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12020037
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6359 MYRTLEWOOD DR CONTRACTOR:SMART PLUMBERS& PERMIT NO: 12020037 ROOTERS OWNER'S NAME: ULICKI ROBERT L AND PATRICIA K 2112 SANTA CRUZ AVE DATE ISSUED:02/09/2012 OWNER'S PHONE: 4484463718 SANTA CLARA,CA 95051 PEIONE NO:(408)247-2400 LICENSED.CONTRALCTORIS DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.4 MECH ' RESIDENTIAL COMMERCIAL ' Contractor-s&&*-�m4ettl Date ( I JOB DESCRIPTION:REPLACE WATER LINE GALVANIZED TO COPPER FOR I hereby affirm that I am licensed tinder the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions KITCHEN,LAUNDRY AND WATER HEATER Code and that my license is in full force and effect. I hereby affirm tinder 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 Sq.Ft Floor Area: Valuation: Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36917001.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for*inspection purposes. (We)agree to save indemnity and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may c-tie against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Addi i nal y,the applicant understands and will comply with all non-point source r ,ulatioins per the Cupertino Municipal Code,Section 9.18. Issued by: -,2 Sip-nature Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to rernove all new materials for the following two reasons: inspection. 1,as owner of the property,or my employees with wag es as their sole compensation, will do(lie work,and the,structure is not intended or offered for sale(Sec.7044, Signature.of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm tinder penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-Insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will ulaintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of(he work for which this permit is issued,I shall Health&Sa Code,Sections 25505,25533,and 25534. Health not employ any person in any nianner so as to become subject to the Worker's I Compensation laws of Califorriia. If,after making this certificate of exemption,I Owner t orize bent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 2-- f f)rthwitli comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of Nwirk's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against I labilities,judgment-,, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all tion-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9,18. Licensed Professional Signature Date I I 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: PERMIT# � OWNER'S NAME: t �` PHONE# c5w GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: 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 SUBCONT TORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 1Z — Signature Date Please check applicable subcontractors and complete the following information: V 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 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36917001.00 DATE ISSUED. . . . . . . : 02/09/2012 RECEIPT #. . . . . . . . . : BS000015969 REFERENCE ID # . . . : 12020037 SITE ADDRESS . . . . . : 6359 MYRTLEWOOD DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ULICKI ROBERT L AND PATRICIA K ADDRESS . . . . . . . . . . : 6359 MYRTLEWOOD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4624 RECEIVED FROM . . . . : MIKE W RA CONTRACTOR . . . . . . . : JIN LEE LIC # 31236 COMPANY . . . . . . . . . . : SMART PLUMBERS & ROOTERS ADDRESS . . . . . . . . . . : 2112 SANTA CRUZ AVE CITY/STATE/ZIP . . . : SANTA CLARA, CA 95051 TELEPHONE . . . . . . . . : {408) 247-2400 'FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1ADMIN HOURS 1 .00 41.00 0. 00 41.00 0.00 1BCBSC VALUATION 2, 800 .00 1. 00 0 .00 1 .00 0.00 1BSEISMICR VALUATION 2, 800 .00 0 .50 0. 00 0 .50 0 . 00 1PPERMITFE FLAT RATE 1 .00 44 . 00 0 .00 44 .00 0 .00 1PREPPIPE 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 174 .50 0 .00 174 .50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 174 .50 VISA --------------- TOTAL RECEIPT 174 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING .301 ROUGH PLUMBING 302 TUB & OR SHOWER 506 GAS TEST 507 FINAL PLUMBING CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 6359 myrtlewood dr. DATE: 02/09/2012 REVIEWED BY: bobs. APN: BP#: VALUATION: $2,800 PERMIT TYPE: Plumbing Permit --TPLAN CHECK TYPE: Alteration (Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPDP USE: p PERMIT TYPE: WORK re lace water line galvinized to copper for kitchen laundry, and water heater. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Area 1 PREPPIPE 1 # $44 TOTALS: $44.00 Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT E .. ........... Other Plumb Insp. 0.0 hrs $44.00 NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public FVorks,Fire,Sanitary Sewer District,School District,etc.). These,Les are based on the relinsna ire ormation available and are on1v an estimate. Contact the De t or addn'l in o. FEE ITEMS / :�'A$ e.=r _�_' '. g 1 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $44.00 PME Permit Fee: $44.00 Administrative Fee: ]ADMIN $41.00 Work Without Permit? 0 Yes Q No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 IBSEISAIICR $0.50 Select an Administrative Item °F dig Suds IBC,BSC $1.00 SUBTOTALS: $174.50 $0.00 TOTAL FEE: $174.50 Revised: 1/19/2012 lo2, ()A v0.5 q GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERT{NO (408)777-3228- FAX(408)777-3333- building(d�cupertino.org MISC '° PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS � �© � AFN# 4J / O D 1 ((✓ OWNER NAMEPHONE r 3W E-MAIL C C` 44 STREET ADDRESS CITY,STATE,ZIP FAX CONTACT NAMEHONE E-MAIL _ O STREET ADDRESS CITY STATE, ZIP - ` FAX I MM , ❑OWNER ❑ OWNER-BUIIAER ❑ OWNER AGENT 90"CONTRAcToR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME L12 E ER LICENSE TYPE BUS.LIC# lPA 4r—: COMPANY AME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP P j ARCHITECTIENGINEER NAME ,r LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF EnFDrDUpLEX ❑ 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 QAk&."L6ed 4 Pe::::: TOTAL VALUATION: �, RECEIVED BY: G 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 provid es 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 tobuil ' g constructions uthorize representatives of Cupertino to enter the above-identified property for inspection pulposes. Signature of Applicant/Agent: Date: �-- UPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER ❑ EXPRESS U W ❑ STANDARD U ❑ LARGE a ❑ MAJOR MEPMrscApp 1011.doc revised 06/21/11