Loading...
12020119 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10111 CARMEN RD CONTRACTOR: DAN CASTILLO'S PERMrr NO: 12020119 PLUMBING OWNER'S NAME: CHILLARIGE ANIL KUMAR V 1720 HESTER AVE DATE ISSUED:02/27/2012 OWNER'S PHONE: 4085844894 SAN JOSE, CA 95128 PHONE NO:(408)706-1092 LICENSED CONTRACTOR'S DECLARATION n BUILDING PERMIT INFO: t3LDc ELECT PLIA113 License Class(— Lic.# ("_ � J�IEC11 RESIDENTIAL COMy-IERCIAI. Contractor ��Gr� (�"�-,.5�///y Date �� �-,/Z 1 hereby affirm that hat 1 am licensed under the provisions of Chapter 9 JOBDESCRIPTION: RF,1'LACF;WA'I'f:K F11?A"I IiR"fO"I'ANKLI:SS WA fER HEATI?R, (commencing with Section 7000)of Division 3 of the Business&Professions COPPER RF,-1'll'G&REPLACE'WATFR MAIN 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. Sq.Ft Floor Area: Valuation:$7000 1 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 i ll this G APN Number:35701010.00 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. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT 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 DAYS OM LAST CALLED 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 7`�,� granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ";::21 /� , g^f ����// RF,-ROOFS: Sign re j ts%V!� Date 7 -/'Z 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 i inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"012 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) 1,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. 1 will 1 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 1 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 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized age nt. Datr.�__Z7 'Z 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,1 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 indemnity 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 1 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 Prol'essional 9.18. Signature Date CITY OF CUPERTINO ITEM 1 OF 1 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35701010 . 00 DATE ISSUED. . . . . . . : 02/27/2012 RECEIPT # . . . . . . . . . BS000016125 REFERENCE ID # . . . 12020119 SITE ADDRESS . . . . . : 10111 CARMEN RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER CHILLARIGE ANIL KUMAR V ADDRESS 10111 CARMEN RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ANIL KUMAR CONTRACTOR . . . . . . . : DAN CASTILLO LIC # 31097 COMPANY . . . . . . . . . . : DAN CASTILLO' S PLUMBING ADDRESS 1720 HESTER AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95128 TELEPHONE . . . . . . . . : (408) 706-1092 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- --------- - -ADMIN HOURS 1 . 00 41 . 00 41 . 00 0 . 00 0 . 00 1BCBSC VALUATION 7, 000 . 00 1 . 00 1 . 00 0 . 00 0 . 00 1BPWSVCS WATER SERVICE 1 . 00 22 . 00 22 . 00 0 . 00 0 . 00 1BSEISMICR VALUATION 7, 000 . 00 0 . 70 0 . 70 0 . 00 0 . 00 1PPERMITFE FLAT RATE 1 . 00 44 . 00 44 . 00 0 . 00 0 . 00 1PRREPIPE NO OF FIXTURE 1 . 00 12 . 00 12 . 00 0 . 00 0 . 00 1PRWHEATR UNITS 1 . 00 26 . 00 0 . 00 26 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 44 . 00 0 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 190 . 70 164 . 70 26 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 26 . 00 VISA --------------- TOTAL RECEIPT 26 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ----- ---------------- ------ - 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10111 Carmen Rd DATE: 02/27/2012 REVIEWED BY: RDW APN: BP#: *VALUATION: 1$7,000 *PERMIT7 TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Du lex PENTAMATION 1 RPRP USE: p PERMIT TYPE: WORK Copper re i e and water main replacement. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe Interior 1PRREPIPE 1 # $12 Water Service 1 BPWSVCS 1 # $22 TOTALS: $34.00 T-7 Plumb. Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERNIIT Other Plumb lnsp. 0.0 hrs $44.00 I-] l N©TF.: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These[ees are based on the relimina in ormation available and are onL an estimate. Contact the De t Lor addn'l info, FEE ITEMS (Fee Resolution 11-053 L 7/1'11) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 El PME Unit Fee: $34.00 PME Peitnit Fee: $44.00 Administrative Fee: ]ADMIN $41.00 Work Without Permit? 0 Yes 0 No $0,00 Travel Documentation Fee: I TRAVDOC $44.00 Strong Motion Fee: IBSEISMICR $0.70 Select an Administrative Item Bldg Stds Cormnission Fee: IBCBSC $1.00 SUBTOTALS. $164.70 $0.00 TOTAL'FEE: $164.70 Revised: 1/19/2012 GENERAL PERMIT APPLICATION MEP 10 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MIS GUPERTINO (408)777-3228•FAX(408)777-3333•buildingcd)cupertino.org IC t2v2 Ottcl PLUMBING MECHANICAL ELECTRICAL MISCELLANEOUS PROJECT ADDRESS APN u � L �, � L.00v\.'i Q.L', 6 Z c. OWNERNAME \ �. \�C `.;�.- PHONE 1`t � I t ��! E-MAIL STREET ADDRESS k0 1 �?,__w"� �J fL/j� CITY, STATE,`ZIP CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT Ok CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAL� J LICENSE NUMBER LICENSE TYPE BUS.LIC u COMPANY NAME E-MAIL FAX i STREET ADDRESS CITY,STATE,ZIP / PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL. FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK �� ` ��� _�:>'�.�'\ \I � �1 Lt\1, ;L�t.,�`-."l �...'LC'ls. •. .. 17 TOTAL VALUATION: a)c,' C/-?C) 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 read this application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b ding construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: c- �Lv( Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY pWp ❑ OVER-THE-COUNTER F ❑ EXPRESS z ❑ STANDARD a ❑ LARGE a ❑ MAJOR MEPMiscApp_201 1.doc revised 06/21/11