16010009CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20708 GARDEN CREST CT
CONTRACTOR: TRENCHFREE INC PERMIT NO: 16010009
OWNER'S NAME: SATYANARAYANA VEMPATI
PO BOX U DATE ISSUED: 01/04/2016
OWNER'S PHONE: 4089731670
SAN JOSE, CA 95151 PHONE NO: (408) 726-7926
R
❑ 'S DECLARATION
LICENSED CONTRACTOR'S
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
REPLACE WATER SERVICE FROM METER TO PROPERTY
License Class • 3� ti Z Lic. #
Contractor he dtG, Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(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.
Sq. Ft Floor Area:
Valuation: $2350
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36230053.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. VA - (�
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. I 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 FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,'3
`
costs, and expenses which may accrue against said City in consequence of the
Date: I(0
I /4/
granting of this permit. Additionally, the applicant understands and will comply
Issued by:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
-_!
J //� / /
RE -ROOFS:
being installed. If is
Signature Date/ 10
All roofs shall be inspected prior to any roofing material a roof
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR.BETTER
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 & Professions Code)
I, 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. I will
I 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 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 I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I 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 which this
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent, -- ^� Date:
permit is issued.
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
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 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and 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 and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
4
CUPERT[t-40-
GENERAL PERMIT APPLICATION 1K0' -
ME P
C0MMiUNITY DEVELOPYiENT DEPARTMENT • BUILDING DIVISION
10300 T ORRE AVENUE • CUPER T INO, CA 55014-3255
(408) 777-3228 • FAX (408) 777-3333 • build inoCcDouoertino.org
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USE OF ❑ SED or DUPLEX ❑ MIULTI-F.41,M-Y
PROJECT R% R'II.DLf?N'D ❑ YES PROi=CT IN ❑ YES
IS TFIE BLDG AN ❑ =S
BTIDLNIG: ❑ C01,OJrr.CL�L
L7.2B� ''L,\=- rkCEApak ❑ NO FLOOD ZOMS ❑ NO
EICFLERfi0h.E? ❑ NO
DESCRIPTION OF WORK
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TOTAL VALUATION: 35-0
r R�CFIZD Bl ��
By my signaL=e below, I certify to each of the following: I am the propefty owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of \Teak and verify it is accurate. I agree to comply with all applicable local
crd mces and state laVN's relate g to bu l' _ nsu action. I authorize representatives of Cupertino to enter the above-identif.ed property for ins pec ion purposes.
S1 �ai'�re of A.pplican t/Agent:
Date: f� �—J
SU-PPLENENTAL LN ORv?ATION REQUIRED
_ a OFTSCE T SE ONL1F01 NORM
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f 3
Oak
T7
IZJOR' £
1 €Pl1j7scZpp_2011.doe revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
im
ADDRESS 20708 Garden Place Ct
I DATE: 0110412016
REVIEWED BY: PAUL
I'I
APN: 362 30 053
1 BP#:
*VALUATION: 1$2,350
I°PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
M" . Fee:
PENTAMATION
I PERMIT TYPE: 1 RPWS
WORK
Replace water service from meter to property
SCOPE
Akfech. Pion I I
Plumb. Plan Check 1 0.0 1 hrs $0.00
1.,Ie£;—P!an e."i "
IPeer h, zee:
Plumb. Permit Fee: IPPERMIT
00.,er "I'lech. hfsp.
Other Plumb Insp. 1 0.0 hrs 1 $48.00
nb. Fei�:
M" . Fee:
VOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
,uistrict,eta). inese-jees are based on tile preliminary information available ana are only an estimate. Contact the Dept for aaan'l info.
FEE ITEMS (Fee Resolution .1.1-053.Ea.'7111131
FEE
QTY/FEE
MISC ITEMS
Phin
PME Plan Check:
$0.00
F-1
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
(Onsll-u-11,0n 7,ay.,
F
Administrative Fee: 1,4DMIN
$45.00
Work Without Permit? 0 Yes (D No
$0.00
1
Travel Documentation Fee: I TR,4 VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:,
$167.50
$0.001" "TOTAL FE
$167.50
Revised: 10/01/2015