12060039 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7552 ERIN WAY CONTRACTOR:17IX IT PLUMBING PERMIT NO: 12060039
OWNER'S NAME: RAJEEVA&ANJU GAUR 15201 CAIIIELOT DR DATE. ISSUED:06/072012
OW'NER'S PHONE: 6505844342 SAN JOSE,CA 95132 PHONE NO:(408)509.2772
❑ LICENSED C:ON'fRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class '3fr' Lic.q SOCod/S
—y— /� MECH r RESIDENTIAL r COMMERCIAL r
Contractor Vc-✓far/ c« Dale b— 7-7�i
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALLATION OI'PROPBRTY LINE:CLEAN-OIJT
(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 penally 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 fix which this permit is issued. Sq.Ft Floor Area: Valuation:$2000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,lir the performance of the work for which this
permit is issued APN Number:35921030.00 Occupancy'rype:
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is 1E
coffee[. I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORWI NOT STARTED
to building construction,and hereby authorize representatives of this city to enter ,.
upon the above mentioned properly'IIIinspectionpurposes. (We)agree to save WITHIN 180 DAYS^OF*ER'WliISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 'I
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROWL`A" AL ED INSPECTION.
granting of this permit Additionally,the applicant understands and will comply
with all non-point source re_:ula[ions per the Cupertino Municipal Code,Section Issued by: TGy Date: b -.7 '19'%9
9,18.
Signature '�� Date
RF:ROOF'S:
❑ OWNER-BUILDER DECLARATION Alf'roofs shat be inspected prior to any roofing material heitg installed. Ira roof is
ins[alled,`i(Kou first obtaining art inspection,I agree to remove all new materials for
1 hereby affirm that I am exempt from the Contractor's License Law for one of inspec ran.
the following Iwo reasons:
I,as owner of the property,or my employees with wages as their sole compensation,
Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner oflhe property,am exclusively contracting with licensed contractors to AL[.ROOF COVERINGS TO BE CLASS"A"OR BE'IFFER
construct the project(Sec.7044.Business&Professions Code).
1 hereby affirm under penally of perjury one of the following three ILA/-,ARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have mid will maintain a Certificate of Consent to self-insure for Worker's California Health&Safely Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ileallh&
performance of flic work fix which this permit is issued. Safety Code,Section 25532(a)should 1 store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 use equipment or devices which emit hazardous air
Section 3700 of the labor Code.for the performance of the work for which this contaminants as defined by the Ray Area Air Quality Management District 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
I certify that in the performance of dee work for which this permit is issued,I shall Ilealth&Safely Code,Sections 25505.25533,and 25534.
not employ an} person in any manner so as to become subject to the Worker's Owner or authorized agent:
Conipensationla%%s(il'Calil'omia. If.after making this certificate of exemption.I efDale: 7-12-
become
-iZbecome subject to the Worker's Compensation provisions of the Labor Code,1 must
forthwilh compl}'with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a cons[rction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
correct I agree to comply with all city and county ordinances and stale Imus relating
to building construction,and hcrch}'authorize representatives of this city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments. :ANC.III'I'F.CT:S DECLARATION
costs,and expenses which may aceme against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with of nun-point Source legulaiiams per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date.
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
CUPEI�TINO
Building De argent
JOB ADDRESS: PERMIT#
755,? c-rin wc,4
OWNER'S NAME: PR 1,eejckPHONE # yog- cot- 1'72
GENERAL CONTRACTOR F _ FAX #
I am not using any subcontractors: 6 Signature Date
Date
Please check applicable subcontractors and corn Tete the following 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
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35921030.00
DATE ISSUED. . . . . . . : 06/07/2012
RECEIPT #. . . . . . . . . : BS000017016
REFERENCE ID # . . . : 12060039
SITE ADDRESS . . . . . : 7552 ERIN WAY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . i CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RAJEEVA & ANJU GAUR
ADDRESS 7552 ERIN WY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4321
RECEIVED FROM . . . . : JUAN A ALCANTARA
CONTRACTOR . . . . . . . : JUAN ALCANTARA LIC # 30728
COMPANY . . . . . . . . . . : FIX IT PLUMBING
ADDRESS . . . . . . . . . . : 15201 CAMELOT DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95132
TELEPHONE . . . . . . . . : (408) 509-2772
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
-ADMIN HOURS 1.00 41. 00 0. 00 41 .00 0. 00
1BCBSC VALUATION 2, 000.00 1. 00 0.00 1 .00 0.00
1BSEISMICR VALUATION 2, 000. 00 0. 50 0.00 0.50 0.00
1PPERMITFE FLAT RATE 1. 00 44 . 00 0. 00 44 .00 0.00
1PRSEWER UNITS 1. 00 22 . 00 0. 00 22 .00 0 . 00
1TRAVDOC FLAT RATE- 1 .00 44 . 00 0.00 44 .00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 152. 50 0.00 152 .50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
-------- -- ------- --------------- --------------------
CREDIT CARD 152.50 AMEX
---------------
TOTAL RECEIPT - 152.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 7552 Erin Way DATE: 06/07/2012 TREVIEWED BY: Sean
12 APN: BP#: 'VALUATION: $2,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION
USE: SFD Or Duplex PERMIT TYPE: 1 RPS A
WORK Installation of property line clean-out.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $22
TOTALS: $22.00
Plumb. Plan Check 0.0 hrs $0.00 1:7vr. Phm O„ck
J-G•,:1,. 1t1 l,rur Pi°r: Plumb. Permit Fee: /PPERMIT 1
0"' l"'mirPr.::
Udu-r 11orh_ bre;,. Other Plumb Insp. 0.0 hrs $44.00 ih1... 1'1"' Lup,
.LL;ri,. h,•p. (:'r: Plun,h_ bmp. FPi: 1il,.,. I.../" l:'C
NOTE: This estimate does not includefees 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 onl•an estimate. Contact the De r or addn'l into.
FEE ITEMS (Fee Re.sohuion I1-053 ER' 711.111) FEE QTY/FEE MISC ITEMS
Plan (_/w,k / .,4,
Sllp/)l. PC/ "',
PME Plan Check: $0.00
bl.,p h'r"
PME Unit Fee: $22.00
PME Permit Fee: $44.00
Qolso u(lion T,n.
Administrative Fee: IADMIN $41.00
Work Without Permit? O Yes G) No $0.00
,IJonnrrd 1'h uutin� Fae•a':
Travel Documentation Fee: ITRAVDOC $44.00
Shone Motion I'CC: IBSEISMICR $0.50 Select an Administrative Item
131dc Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $152.50 $0.00 TOTAL FEE: $152.50
Revised: 06105/2012
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M '
SC
CUPERTINO (408)777-3228 •FAX(408)T77-3333•buildino(c,cuoertino.orD
,)?I-PLUMBING DMECHANICAL ELECTRICAL ❑WSCELLAilgEGlJS
PROJECT ADDRESS C APN a �t� ` 0 ^ ,�
` •7 e c� J'V
OWN17t NAME 7 S5-G /—r/�' C J ONE��' c�j/-yWE MAD.
rXl STREET ADDRESS/ G CITY,SLATE,ZIP ✓ FAX
CONTACT NAME u�` AA C_ ^ PHONE XOZ^I?n 5 E-MAIL
STREET ADDRESS UV 1 CITY,STATE, L FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR ADEM ❑ ARLTGTELT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LJCENSENUMBER LICENSE TYPE BUS.LIC 0
COMEANY NAME E-MAIL FAX
STREET ADDRESS CRY,STATE,21P PHONE
qcL,4i3--(ejqj
ARCHRECTIENGINEER NAME LICENSENUMBERC
-3r C BUS.LIC9
CONVANYNME' l)
E-MAILyCrysC' A
0AAU .
CJIcl"T.
STREET ADDRESS IliCITY STATE ZfP PHONE
S CAO--"e b� Q9 S Z
USE OF BFD wOUPLE( ❑ MULTI-FAMD.Y PROLECTIN WDDIAND ❑ YES PROJECT IN ❑YES ISTHEBLDGAN ❑ YES
BUILDING: COMMERCIAL URBAN OITERFACEAREA %NO 'FLOOD ZONE IPINO OLTiLER flo k. NO
DESCRIPTION OF WORK
TOTAL VALUATION: f Gb(] ZZ�] "'� RECEIVED BY:
By my signature below,I certify to each of the following,: I am the property owner or authorized agent to act on the property owner's behalf. I have Rad this
application and the information I have provided is correct I have read the Description of Work and verify it is accurate. I agree lu comply With all applicable local
ordinances and stare laws relating to building construction. I authorize representatives of Cupertino to enter the above-identifiedprope.—.y:or inspection puiposes.
Signature ofApplicant/Agrnt n Dare:
S AL"INFORMATION REQUIRED OFFICE USE ONLY
W OVER-THE-COUNTER
s
❑ LXI'RESS
U
❑ STANDARD
U
❑ LARGE
❑ MAJOR
MHPMac4pp_2011.doc revised 06/21/11