10090037 CITY OF CUPERTINO 13UILDING PERMIT
BUILDING ADDRESS: 7408 ROLLINGDELL DR COIITRACTOR:RAMASWAMY&UMA PERMIT NO: 10090037
VIS�3WANATH
106�i8 HALE PL DATE ISSUED:09/07/2010
JER'S NAME: RAMASWAMY&UM
VIS
PHONE NO:
UwNER'S PHONE: 4082538474
CU'ERTINO,CA 95014
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# MECH RESIDENTIAL COMMERCIAL
Contractor Date
JD B DESCRIPTION: INSTALLING TANKLESS WATER HEATER AT HOME B
I hereby affirm that I am licensed under the provisions of Chapter 9 Op�NER
(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 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. y Ft Floor Area: Valuation:$2000
I have and will maintain Worker's Compensation Insurance,as provided for b S(,
Section 3700 of the Labor Code,for the performance of the work for which this Occupancy Type:
permit is issued. A PN Number:35931039.00
APPLICANT CERTIFICATION
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 80 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 D OM LAST CALLEI, INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: _ �^ !� Date:
9.18.
Date____
•3ture
RE-ROOFS:
OWNER-BUILDER DECLARATION k11 roofs shall be inspected prior to any roofing material being installed.If a roof is
ntractor's License Law for one of nstalled without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Co
nspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the
Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Healtuh&Safety Code,Sections 25505 requirements25 33r 9
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 Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I 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 Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
e of the work for which this permit is issued,I shall
Health&Safety Code,Sections 25505,25533,and 25534.
I certify that in the performanc
Worker's
not employ any person in any manner so as to become subject to the l
Compensation laws of California. If,after making this certificate of exemption,I Owner o t oriz d sg Date:__` _
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
APPLICANTCERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above informatiis for which this permit is issued(Sec.3097,Civ C.)
on
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and herebyauthorize
orize representatives
presenta iv�Weof t is city
to save
Lender's Address
•the above mentioned property P ( )agree
.nnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18. Licensed Professional
Date C1 D
Signature
CITY OF CUPERTINO
� �
FEE ESTIMATOR-BUILDING DIVISION
rl+
ADDRESS: DATE: REVIEWED BY:
APN: BN: *VALUATION: $2,000
;*PRMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION
SFD or Du lex 1 0 11. . �� PERMIT TYPE: PRWHEATR
USE: p 1,1.0011 .L�r.� .
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1 PRWHEATR 1 # $25
Piping, Gas <=4 Outlets 1 PGASRES 1 # $63
TOTALS: $88.00
Plumb.Plan Check 0.0 hrs $0.001 VC
Plumb.Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 hrs $42.00 p,
£`.'zrur%. his t f<1cc_lnzp 1` v,
NOTE. These fees are based on the preliminaly in ormation available and are on1v an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 09-051 Eff 74/10) FEEQTY/FEE MISC ITEMS
Plug C'Ir �ck f�ec�:
E= I
slip /. PC FCC,
PME Plan Check: $0.100
Pcnnit Fcc..
Sup/. 1ny f'Ce
PME Unit Fee: $88.00
PME Permit Fee: $42.00
Constrlw!ion Tin
,
�c;U1f�Itt'ttt /c!'Yft`tl' "E'e,':
Work Without Permit? 0 Yes (F) No $0.00
P1ttt,`ttttt p
['ccs'
Travel Documentation Fee: ITRAVDOC $42.00
Select an Administrative Item
Bld_ tds Commission Fee: IBCBSC $1.00
SUBTOTALS: $173.00 $0.00 TOTAL FEE: $173.00
Revised: 9/01/2010
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
5 ITEMS OF 5 COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35933039 .00
DATE ISSUED. . . . . . . : 09/07/2010
RECEIPT #. . . . . . . . . BS00()011390
REFERENCE ID # 10090037
SITE ADDRESS 7408 ROLLINGDELL DR
SUBDIVISION . . . . . . .
CITY CUPE 2TINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RAMASWAMY & UMA VISHWANATH
ADDRESS : 10668 HALE PL
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : RAMASWAMY VISHWANAT
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : RAMP.SWAMY & UMA VISHWANATH
ADDRESS . 106E8 HALE PL
CITY/STATE/ZIP CUPERTINO, CA 95014
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AP1OUNT PD-TO-DT THIS REC- --NEW-BAL-
---------
---------- ------------- 1. 00 0 .0
1BCBSC VALUATION 2, 000. 00 1.00 0 .00 0 . 00 63 .00 0 .00
1PGASRES OUTLETS 1.00 63 .00 0 .00 42 . 00 0 .00
1PPERMITFE FLAT RATE 1. 00 42 .00 0 . 00 25 .00 0 .00
1PRWHEATR UNITS 1.00 25. 00
1. 00 4200 0 .00 42 . 00 0 . 00
.
1TRAVDOC FLAT RATE ---------- ----------
TOTAL PERMIT
173 .00 0 .00 173 . 00 0 .00
REFERENCE NUMBER
__
AMOUNT --
METHOD OF PAYMENT ---------
---------------
CHECK 173 .00 #2106
---------------
TOTAL RECEIPT 173 .00
VOICE ID DESCRIPTION
VOICE ID DESCRIPTION
-------------
-- -- -- 301 ROUGH PLUMBING
202 UNDERFLOOR PLUMBING
506 GAS TEST 507 FINAL PLUMBING
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228- FAX(408)777-3333• builc ingOu Cupertino.org
CUPERTINO
Dear Property Owner(s):
An application for a building permit has been submitted in you,name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS BP#
�. �Cwt�Ll��,��1-1- �k APV
OWNER NAME prN A�C,4IAMy \/6rJt VA N OWNER ADDR=SS
DESCRIPTION OF WOR/K:
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the perp itting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.)
I understand a frequent practice of unlicensed pe-sons is to have the property owner obtain an "Owner-
'guilder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner-Builder, may be held liable an subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting a 3 an Owner-Builder and am aware of the limits of my
insurance coverage for injuries to workers on my propertI.
2. 1 understand building permits are not required to De signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
3. 1 understand as an "Owner-Builder' I am the resF onsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a lice nsed Contractor and having the permit filed in his or her
LLn��ar�me instead of my own.
!�_�,- 4. I understand Contractors are required by law to tie licensed and bonded in California and to list their license
numbers on permits and contracts.
w,r 5. 1 understand if I employ or otherwise engage ani persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred do lars ($500), including labor and materials, I may be
considered an"employer" under state and federal law.
N/ 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and
federal government,withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
V�
7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the ntent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
L� 8.'1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
defects in the workmanship or materials.
OwnerBui[derForm_2010.doc revised 04/14/10
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 14o PP- PERMIT# 00
OWNER'S NAME: khMAS WA-M'I V 1S HWA1v4Tfi) PHONE# U 0C-X S�3^ g
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in th�city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY IMPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. � Dq 104 t t O
I am not using any subcontractors: L"�'%' Date
Signs ture
Please check applicable subcontractors and complete 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
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
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APPkO LVED
1N ACCORDAN( I WITH I HE CITY Oi
CUPLRTINO COUF_S AND ORDINANCES
' r , �--- - SCF t a'S j ,tf fir, 1p •r ..
SIGNED _ V ;.iP
This set of plans aA�Sfficafions MUST k' �� � u�, `" AhF
I� be kept on the job at all times and it is
�i unlawful to make any changes or alterations
Imo' v. • �t u 3";i
on same without written permission from
the BuildingDepartment,City of Cupertino r
The stampig of this plan and specifications . �•}- I els" ,r,
SHALL NOT be held tormit or to be an
approval of the violation o any provisions
of any City Ordinance or State law. ;
Y PP RV
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