The URL can be used to link to this page

12010040 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21000 STEVENS CREEK RD CONTRACTOR:THOMAS PLUMBING INC PERMIT NO: 12010040 OWNER'S NAME: FIRSTRO INVESTMENTS LLC 195 SAN PEDRO AVE STE C1 DATE ISSUED:01/05/2012 OWNER'S PHONE: 4088397381 MORGAN HILL,CA 95037 PHONE NO:(408)736-3050 19 LICENSED CONTRACTOR'S DECLARATIONF _//�� v BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class � Lic.# 3�U/U C U MECH F RESIDENTIAL COMMERCIAL Contractor 'lifts / �l�h�j( Date 1 5 1 hereby affirm that I am licensed nder the provisions of Chapter 9 JOB DESCRIPTION:REPLACE SEWER LINE AT COMMERCIAL PROPERTY (commencing with Section 7000)of Division 3 of the Business&Professions LINE 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. 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 Sq.Ft Floor Area: Valuation:$1000 permit is issued. APPLICANT CERTIFICATION APN Number:35907005.00 Occupancy Type: 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 PERMIT EXPIWORK 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 O ERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS ER.0 CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date ' Issued b. . Date: ❑ OWNER-BUILDER DECLARATION ` } RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of q�} fs s be inspected prior to any roofing material being installed.If a roof is the following two reasons: in I r first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, 'ns will do the work,and the structure is not intended or offered for sale(Sec.7044, L.f Business&Professions Code) �,: 6Pie of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors toI construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I 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. Additionally,should I use equipment or devices which emit hazardous air permit is issued. 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 Health&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 Ow ora hoagent: ' ' forthwith comply with such provisions or this permit shall be deemed revoked. wM Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of mrk's correct.I 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 costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 6 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35907005. 00 DATE ISSUED. . . . . . . : 01/05/2012 RECEIPT #. . . . . . . . . : BS000015677 REFERENCE ID # . . . : 12010040 SITE ADDRESS . . . . . : 21000 STEVENS CREEK RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : FIRSTRO INVESTMENTS LLC ADDRESS . . . . . . . . . . : 1030 E EL CAMINO REAL UNIT 511 CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086 RECEIVED FROM . . . . : THOMAS PLUMBING, INC CONTRACTOR . . . . . . . : THOMAS, BENJAMIN J LIC # 9331 COMPANY . . . . . . . . . . : THOMAS PLUMBING INC ADDRESS . . . . . . . . . . : 195 SAN PEDRO AVE STE Cl CITY/STATE/ZIP . . . : MORGAN HILL, CA 95037 TELEPHONE . . . . . . . . : (408) 736-3050 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 1, 000 .00 1. 00 0. 00 1 .00 0. 00 1BSEISMICO VALUATION 1, 000 .00 0.50 0. 00 0.50 0. 00 1PCSEWER UNITS 1 .00 22 . 00 0. 00 22 .00 0. 00 1PPERMITFE FLAT RATE 1. 00 44. 00 0. 00 44 .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 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21000 stvns crk blvd. DATE: 01/05/2012 REVIEWED BY: bobs. APN: BP#: "VALUATION: j$1,000 PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY Commercial Building PENTAMATION 1CPSS USE: I PERMIT TYPE: WORK re lace sewer line at commercial property line. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PCSEWER 1 # $22 TOTALS: $22.00 Plumb.Plan Check 0.0 Frs $0.00 Plumb.Permit Fee: 1PPERMIT Other Plumb Insp. 10.0-1hrs $44.00 NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelinina information available and are only an estimate. Contact the De t or addn I info, FEE ITEMS (]-',-,(,Resolution 11-053 Gff. 7,1/11) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $22.00 PME Permit Fee: $44.00 Administrative Fee: ]ADMIN $41.00 Work Without Permit? Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 A Stronf4 Motion Fee: IBSEISMICO $0.50 Select an Administrative Item Bld-g Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $152.50 $0.00 TOTAL FEE: $152.50 Revised: 1/01/2012 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: _92 e4jCr /d PERMIT# 2,-�t v OWNER'S NAME: Tnve ' .eh�S L-GG PHONE# qDS" �� GENERAL CONTRACTOR: yy, r hL BUSINESS LICENSE# j X00`ec) ADDRESS: CITY/ZIPCODE: li ' Q�63 *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. �^ `, l I am not using any subcontractors: Signature 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 Pa,w)- Ids/r � Owner/Contractor Signature Date GENERAL PERMIT APPLICATION MEP La COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333• build ing(cDcupert no.org MISC CUPERTINO LUMBING ❑IvIECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS C`)D /+ e/, U Q APN# OWNER NAME PHONE ,!l?tl^ S� E-MAIL STREET ADDRESS CITY, STATE,ZIP 6 J FAX CONTACT NAMED J/I� p✓� PHONE [,y�_`1n/_!/_(� E-MAIL STREET ADDRESS l CITY,STATE, ZIP ( (P ! FAX ❑OWNER ❑ OWNER-BUILDER OWNERAGE T CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR N T `7 LICENSE NUMBER C LICENSE TYPE BUS.LIC# �37tc y - 7te COMPANY NAME �fi Q E-MAIL �)_ s f ek ae l FAX STREETADDRESS Wl)`�#AJ'� ar CITY,STATE,ZIP/ Qn /� 507 PHONE 0- rLt�Q ARCHITECT/ENGINEER NAME I LICENSE NUMBER / BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK Re /'r O //' r �� TOTAL VALUATION: RECEIVED BY: J 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.,have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating uilding onstruction`I authorize representatives of Cupertino to enter the above-identified property for inspection p4poses. Signature of Apphcant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED =CE USE ONLY ffllloVER-THE-COUNTER G ❑ EXPRESS Y U W ❑ STANDARD S U Z ❑ LARGE c ❑ MAJOR MEPMucApp_2011.doc revised 06/21111