- �� I am not using any subcontractors: �`'� �� a �`� � S .gnature Date Please check a licable subcontractors and com lete the followin information: SUBCONTRACTOR BUSI]vESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date