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07090180CITE' OF CUPERTINO BUILDING DIVISION PERMIT BUIL[�1P{G�RGI 7jICKSBURG DR OWNE lR'S NAME: SENTHIL PALAMJAMY ONE: ARCHr1ECTIENGINEER: �z z° LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect 1 �1 License Class _ Lic. ffl L - Date Contractor ARCHITECTS DECLAMATION 1 understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior w its issuance, also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 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 and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or thmogh his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: PLUMBERS ON CALL PERMIT NO. 07090180 PEWMM ISSUE DATE 520 E MCGLINCY LN 09/26/2007 SANITARY NO. CONTROL NO. (408) 879-0483 BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description RE -PIPE REPLACE MAIN SVC & ADD EXISTING GALV TO COPPER [-Sq. Ft. Floor Area I $7270 Valuation ❑ I have and will maintain a Ceriricate of Consent to self -insure forworkeesCompen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worke C mpe ation Ins ncc ca 'er and Policy number are: Carrier lity No.: CERTIFICATE DF EXEMPTION FROM'WORKERS' COMPENSATION INSURANCE (This section need not he completed if the permit is for one hundred dollars ($100) or Icss.) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name 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, indemnify and keep harmless the City of Cupertino against liabilities, judgmcns, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT HAZOU MATERIALS DISCLOSURE r Will the applican ut building occupant store or handle hazardous material as defined by the Cupe no Mu cipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yes o Will the applicant or fu m building occupant use equipment or devices which emit hazardous air contaminan as defined by the Bay Area Air Quality Management District? Cl Yes No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534. I understand that if the building docs not currently have a tenant, that it is my responsibility to notify the occupant of the requjw=ns which niust be inct prior to issuance of a Certificate of Occupancy Owner or 3 690701 .Adf Number Issued by Re -roofs Required Inspections Type of Roof 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 rr aterials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better CITY F CUPEt�T1NO CITY OF CUPERTINO 0-7N 01 REPIPE/S{E I`_/MAIN SERVICE PERMIT APPLICATION FORM APN # �co`?o�3,00 Bldg. Permit Fees Date: Oaf Z6 0 Building Address: C -as Piping System Fee PLUMBING O-2,2 V Plumbing Permit Issuance PLUMBING Owner's Name: � Lot -g4b - qTz, Ph o e #: Contractor: v CCIM Phonc: �3 L,icer�se#: s o� d - -B� �2q�I Contact: Phone: o4-gv�l Cupertino Business License #: Bui ding P it Info: S, -wage Disposal PLUMBING Bldg ❑ Elect ❑ Plumb Job Description: Business License BUILDING Q i0c mvVkcr-AA^i a1 C2 ry c, ud An C Resi e tial Commercial ❑ Cost of Project: 19 20 Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS C -as Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re ipe of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER S -1wers PLUMBING BPSEWAGE S, -wage Disposal PLUMBING BUSLIC Business License BUILDING 2 ITEMS OF 2 CITY OF CUPERTINO PERMIT' RECEIPT Sec: Twp: Rng: Sub: Bl}:: Lot: APN ......... 36M7010.00 DATE ISSUED.......: 09,'26/2007 RECEIPT #.......... BS000002770 REFERENCE ID # ...: 07090180 SITE ADDRESS .....: 10::21 VICKSBURG DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ......: OPERATOR: patg COPY # : 1 OWNER SE11THIL PALAMJAMY ADDRESS 10221 VICKSBURG DR CITY/STATE/ZIP ...: CUPERTINO CA, 95014-3358 RECEIVED FROM ....: PLUMBERS ON CALL CONTRACTOR .......: R013IE DOBKINS LIC # 27158 COMPANY PLUMBERS ON CALL ADDRESS ..........: 520 E MCGLINCY LN CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE (408) 879-0483 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- BPWSVCS WATER SERVICE --------------------- 1.00 9.00 ---------- 0.00 9.00 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 ---------- 0.00 ---------- TOTAL PERMIT ---------- 49.79 ---------- 0.00 49.79 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 49.79 --------------- 49.79 VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING REFERENCE NUMBER -------------------- #15256 VOICE ID DESCRIPTION -------- ---------------------------- 502 FINAL PLUMBING ENERGY CITY OF -.UPEI�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # '? 0 '�70e` O Lo V � c BUSINESS NAME PHONE # �(DW - �-�1- Oc{f 3 OWNER'S NAME:OL(►�t GENERAL CONTRALTO : �, FAX # I am not using any subcontractor eete ate subcontractors and com Al followin information: ease c ec "Ey- 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 Plumbing Roofing Septic Tank Sheet Metal Rock E]!heet ile i fl fV-1 err actor Signature 001 b Daie