The URL can be used to link to this page

12020107CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 5938 SUTTON PARK PL OWNER'S NANIE: ROBERTS .TAMES A AND JANET OWNER'S PHONE: 40825 79`)80 ❑ LICENSED CONTRACTOR'S DECLARATION License Class ' Lic. # R Conl tractor loeron 9'j1q Date 23 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing 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 f, 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 p'orker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION is I certify chat I have read this application and state that the above information 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 trnentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the Citv of Cupertino against liabilities, judgments, cost_,, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant u erstands and will comply with all non -point source regulations per the Cupert" Municipal Code, Section 9.18. Signatu e ate J Z ❑ OWNER -BUILDER DECLARATION CONTRACTOR: WATER QUALITY PLUMBING 1860 ALMADEN RD PERMIT NO: 12020107 DATE ISSUED: 02/23/2012 SAN JOSE, CA 95123 PHONE NO: (408)267-9330 BUILDING PERMIT INFO: BLDG ELECT r— PLUMB � MECH _. RESIDENTIAL F COMMERCIAL JOB DESCRIPTION: REPLACE WATER MAIN LINE Sq. Ft Floor Area: I Valuation: $1500 APN Number: 37535031.00 Occupancy Type: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: [, as owner of the property, or my employees with wages as their sole compensation, will do the work, and die structure is not intended or offered for sale (Sec. '7044, Business &-. Professions Code) [, as owner of the property, am exclusively contracting with licensed contractors to construct the project 6ec.7044, Business &- Professions Code). I hereby affirin tinder penalty of perjury one of the following three 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 pertttit 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 Connpensation laws of California. If, after making this ccrtific, e of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Date:,Z' Z-- 3 Issued by:-�, �— 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed If a roof is installed without first obtaining all inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter' 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safetv Code, Section 25532(a) should t store or handle hazardous material. Additionally, should [ use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 2A05. 25531 and 25534. Owner� ithori :r t: \ 7 4t�te: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rlig: Sub: Blk: Lot: APN ........ : 37535031.00 DATE ISSUED.......: 02/23/2012 RECEIPT #.........: BS000016097 REFERENCE ID # ... 12020107 SITE ADDRESS ..... 5938 SUTTON PARK PL SUBDIVISION ...... CITY ............. CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : I OWNER ............ ROBERTS JAMES A AND JANET ADDRESS .......... 5938 SUTTON PL CITY/STATE/ZIP ... CUPERTINO, CA 95014-3531 RECEIVED FROM .... : MARTY SATALINO JR METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 152.50 --------------- 152.50 VOICE ID DESCRIPTION -------- ---------------------------- 106 SEWER & WATER 507 FINAL PLUMBING REFERENCE NUMBER -------------------- AMEX VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING CONTRACTOR ....... SATALINO, MARTY LIC # 21526 COMPANY .......... WATER QUALITY PLUMBING ADDRESS .......... 1860 ALMADEN RD CITY/STATE//ZIP ... SAN JOSE, CA 95123 TELEPHONE ........ (408)267-9330 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 1,500.00 1.00 0.00 1.00 0.00 lBPwSVCS WATER SERVICE 1.00 22.00 0.00 22.00 0.00 1BSEISMICR VALUATION 1,500.00 0.50 0.00 0.50 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 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 152.50 --------------- 152.50 VOICE ID DESCRIPTION -------- ---------------------------- 106 SEWER & WATER 507 FINAL PLUMBING REFERENCE NUMBER -------------------- AMEX VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING CITY OF CUPERTINO j FEE ESTIMATOR - BUILDING DIVISION BY: bob s. ADDRESS: 5938 sutton park pl. DATE: 02/23/2012 REVIEWED APN: BP#: VALUATION: $1,500 PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PE+ NTAhIATION PRIMARY SFD or Duplex PERMIT TYPE: USE: �voRK re lace water main line. SCOPE 1 RPWS ly 7 -TE: This estimate does not include fees due to otherir�ormation tavailable and are oTnly an estimate. eContact tl a Dentr District, addn'l in School District, etc.). These es are based on the relinsna / MISC ITEMS FEE ITEMS '-.;' 7 t t = FEE QTYfFEE PME Plan Check: $0.0 PME Unit Fee: $22.00 PME Permit Fee: $44.00 Administrative Fee: IAD�it1N $41.00 E:= Work Without Pennit? (� Y e. G No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 I1 - ice' - IBSEISMICR $0.50 Select an Administrative item IBCBSC $1.00 SUBTOTALS: $152.50 $0.00 TOTAL FEE: $152.50 Revised: 1/19/2012 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: PERMIT # ��-- l Q OWNER'S NAME: PHONE # - K GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: e *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 HAVEBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: �>'fj 9 Date 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 D Roofing Septic Tank Sheet Metal Sheet Rock Tile �>'fj 9 Date GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DNISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 7T7-3333 - building(&cupertinc.crg MEP MEPMisc gpp?011.doc revised 06/21/11