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B-2018-0009CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0009 21840 TERRACE DR CUPERTINO, CA 95014-4743 (356 25 002) MARTI'S PLUMBING SERVICE INC SAN JOSE, CA 95125 OWNER'S NAME: KALYANASUNDARAM RAMKARTHIK C AND NATARAJAN OWNER'S PHONE: 408-242-0464 LICENSED CONTRACTOR'S DECLARATION License Class C-3¢ Lic. #958020 Contractor MARTI'S PLUMBING SERVICE INC Date 12/31/2019 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 b in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1. 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. I e 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 permit is issued. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the ap�erCu nds nd will comply with all non -point source regulatio o unicipal Code, Section 9.18. Signatu Date 1/3/2018 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 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. 2. 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 permit is issued. 3. 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 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. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 9.18. Signature Date 1/3/2018 DATE ISSUED: 01/03/2018 PHONE NO: (408) 315-3190 BUILDING PERMIT INFO: X BLDG —ELECT X PLUMB _ MECH $ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPLACE 1/2" BLACK IRON GAS LINE - GAS RANGE AND DRYER (75000 BTU) Sq. Ft Floor Area: I Valuation: $1750.00 APN Number: Occupancy Type: 356 25 002 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: Abby Avende RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 1/3/2018 11 A 11 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipo Co4a, Chapter 9.12 and the Health & Safety Code, Sections 25505 , a d 25534. Owner or authorized agent: Date: 1/31201$ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • building@cupertino.org PEMIT #B - )0l CUPERETINO I REV# DEF# ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA PROJECT ADDRESS �1 410-�r6CR' p� AI'N OWNER NAMF, �/� PHO , �� E-MAIL +� STREET ADDRESS CTI Y STATE, ZIP rP b a cam. CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY NAME LICE S UMBERLICENSE TYPE C� �v 'j q G 3� a „� S ET DDRESS 71� t , STATE, ZIP ms )a r s' E-MAIL P NE BUS. LIC # ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTACT NAME'AQ lw�e& E-MAIL STREET ADDRESS. ,� � � CCJ�, STATE, ZII' � � IP44YI �-�� NE 7 �J 0 DESCRIPTON SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL []COMMERCIAL USE TYPE OCC SQ.FT. VALUATION ($) EXISTING USE I EXISTING SF NEW FLOOR SF I PORCH SF DECK SF DEMO SF STORIES # TOTAL NET SF REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ ATTACHED BATHROOM SF SF SF SF ❑ DETACHED EICHLER YES SECOND STORY ADDnTON O YES FIREISPRINKLERS [I NO ❑❑ NO NO DWELLING SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER UNITS # UNIT ADDITON: []NO S F POOL$1] FIBERGLASS VINYL -LINED ❑ GUNITE [:]PREFABRICATED POOL - SF SPA - SF SPA ATTACHED ❑ YES ❑ NO TOTAL - SF REC V D BY: TOAL VALUATION: Coininrrrial or Multi -Family Buildings with Public Swimming Pools requires Department o(Environmental Heath apyroval ,{,N /� 2 �OvTHEER RE -ROOF EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ElWOOD SHINGLES E]TILE (SPECIFY) REMOVE /REPLACE Q NO IF NO PLYWOOD ❑'h" ❑ 3/8" PLYWOOD TYPE: PITCH: ROOF CLASS YES I # OF LAYERS THICKNESS ❑ 5/8" OTHER ❑ OSB ❑ CDX OTHER -:121 A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER *Provide a signed copy of the Cupertino's Tear -Off Policy SF #of SQUARES 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 I 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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection p3pposes, I cknowledge and authorize all information co d on this application form to be made available for public record. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED *New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. *HOA -Provide a letter of approval from the Home Owner's Association B1dgApp_2017.doc revised 08101117