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11120049 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7604 NEWCASTLE DR CONTRACTOR:GREAT AMERICAN PERMITNO: 11120049 PLUMBING CO INC OWNER'S NAME: VIVIAN HERMAN P O BOX 26942 DATE ISSUED: 12/07/2011 ER'S PHONE: 4082577750 SAN JOSE,CA 95159 PHONE NO:(408)279-1515 ❑ LICENSED CONTRACT'OR'S DECLARATION r r r BUILDING Pl',RMIT INFO: BLDG HLECIPLUMB License Class C 3 Lic.H_SZ)(oG C r r r MECII RESIDENTIAL f— Contraclor6&eA7'"*rt(Mr 2aK& oto Q- —11 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INS'I'ALI.NEW PROPERTY LINK CLEAN OUT (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: 1 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:$1950 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 APN Number:36617009.00 Occuponcy Type: permit is issued. APPLICANT CER'T'IFICATION 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 stale 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, costs,and expenses which may accrue against said City in consequence of the Issued b Dote: granting of this permit. Additionally,the applicant understands and will comply r with all non-pro source regulations per the Cupertino Municipal Code,Section 9.18. RF--ROOFS: Signature Date (EZ 7-f/ 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 10 IF V inspection. OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contn¢Inr's License Law for one of Signature ol'ApplicanL Date: the following two reasons: ALI,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 IIA7.ARDOOS 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 Cade,Sections 25505,25533,and 25534. 1 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 1 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 flay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cuperli n Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the health&Safely Code,Sect ns 550 , 33,an Section 3700 of the Labor Code,for the performance of the work for which this �f Owner or authorized ogent 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 Compensation laws ofCalifomia. If,alter making this certiflcaEe of exemption,I CONS '12UCTION LF-NDTNG 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 deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPI,ICAN'I'CER'I'IPICA'I'ION 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 oo the above mentioned property for inspection purposes.(We)agree to save mmnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION' Is,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 CITY OF CUPERTINO •6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36617009 . 00 DATE ISSUED. . . . . . . : 12/07/2011 RECEIPT # . . . . . . . . . : BS000015509 REFERENCE ID # . . . 11120049 SITE ADDRESS . . . . . : 7604 NEWCASTLE DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER VIVIAN HERMAN ADDRESS 7604 NEWCASTLE DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5221 RECEIVED FROM . . . . : THE GREAT AMERICAN CONTRACTOR . . . . . . . : CORPORATION LIC # 18061 COMPANY GREAT AMERICAN PLUMBING CO INC ADDRESS P 0 BOX 26942 . CITY/STATE/ZIP . . . : SAN JOSE, CA 95159 TELEPHONE . . . . . . . . : (408) 279-1515 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00 1BCBSC VALUATION 1, 950 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 1, 950 . 00 0 . 50 0 . 00 0 . 50 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 . 50 0 . 00 152 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --=------------ -------------------- CHECK 152 . 50 121268 --------------- TOTAL RECEIPT 152 . 50 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: 7604 new castle dr. DATE: 12/07/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$1,950 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/Repair PRIMARY SFD or Duplex PENTAMATION 1 RPSS USE: PERMIT TYPE: WORK install new property line clean out. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $22 TOTALS: $22.00 Iferh. Phar Check Plumb.Plan Check "00 $0.00 Ele".Plnu Chcck .Meeh. Peruur Fire.' Plumb.Permit Fee: IPPERMIT Elle. Prrnel Fee: Olhev,lf,.rlr.hlxp. Other Plumb Insp. 0.0 1 Ins $44.00 Olh<o A'k-o. Insp, Heck Imp. Fee: Pliveb. bup,Fee: Liles Insp. Pee.: NOTE: This estimate does not Include fees due to other Departments(!e.Planning,Public Works, Fire,Sanitary Sewer District,School District etc. . These fees are bared on the prelimina in ormation available and are only an estimate. Contact the De t or addn'i info. FEE ITEMS (Fee Resolution 11-05)F_B 711!111 FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl, PC.Fee PME Plan Check: $0.00 Permit Fee: Supp/. Luse,e u PME Unit Fee: $22.00 PME Permit Fee: $44.00 C'nnatrriefion 'lila Administrative Fee: (ADMIN $41.00 Work Without Permit? O Yes 0 No $0.00 :1tivancetl Planning Fees: Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $152.50 $0.00 TOTAL FEE: 1 $152.50 Revised: 10/01/2011 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• buildinG(")c.cuoertino.orD M I S I I i Zoa-1 q LUMI3ING EIMECHANICAL ELECTRICAL EIMISCaLkNECUS PROJECT ADDRESS G AIN# OWNER NAME `vl PHONE E-MAD- —` STREETA15DUSS CITY, STATE,ZD' FAX COMACi NAME #* eru✓,,�VIC6 N ,K/ PHONE STREEr ADDRESS CRY, A ZIP FAX 7 /I 3 13 OWNER 13OwNER-BUDDER 13M11OWNERAGENT I WNTCrOR CONTRACTOR AGENT ENGINEER. EI❑ENGINEDEVELOPER ❑TENANT CONTRACTOR NAMELICENSE NUMB ER LICENSEM BUS.LICK r COMPANY NAME E-MAJL FAX STREET AODAESS04 6rie0wyk AveCITY.'9's �[P PHONE ARCHRECTIEdGINEEI NAME LICENSE NUMBER BUS,BUS.LIC p CDMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE SE OP aDUPLEX [3MULTI-FAMD-Y PROIECT IN WDDLAND ❑ YES PROJECT IN ❑YES ISTHEBLDGAN ❑YES BVIIDDJ0: ❑COMMERCIAL URBAN INTERFACEAREA ❑ NO FLOOD ZONE 0 N EICHLER HOME) E3 NO DESCRIPTION OF WORK '�+ LL L Pv� L�•rr cc r'� TOTAL VALUATION: C� CIRECEIVED 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 I ha a provided is correct j have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating building co tion 1 authorize Cupertino to enter the above-identi5ed property for inspection pu@oses. Signature of ApplicanNAgent: I& Date:�T7 LEMENTAL INFORMATION REQUIRED OFFIC JSE ONLY y OVER•7HECOUN7ER d ❑ EXPRESS Y U S ❑ STANDARD U ❑ LARGE 6 ❑ MAJOR MEPMucApp_2011.doc revised 06/1]/]1 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: PERMIT# O d OWNER'S NAME: PHONE# B--Z 7 -iS75— GENERAL CONTRACTOR: R.T- USINESS LICENSE# ADDRESS: q a CITY/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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Signature Date Please check applicable subcontracto and complete the following information: t/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing map Flooring/Carpeting Linoleum / Wood Glass /Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Alk Sheet Rock Tile Owner/Contractor Signature Date