The URL can be used to link to this page

11120065 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20324 GILLICK WAY CONTRACTOR:GOGO ROOTER PERMIT NO: 11120065 OWNER'S NAME: HIRAI FRED M AND DONNA R 2530 BERRYESSA RD STE 509 DATE ISSUED: 12/09/2011 OWNER'S PHONE: 4087958954 SAN JOSE,CA 95132 P1101NF.NO:(408)282.7026 LICENSED CONTRACT'OR'S DECLARATION ION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class (:� 3�o Lic.4 _(7`0 ` /' 0 P__. %,, / �_ r MECH r RESIDENTIAL r COMMERCIAL r Comrnclor V � l9T> I�C:O q4 Z" %tOl hereby affirm that 1 am licensed under the provisions of Chat pter 9 JOB DESCRIPTION: REPLACE EXISTING S17WER LINE AND ADD PROPERTY (commencing with Section 7000)of Division 3 of the Business&Professions LINK Code and that my license is in full force and effect. CLEAN OUT 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. 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 which this Sq.Ft Floor Area: Valuation:$5125 permit is issued. APPLICANT CERTIFICATION APN Number:36936038.00 Occupancy Type: I certify that I have read this application and slate 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 save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature -,/GDail ^9�Q� Issued by: Date: OWNER-BUILDER DECLARATION RE-ROOFS: ,*by affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials Ibr I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER hereby affirm under penalty of perjury one of the following three declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's IIA7.ARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Ileallh&Safety Code,Sections 25505,25533,and 25534. 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 O forthwith comply with such provisions or this permit shall be deemed revoked. E1�zL �Uate• APPLICANT CER'11FICAITON CONSTRUC'T'ION LENDING AGENCY I certify that 1 have read this application and slate that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct 1 agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address cos and expenses which may accrue against said City in consequence of lite go of this permit.Additionally,the applicant understands and will comply a non-point source regulations per the Cupertino Municipal Code,Section ARCIIITECT•'S DECLARATION 9'18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO • 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36936038 . 00 DATE ISSUED. . . . . . . : 12/09/2011 RECEIPT # . . . . . . . . . : BS000015538 REFERENCE ID # . . . : 11120065 SITE ADDRESS . . . . . : 20324 GILLICK WAY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HIRAI FRED M AND DONNA R ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4413 RECEIVED FROM . . . . : JOHN ANDERSON CONTRACTOR . . . . . . . : DUARTE TADEU LIC # 28801 COMPANY . . . . . . . . . . : GOGO ROOTER ADDRESS . . . . . . . . . . : 2530 BERRYESSA RD STE 509 CITY/STATE/ZIP . . . : SAN JOSE, CA 95132 TELEPHONE . . . . . . . . : (408) 282-7026 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00 1BCBSC VALUATION 5, 125 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 5, 125 .00 0. 51 0 . 00 0 . 51 0 . 00 1PPERMITFE FLAT RATE 1 . 00 44 . 00 0 .00 44 . 00 0 . 00 1PRSEWER UNITS 1 . 00 22 . 00 0 .00 22 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 152 . 51 0 . 00 152 . 51 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 152 . 51 VISA --------------- TOTAL RECEIPT 152 .51 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING • CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION • ADDRESS: 20324 gillick way DATE: 12/09/2011 REVIEWED BY: bobs. APN: 3 3 0391 BP#: "VALUATION: $5,125 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPSS USE: PERMIT TYPE: WORK replace existing sewer line add property line clean out. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $22 TOTALS: $22.0011 dfedi. PLvr Check Plumb.Plan Check 0.0 hrs $0.00 ii(ec.Plan(hecl,- Mach, Permit F,c: Plumb. Permit Fee: IPPERMIT I E'lec. Permit fire: • ihAer 8ir,•/r.h-av Other Plumb Insp. 0.0 hrs 1 $44.00 011ie., Ele;:. insp. Li I ,Vecls.Inep. !'ee: Plumb. In"o./"P<;' &'ler.Invn. rete NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc. . These fees are based on the Prelinina information avai(ab(e and are only an estimate. Contact the De ! or addn'I Info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fec: .Srippl. PC Fee PME Plan Check: $0.00 Permit Pce: Srrpph hcsp Feu PME Unit Fee: $22.00 PME Permit Fee: $44.00 Colistructiort 7'ba': Administrative Fee: IADMIN $41.00 Work Without Permit? Yes 0 No $0.00 -1,h'aneud Plarmin, Foes: Travel Documentation Fee: ITRA VDOC $44.00 Strone Motion Fee: IBSEISMICR $0.51 Select an Administrative Item • Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $152.511 $0.001 TOTAL FEE: $152.51 Revised: 12/04/2011 GENERAL PERMIT APPLICATION 1110?0&5 MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 • CUPERTINO 2 (408)M-3228-FAX(408)777-3333• buildinG(a)cuoertino.oro M I S PLUMBING EIMECHANICAL ELECTRICAL MISCELLANEOUS PROJECT ADDRESS � AFyN# Qc�j Q lP D 3 5 ADZRE C7-7 �tl 5'C(. ffi � d/,VW FAX T'yp}ZAT�I�Np�A¢ME CTrY4TA FAX ❑OWNER ❑ owm-surlmm ❑ OWNERAGENT tj CO TRACIVR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGDIEER ❑ DEVEIAPER ❑TENANT CO ORNAME LI ER LICE4A7( BUS.LICN,:,,,2Q8-0 CDMFANY,7�da�� y 2 �+�. E-MAD- Q FAX IJ ((,J/ STREEb0 cJ tJ 8e, 2- t�'�,y� id YID C11SrA C✓/ / ` /3� PHONE ARCHITECTV�/ENGINEER NAME LICENSE NUMBER `l BUS.LICA COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 14 SE OF ❑SFO or DUPLEX [IMULTI-FAMB.Y PROJECT IN WILDLWD El YES PROIECTIN ❑YES IS THE BLDG AN ❑ YES BUDDING: ❑WMMERCIAL URBANINTRFACEARFA ❑ NO FLOODP.ONE [3 NO EICHLER HOME? ❑NO DESCRIPTION OFWORF J7--(?-- 4r olln / / t 1 /� J_ TOTAL VALUATION: / CV RECEIVED BY: By my signature below,I certify to each of the following: I=the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have prov' s comet.)have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state Iews relating m n onstructionL I auth0 'z sen 'v of Cupertino to enter the above-idrntifled property for inspection purposes. Signature ofApplicenVAgenD Date: PTFMENTAT W0FWAn0NF&QLTMD OFFICE USE 9NLY m OVER-THF-COUNTER 6 ❑ EXPRESS Y u ElSTANDARD U u ❑ LARGE G ❑ MAJOR MEPMucApp_2011.doc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 •U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS:-9—e) PER # OWNER'SNAME: /jOn'P-�- lh/tL) PHONE#e/OV D —59-5'7 GENERAL CONTRACTOR: Czel/ BUSINESS LICENSE# o2F ADDRESS: 3 .v, /9e4- a S-T C,9, 9S ITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL I7BCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: 4gnatlfre Date 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