07110095 CITY OF CUP�:RTINO .�������-� ��������`�
BU[LDING DIVISION PERMIT , : .. :. . .
;,:
;
BUIL I A DRESS: PERMIT NO.
����4 PALM AVE CALIFOFNIA WATER HEATERS & 07110095 .
PERMI'f LSSUE DATE
„ANER'S NAME: .
CHANDAR , VENKATARAMAN & SUBHA 2 0 4 E� �JD AV:� ,# 8 4 2 11 / 16 / 2 0 0 7
SANITARY NO. CONTROL NO.
PHONE: � 6' S� 8-1575
BUII.DING PERMIT 1NF0
ARCHI'IEC['/ENGIPIHER: BLDG ELECf PLUMB MECH
� � � �
u p�p LICENSED CON7RAC1'OR'S DECLARATION JOb D0SCi1ptI0I1
� 1 M.�cby aflirm �hat 1 am liwnacd undcr pmvisions of Chap�cr 9(commcncing
� Z� wi�h Sccdon 70(x)) of Division 3 of thc Busincss and Profcssions Codc, an d m liccnsc is PRO P ER7 'Y C LEAN - OUT
�� y in full force and tec �. � 1 J �' ��
' � ? Licenac asa
f 0 p� .. ~..- Conuactor
� A CHI7ECCS DECLARATION
'� � I undcrstanJ my plans shall 6e wcd u public rccords
�yU
4 O y Licensed Pmfcuional
OWNER-BUILDER DECLARATION
� <� 1 t�crcby affirm tha� I am excmpt Crom �hc Conuactor's Liccnsc Law for the
L p O follawing rca4on. (Sccuon 7031.5, Busincss and Profcssions Cafc: Any city or county
K$� which requiros a permit to conswct, aitcr. improvc. dcmalish. or repair any suucw�c
'� " �' prior W i1s issuance, also requires �he applicant for such pertnit �o filc a signed stammen� Ft. Floor Area Valuation
— Z< thai hc is liccnscd pursuant to �hc �novisions o( thc Cnnuxtor's Liccnse Law (Chaptcr 9 Sq • $12 0 0
Y t�-� �(commencing wi�h Sccdon 7000) nf Division 3 oC ihc Busincss and Professions Codc) or
y�� ihat he is exempt thracfrom snd �e buis Cor the allegcd ettmption. Any violation ot QCCU SiIC Z
Section 7031.5 by a�ry applicant for a pem�it subjecu ihe applicant to a civil penalty of 3 5 7 0 4 0:? 2'°�(� Number p }� y�
not mwe rhan five hundied dollars (5500�
❑ I. u owncr ot tlie properey. a my employces with wages as the'v sok compensedon,
will do the work and �he swctme is not intended or of[ered for salc (Sec. 7044 B�siness Required In spections
snd Pmfcssiom Code: The Conuxtors License Law does not spply to an owner of
propeny wlw builda a improves thereon, and wM does such worlc himseltor ttwugh hia
own employces, provided that such improvements sre not imm�ded or otfercd for sala U,
however. �he building or improvement is sold within one yesr of completion. the ownu-
buildu will have the burden o[ proving that he did not build or improvc for purpoae of r; °
sak.).
�[, u owner of the property, am exclusively conuuting wiih Gcensed rnnuactas W
consuuct the projea (Sec. 7044. Busines� and Protessions Code:) The Conuactors Li-
conse Law docs not apply to an owner of propeny who builds or improves Wercon, and ,
who convacts for such projecls with a conlrutor(s) licensed pursuane to �he Convu[ors
' �cense Law.
I am ea�empt under See. . B& P C for ihis reuan
Uwner �a�
WORKER'S COMPENSATfON DECLARATION
1 hercby affirm under penalty of perjury one of the follawing declars�ions:
nd wiil mainuin a CcrtiGcate of Consent lo xlf-insurc (ar Workcr's Compen-
'on, u providcd for by Secuon 3700 of the Iabor Code. far the pecformana o[ thc
worr for which Ihis permit is issued.
❑ f havc and will m�intain Workcr's Compensadon lnsurance, as rcquired by Scction ,
3700 of thc Labor Code, Cor thc pcdormance of 1he work for which this permit is issued.
My Workers Compensauon Insunnce carricr and Poliry number arc:
Camer: Policy No.:
CER7'IFICA'I'E OF EXEMPI70N FROM WORKERS' .
COMPENSATION 1NSURANCE
(Chis scction necd not bc canpletcd if the permit is for anc hundred dollars (5100) .
or Icss.)
I cenify thnt in thc performa�rce of ihc work for which �his permi� is issued, I shall not
employ any person in �ny manncr so ac W become wbject ip � W ' Co tion
Laws of Gtifomia. � `�
Applicant
NOTICE TO APP CAM: If, aftcr making �is Ccni6catc of ExempGon, you should
bccome subjcct w �he Worker's Compensetion provisions of �hc La6or Codc, you must
�,Z forthwit6 comply with such provisions or this pecmit shall bc dccmcd ccvokcd.
� O CONSTRUCf10N LENDING AGENCY
(..� i..� [ hc�epy a(fitm Uut thme is a consuucdnn Icnding agcncy Cor ihc perfortnancc uf �
p�„ �� work [or which �his permit is issucd (Scc. 3097, Civ. C.) ,
W Q Lendcr's Nvnc
] z L.cnde�s Address
I cenify �hal I have rcad �his application and statc �hat U�c ahovc informatiun is
w� cortect. I a6rce to comply wiU� all city and counry onlinar�ces and su�e Iaws reladng w
0 U building consuuction, and hereby authoriae mpresemauvcs of ihis city w cn�cr upon thc
� W aAove-mcntioned propcny (or inspection purposes
a (We) agree to save. indcmnify and keep lunnless the Ci�y of Cupertina against
„�„� � liabiliuu, judgmcn�s.cosLt and expensca which may in any way accruc againsl seid City �/���
V z in canuquence oC Wc granung o[ this permi� Date
�"� APPLICANT UNDERSTANDS AND WILL COMPLY WI'1'H ALL NON-PO1NT Issued ty: �
S �j��� � d�l�i �7 Re-roof � /��/�'
S of Applicant/Contractor �°� T vf Roof s �i� ,!
HAZARDOUS MATF1tIALS DISCLOSURE YPe
Will ihc appliant or futwc building occupuu storc or handlc ha•rardous matcrial /
efined by 1hc Cupenino Municipal Codc. Chaplcr 9.12. and thc Hcalth and Safety `
_.,� Scction 25532(a)T All rooi s shall be inspected prior to any roofing material being installed.
❑Y� �e.�----... .
Will thc appiicant or futurc building occupant usc equipment or dcvices which
If a roo� is installed without first obtaining an inspection, I agree to remove
cmi� harardous air contaminan�s az dcfincd by the Bay Atca Air QualilY Managcmcn� all new materials for inspection.
a���� ��
O Y�
1 havc rcad the ha�ardcws maicrisls requi�emenls undcr Chaplcr 6.95 of Ihc CaliCor•
nia ticalth dc Satcty Cadc. Scctiats 255U5, 25533 arul 25534. f undcrstand thu if ihc building
does not curtcntly have a �enan4 �«is my responsibiliry w notiCy dx occupant of ihe
rcyuimmcn�s whi u be me� � a�u�� or. c�r�� ar o����r. Signatu •e of Applicant Date n
T �A�*-�� �� 1 �'�� All roof coverings to be Class "B" or better ��
Owncr or authorized agcnt Daic
�7i/ uU�'�
��,
� CITY OF (:UPERTINO
���� REPIPE/� 1�� ��� �/MAIN SERVICE
CUPEl�TINO PERMIT APPLICATION FORM
APN #�� � y�� �� r �� Date: / _ % ` � ��
_� b
Building Address: a ���� � � ����,.--
Owner's Name: Phone #: L��� --
�` G'� r��1� ►�` �� �-��z�
Contractor: Phone: License #: /
/� �' id-1 �i•-� �i •�-,�,�s ' � yJ'»� ��. 6,:�' - 7,i�i EX �l 7c�g G t�D
G C� !r o l .r
Contact: Phone: �// Cupertino Business License #:
� �---..
l% � J T-�7
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description: _ > ,---
�m ✓ � Gl��-�� — � w �
Residential �--- Commercial ❑
Cost of Project:
�ao�.�o G,�h�� �-- �����
Qty. if
Applicable Fee ID Fee Description Fee Grou
BPERMFEE ]31dg. Permit Fees BUILDING
BPGAS �sas Piping System Fee PLUMBING
PPERMITFEE ]'lumbing Permit Issuance PLUMBING
BPREPIPE ]Zepi e of Fixtures PLUMBING
BPFIXTURE :''blg. Fixture PLUMBING
BPWSVCS :vlain Water Service PLUMBING
BPSEWER �;ewers PLUMBING
BPSEWAGE 3ewage Disposal PLUMBING
BUSLIC Business License BUILDING
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 3`_704022.00
DATE ISSUED.......: 11/16/2007
RECEIPT #.......... B::000003258
REFERENCE ID # ...: 0�110095
SITE ADDRESS .....: 2�324 PALM AVE
SUBDIVISION .......
CITY .............. CLfPERTINO
IMPACT AREA .......
OWNER ............: CFLANDAR, VENKATARAMAN & SUBHA
ADDRESS ........... 2�;324 PALM AVE
CITY/STATE/ZIP ...: CilPERTINO CA 95014
RECEIVED FROM ....: O�'IS C EVERON
CONTR7�CT�R .......: O�.'IS C EVEROM LIC # 25972
COMPANY ..........: C��LIFORNIA WATER I�EATERS &
ADDRESS ..........: 2()4 E 2ND AVE, #842
CITY/STATE/ZIP ...: Stii�T MATEO, CA 94401
TELEPHONE ........: (Ei50)558-1575
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- ----------
BPERMFEE VALUATION 1,200.00 83.16 0.00 83.16 0.00
BPSEWER SEWER SYSTEM 1.00 21.58 0.00 21.58 0.00
BUSLIC FLAT R.ATE 1.00 107.00 0.00 107.00 0.00
PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
----------- ---------- ---------- ----------
TOTAL PERMIT : 252.53 0.00 252.53 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 252.53 #6400
---------------
TOTAL RECEIPT : 252.53
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
506 GAS TEST 507 FINAL PLUMBING
�, , `
Community Development
�,,�, 10300 Torre Avenue
;�'� :' i! �'«
Cupertino CA 95014
:_,� .
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
cuPE� iNo
Buildin De artment
JOB ADDRESS: ��,3v2.G� c� /rl Qc.��, PERMIT #
G.:,� r ��� G �'>��� � � ���� �'S' _
OWNER'S NAME: ��r. G�,��� � PHONE # �-�-�-- 7�� F� Y,�
GENERAL CONTRACTO � �-� �r� � #
I am not using any subcontractors: -- 1 "f�""° �
� �ignature Date
Please check a licable subcontractors and cor.z lete the followin information
SUBCONTRACTOR BUSINESS 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
umbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
G1- ll --� �
Owner/Contractor Signature Date
FROM :CUPERTINOSANITARYDISTRICT FAX N0. ;�G082535173 Nov. 26 2007 04:33PM P1
` � a ��o►�ir�,� ,
1]15TR1CT MANnGER•�NGIN�K{� �,► C r.P� �OAFt.C� OF DIRECTORS
MARK 7HOMA8 tk COMPANY, INC. � `� � STEPHEN C. ANDR�wS
DAVIb �. R,pS6 � w W1LLlAM A. B09WOtZTH
'YGAR! C}C JOki M. GATTO
D18TR1C7 COUNS�L �.�S:F.A�'I�,E h� R71S F3, YIARRISOi�[
A7KINSON • FARA9YN, LLP. r �e��$��0 1� �' W��yp�l..l_ hf. KERR, JR.
HRI�O�D 8. TOPPEL r
20893 ST�v�NS GRG�K f90ULEVARD, 9U17� 1 OA,
i�
CUPERTINQ, CA LlrORNIA 96014r2134 t �;'�
(408) 253�7'071 P11��N� • {�08) 25�•517� FA�C
www, cup�rfinvsar7ifarydisfricf.coin.O�
F�,��: ct.�sn - Mo�
Buildin� T)ept. — C't�pertino
Cit:y of �:u peri;ino
,�tir�.: R«i:lci:in� T)epalrtanent.
lU3QQ Tc�rye A.ve.
C'.upertirio, CA 9501.4-3202
O� r
I�
SL�bject: Install Yroperty Line Clenn -()ul ' I
Narne; Chaudax Residence
A.d.d.ress: 2232� Paln� Avenue
�I'N: 357-04�022
Pe.r�uit No.07110095
■ V�dcotapc azzd i'roperfy l.iue Cleanout inspec1:ec[
No additi��nal conditinns/re��uirc�ent.s by tl�e Dr.s��ric�
c
Ins�ecLor: Geor•gc �ar�tios/ Rnge:r �� n.tuy .............................:... �:..
Dxtc:...1.1.�20-200'� ................... S�init�iry Sc:wcx I�ucation:
c�: I'rc�perl:y Own.er
SUPPLYING SANITARY SEWCRAGC SLRVICL=S FOk: CITY OF CUPER "INO, PpRTinN9 OF THF. CITIF..S OF SARATOGA, SUNNYVALG Los A�'ros Atv�
SUF2ROtJN01NG �NINCC7RNUHATEDAREAS