14030083 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10158 RIDGEWAY DR CONTRACTOR:CONSOLIDATED PERMIT NO: 14030083
PLUMBING INC
OWNER'S NAME: TEJAS AND ALKA DESAI 3732 CHARTER PARK DR STE D DATE ISSUED:03/13/2014
OWNER'S PHONE: 4084222214 SAN JOSE,CA 95136 PHONE NO:(408)978-3093
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
REPAIR AND REPLACE(E)SEWER LINE,INSTALL(N)
License Class Lic.# -57� PROPERTY LINE CLEANOUT
Contractor Date
3/
I hereby rm tha am licensed under the provisions of Chapter 9 lias .
(commencing with Section 7000)of Division 3 of the Business&Professions � .'
Code and that my license is in full force and effect. f<;,
Y
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 ,
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:$17500
I 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 APN Number:34241011 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 Oy_EE1LA1IT 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 DA`111 C
YS ED 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
Iss
granting of this permit. Additionally,the applicant understands and will comply Date:
with all non-point so e regulat a Cupertino Municipal Code,Section
9 18.
-ROOFS:
Sig re Date 31_401'_11 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
VP
inspection.
❑ 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
1,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 have 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: Health&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 material. 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 Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio ss5 33 4.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized a t• Date:
permit is issued.
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. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender'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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I 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
GENERAL PERMIT APPLICATION CPMEP
'; '� COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
(408) 777-3228•FAX(408)777-3333•buildina aDogoertino.org ��(O MISC
cupltATINQ
LUTABING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLAI,TEOUS
PROJECT ADDRESS I APN# 3 VZ_
_ q1
r l
OWINTERNAME I PHON4P W_ r�L-7 -� E-MAIL
Jim L
STREET ADDRESSCITY,STATE,ZIP I FAX
e
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER- UI DER ❑ OWTIERAGENr ❑ CONTRACTOR EICONTRACTORGEN
AT ❑ ARCHITECT ElENGINEER ElDEVELOPER EITENANT
CONTRACTORN LICENSENUMBER 0 LICENSE TYPE BUS.LIC#
COMPANY N. E-MAIL, FAX
STREET ADDRESS 3 73 y— ^ CITY,STATE ZIP ,3 'E n 7 D :10y
ARCHIMMENGINEERNAMEL (� LICENSE NUMBER BUS.LIC J# (J vll
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT INWII.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA (�❑ NO FLOOD ZONE ❑NO EIC U-ER HOAg? ❑NO
DESCRIPTION OF WORK ®il .1i►�J G
CJCO / VVCC_
4A 1961- dZd &id� Z)e A?X
to
TOTAL
TOTAL VALUATION: 7
By my signature below,I certify to ea owin ' n e p erty owner or authorized agent to act on the pr 0
application and the informatio ave provided is ect. I have re the Description of Work and verify it is ace gree to comply with all applicable local
ordinances and state laws ating to building c tructi orize resentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplic Agent: Date:
ORQ = -
SUPPL MEN IFIvLa.TTONRE UII2ED -��.o�e�zzs�on��-�-=��=
A11�ARD
MEPMisa4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10158 RIDGEWAY DR DATE: 03/13/2014 REVIEWED BY: MELISSA
APN: 342 41 011 BP#: *VALUATION: $17,500
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 RPS
WORK REPAIR AND REPLACE E SEWER LINE INSTALL N PROPERTY LINE CLEANOUT
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $24
TOTALS: $24.00
r � r rf Fti
tr.>ch. 1'Zctn,t zr<.c k Plumb.Plan Check 0.0 1 hrs $0.00 x r(>,.% 1'zri(`heck
Pee: Plumb.Permit Fee: IPPERMIT
01116-lfech. Irt:=> Other Plumb Insp. 0.0 hrs
Slccr r -�� E'izrmb, hSp, Fee
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/131 FEE QTY/FEE MISC ITEMS
Picin (,hock
PME Plan Check: $0.00
PME Unit Fee: $24.00
PME Permit Fee: $47.00
Administrative Fee: 1ADMIN $44.00
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: 1TRAVDOC $47.00
Strong Motion Fee: IBSEISMICR $1.75 Select an Administrative Item
B1�Stds Commission.Fee: IBCBSC $1.00
.
$164.751 $0.00 TOTAL FTE: ` $164.75
Revised: 01/15/2014