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12080243 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6390 MVRTLEWOOD DR CO,NTRACI'OR:EAGLE PLUMBING INC PERMITNO: 12080243 OWNER'S NAME: SRIRAhI NATARMAM 544 1 IASSINGER RD DATE ISSUED:08222012 OWNER'S PHONE: 4086925526 SAN JOSE,CA 951 I I PHONE NO:(408)281-0583 �❑ LICENSED COKI'RAC`FOR'S DECLARATION .1011 DESCRIPTION: RESIDENUTAI U CONINIERCLU, License Class (' — 3 Lic.9 R 11 b Dk' INSTALL 1/2" GAS LINE FOR COOK TOP Contractor P PrG LE PLV MRI AIG, Date 'A -g1: 0—I hereby affirm that 1 am licensed under the provisions of Chapter 9 (cum"Iencing with Section 7000)of Division 3 oft he Business S Professions Code and that my license is in full force and effect. hereby affirm under penalty of perjury one of the follmving two declarations: I hue and will maintain a certilicatc of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,far the performance of the work for which this permit is issued. Sq.Fl Fluor Area: Valuation:$800 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the perfomance of the work for which this APN Number:36919008.00 Occupanc)Type: permit is issued. AI'1'1,1CANT'CER'1'IFIC,\TION I cenify that I have read this application mid 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 stale Imus 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 DAT' Oil LAST CALLED INSI' CTION. indemnify and keep hamdcss the City of Cupertino against liabilities,judgments, (,OY costs,and expenses which may accrue against said City in consequence of the r1 O granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: 2z with all non- nt so ce regidations per the Cupertino Municipal Cade,Section ,pi9.18. RP:ROOFS: Signalur_e Date R-r}r)- i, 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 inspection. ❑ OWNISR-111111.1)ER DECLARA'T'ION Signature of Applicant: Date: I hereby:dfinn thatI out exempt from the Contractor's License Law formic 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) 1,as owner of the property,am exclusively contracting with licensed contractors to 1IA"LARDOUS MATERIALS DISCLOSURE construct die project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California I Iealth S Safety Code.Sections 25505,25533,and 25534. 1 will I herehy affirm under penalty of perjury one of the follmving three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the declarations: 1lealth S Safety Code,Section 25532(x)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 performance of the work for which this permit is issued. will maintain compliance n,ith the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the I Iealth S Safely Code,Se t oa 05. 533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this -aa'l� permit is issued. Owner or authorized a Date: 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,alley making this certificate ofescmption,I CONS-rRUCfION LIiNDING 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 deenmed revoked, work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name A PPLICAN'T'CERTI FICATION lender's Address 1 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 propeny for inspection purposes.(We)agree to save ,\RCIIII'I•:CI"S DECLARATION indemnify and keep harmless the Cit•of Cupertino against liabilities,judgments, costs,mid 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 mid will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Dale CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 6390 Myrtlewood Dr DATE: 08/22/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: $800 °PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1RPGAS USE: •PERMIT TwE: WORK Installation of a 1/2" gas line for a cook top. SCOPE AP11LIANCI?/ EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Gas <=4 Outlets 1PGASRES 1 # $67 TOTALS: $67.00 Mech.Plan Check Plumb. Plan Check 0.0 hrs $0.00 Etc,.Plan Check Alech.Permit Fee: Plumb. Permit Fee: IPPER IT 6lec. Permit Fee: Otber Mec•h.Imp. Other Plumb Insp. 0.0 hrs $45.00 Other Elec.Insp. Adech.Imp.Few: Plumb. h+.sp.Fee: Eler.Insp.Fee: NOTE: This ectinmte does not include jeer due to other Departments(i.e. Planning, Public /forks, Fire,Sunitnp•Sewer District,School District.etc.). Theve fees are based on the prelinfinan•information availnhle and are onh,an evdinate. Contact the De I or addn'I into. FEE ITEMS (Fec llesohuion 11-053 EI/ 771/11) FEE QTY/FEE MISC ITEMS Phin Check Fee: Snppl. PC Fee PME Plan Check: $0.00 Permit Fee: S1111pl. Gap Fee PME Unit Fee: $67.00 PME Permit Fee: $45.00 Consnvtction Tax: T T-77 Administrative Fee: 1nDA-BN $42.00 Work Without Permit? 0 Yes 1) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA UVDOC $45.00 i Strong Motion Fee: /BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $200.50 $0.00 TOTAL FEE: $200.50 Revised: 07/01/2012 GENERAL PERMIT APPLICATION ��3 MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUIL-DING DIVISION 10300 T ORRE AVENUE • CUPER T INO, CA 950143255 IM 23 1 c CUPERTINO (408) 7Tr-3228 • F.4X(-08)T7-3333• buildincCc Guoerdno.oro `� m ?LLMBLNG ❑IrEC_ANICAL ❑ELECT.i!C?.L W FlIvIvus=L4NE.0us ERo+-rAnoR�s �� q � yfZTLCII� �� \ 2. .4PN: 1� � lC% e, OWNENAME STRE:TADOReSS C^f. S.4 ZTP FAX CONTACT NAM. I PHONE I E-MALT SiR—=ADDRESS C:r..SCAT_ ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNEtACENr CONT CTOR ❑CON�. ACFORAG , ❑ ARC.-TCT ❑FNGYEZt ❑ Dry._OPa ❑ =NA CONTACTOR NAMEl I LC?15c VUM3R I _C- 'S'c i`.'PE 19ti5.ilCd \ 1NYE COMPANY NAM' G L L' f` I -i FAXlJ art.—�AnDR=ss ate.STATT Z:F PHONE OEGEf, k I 0 S C Ci\_ CI 91LlfC I .ARGv^7'�12NGIN]=—R I UCENSE NJN ER I SUS.UC9 COMPANY NAME' I E-MAIL FAX ST R=ADDRESS C17 ,STATE,ZIP PHONE -USE.OF -w DUPLE% ❑ ML,,FA Y PRCIEC'i INWS L [I'm MOTECT,N - ❑YES I l5 i}�3LDG AN -. ❑ Y3 BLTLDWG: COMMERC.AL LTSAN iN FAC=ASL'-A ANO FLOOD ZDNE 0 mo* HOMc. NO DESC7,31,7011 OF woR \ S TOTAL VAT UATTON: I RECEIYJ BY: 3y my signa .-e below,I c^j a ' .-1c`ollowi_g; I zsr tc prcoe./owner or arhorud agent:o ac:on:he urooc.y cwnrr's�bbehalf I bav:mad this zupleaaon=d the iafomzdot'.I h +e pm" ed 1 cosec: I Save read Lhe Dseipdon of Work and verity is is a=—,zt. I ag-c=F comply wii all a,Dlicabit local ordinances zDd sa¢laws rladrg g q I auhorm ropresc;z::ves of CuDerdr-c::^e:Lha above-idenu5ed pmpe.-/for inspecdou puF;>eses. Signature ofA�' Date: SUPPLEME .AL INFOR.hL,=W REQTjaED OFFICE USE ONLY y �O VTA-THE-COIBNTER — EXPRESS u ❑ STANDARD L ❑ LARGE ❑ NL OR ACE PMsc4pp-i 011.doc revised 06P1/11 '