The URL can be used to link to this page

12020100 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10162 FIRWOOD DR CONTRACTOR:BENJAMIN FRANKLIN PERMIT NO: 12020100 PLUMBING OWNER'S NAME: KETAN&ALPA SHAH PO BOX 1072 DATE ISSUED:02/2212012 CAMPBELL,CA 95009 PHONE NO:(408)293-1776 ONVNER'S PHONE: 4084398954 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT PLUMB RA . License Class Lic.# 5 7 3,5 7 MECH RESIDENTIAL COMMERCIAL Contractor �eni)'Fy�1t�i '%'��1,J Date 2— Z2 L JOB DESCRIPTION:RUN 40 FEET OF OAS PIPE FOR STOVE I hereby affirm that I am licensed under the provisions of Chapter 9 (coruruencing with Section 7000)of Division 3 of the Business&Professions 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. Sq.Ft Floor Area: Valuation:WOO 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:3423027.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT 'STARTED to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgment`s, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Date: with all non-point source regulations per the Cupertin Municipal Code,Section Issued by' 9.18. Signaaur Date RE-ROOFS: ® VNER- DER DECLARATION 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 I hereby affir at I am exempt from the Contractor's License Law for one of inspection. the following two reasons: Date: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property, ,in exclusively contracting with licensed contractors to construct tire project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. [will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit is issued. vices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or de contaminants as defined by the Bay Area Air Quality Management District I will Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. 1 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 Owner or rrzecl a n ' Date: 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 perm€t shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of ttre granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: TraciC 6 ITEMS OF 9 COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . 34235027 . 00 DATE ISSUED. . . . . . . : 02/22/2012 RECEIPT # . . . . . . . . . : BS000016084 REFERENCE ID # . . . 12020100 SITE ADDRESS . . . . . 10162 FIRWOOD DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : KETAN & ALPA SHAH ADDRESS . . . . . . . . . . . 10162 FIRWOOD DR CITY/STATE/ZIP . . . CUPERTINO, CA 95014 RECEIVED FROM . . . . PERMIT SERVICES INC CONTRACTOR . . . . . . . CHAD NELSON LIC # 28520 COMPANY . . . . . . . . . . BENJAMIN FRANKLIN PLUMBING ADDRESS . . . . . . . . . . PO BOX 1072 CITY/STATE/ZIP . . . : CAMPBELL, CA 95009 TELEPHONE . . . . . . . . : (408) 298-1776 FEE ID UNIT QUANTITY AMOUNT PD-TODT THIS REC NEW BAL- ------- ------------ ----------- 1 .00 41 . 00 0 .00 41 .00 0 .00 1ADMIN HOURS 1 . 00 0 . 00 1 .00 0 .00 1BCBSC VALUATION 1, 500 -00 0 .00 65 . 00 0 .00 1BPGAS OULETS 1 .00 65 . 00 0 . 50 0 . 00 1BSEISMICR VALUATION 1, 500 .00 0 . 50 0 .00 0 .00 IPPERMITFE FLAT RATE 1 .00 44 . 00 0 . 00 44 . 00 0 .00 1TRAVDOC FLAT RATE 1 .00 44 . 00 0 .00 ---44 .00 ---------- ---------- ---------- -- ----- TOTAL PERMIT 195 . 50 0 . 00 195 .50 0 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- -------- -------------------- -------- ---------------------------- 301 ROUGH PLUMBING 202 UNDERFLOOR PLUMBING 506 GAS TEST 507 FINAL PLUMBING � 0 50 --1 X20 �Zeb CITY OF CUPERTINO �P FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10162 Firwood DATE: 02/22/2012 REVIEWED BY: gs APN: BP#: VALUATION: $1,500 .21 PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition /Repair PRIMARY PENTAItiIATION 1 RPGAS USE: SFD or Duplex PERMIT TYPE: WORK run 40' of gas pipe for stove. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Gas <=4 Outlets 1PGASRES 1 # $65 TOTALS: $65.00 Plumb.Plan Check 0.0 hrs $0.00 Plumb. Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $44.00 NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public FPorks,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the grelininary information available and are on/v an estimate. Contact the De t Lor addn'l info. FEE ITEMS sr p ;'-'3 ' ' 1�j FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $65.00 PME Permit Fee: $44.00 Administrative Fee: ]ADMIN $41.00 Work Without Permit? Q Yes Q No $0.00 Travel Documentation Fee: ITRA VDUC $44.00 �,!L pg t,,Aot o ; Fee,. IBSEBMICR $0.50 Select an Administrative Item e IBCBSC $1.00 SUBTOTALS: $195.50 $0.001 TOTAL FEE: $195.50 Revised: 1/19/2012 Building Department City Of Cupertino Is 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: '�i i2 PERMIT# IL U �- OWNER'S NAME: PHONE# J Pd? > 4 3 s GENERAL CONTRACTOR:BE-,uj orM,,J hZ.44--4 t^) BUSINESS LICENSE# ADDRESS: Z2'1>j 6j 1�htt 7E'. CITY/ZIPCODE: 60 10 e- 1 , *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: r-Date Please check applicable subcontract 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 O Contractor Signature Date 00 GENERAL PERMIT APPLICATION1 - MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION,/070 IVISION_/0 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 1 misc (408)777-3228•FAX(408)777-3333•building(d)cupertino.org CUPERTINO LUMBING MECHANICAL ^� ELECTRICAL MISCELLANEOUS PROJECT ADDRESS (_I � I o� 1 1 APN# OWNER NAMEtip - �/4 1 (2, E� _ '3 E-MAIL STREET ADDRESS ,r }f CI C_ S ?E, -- -T I X FAX CONTACT NAME KIM AT BEMJAMIN FRANKLIN �� PHONE 415-459-3266 E-MAIL STREET ADDRESS CITY,STATE, ZIP F415-506-0410 X 22 DIGITAL DR. STE ONE NOVATO, CA 94949 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 1 LICENSE NUMBER LICENSE TYPE BUS.LIC# f'�2AaJ-LI,J P�CM�i �,t' 857357 C36 COMPANY NAME E-MAIL FAX 415-506-0410 BENJAMIN FRANKLIN PLUMBING STREET ADDRESS CITY,STATE,ZIP PHONE 415-459-3266 22 DIGITAL DR. STE ONE NOVATO, CA 94949 ARCHITECT/ENGINEER NAME LTENSErUMBER BUS.LIC# 1� COMPANY NAME j -MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF M SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: El Commercial URBAN INTERFACE AREA El Yes No FLOOD ZONE Yes NO DESCRIPTION OF WORK 4C t •�� J�ni 764-1 L,J S TCA—)t �T UP Z A Aj r:c 7. 3/ Ir D I A-�-1 E"70Z . TOTAL VALUATION: � RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authoriggd ngent 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 Descr ' ork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize sentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 2-1 Z- �— SUPPLEMENL/At1NF0RMkZlQN_-REQUlRED OFFICE USE ONLY OVER-THE-COUNTER ❑ EXPRESS x ❑ STANDARD ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 03116111