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12050039 -CITY,OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20728 GARDEN PLACE CT CONTRACTOR:DEMPSTER PLUMBING PERMIT NO: 12050039 OWNER'S NAME: ERIK IE 1639 POMONA AVE DATE ISSUED:05/03/2012 OWNER'S PHONE: SAN JOSE,CA 95110 PHONE NO:(408)295-3911 LICENSED CONTRACTOR'S DECLARATION JOBDESCRIPTION: RESIDENTIAL COMMERCIAL License Class(C 3-6�� (LVp Lie.N O o S(2)c? WATER SERVICE FROM METER TO HOUSE W/ Contractor 4Ll'-r"' S �,w�r w Date /Z TYPE "L" COPPER PIPING I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 orthe Business&Professions Code and that my license is in full force and effect. I hereby affirm under penally 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 Lab"Code,for the performance of the work for whichthis permit is issued. Sq.FI Floor Area: Valuation:$200 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:36230064.00 Occupancy Type: permit is issued. .V � P y APPLICANT CERTIFICATION 1 certify that I have read this application and slate that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state 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 f"inspection purposes. (We)agree judgments,save 180 DA OM LAST CALLED INSP C indemnify and keep harmless the City of Cupertino against Ii(We)e greetsave costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additional) c applicant understands and will comply Issued by: Date• with all non-point source regul "ms pe the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Dale �Z All roofs shall be inspected prior to any roofing material beug installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION : 1 hereby affirm that I em exempt from the Contractor's License Lew for one of Signature of ApplicantDate: the following two reasons: ALL 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California health&Safety Code,Sections 25505,25533,and 25534. 1 will 1 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 I store or handle hazardous 1 have and will maintain a Cenificme 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 Bay Area Air Quality Management District performance of the work for whichthis permit is issued. will maintain compliance with the Cupertino icipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2550. 5 J3, nd 25534' Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date: I certify that in the performance of the work for which this permit is issued,I shall not employ any person many manner so as to become subject to the Worker's Compensation laws of Cal ifomia. IL after making this certificate of exemption,I CONSTRUCTION LENDING 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 APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and slate that the above information is correct.I agree to comply with all city and county ordinances and stare 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, ARCHITECT'S DECLARATION costs,and expenses which may aceme 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 FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 20728 Garden Place DATE: 05/0312012 REVIEWED BY: Sean APN: BP#: 'VALUATION: $2,000 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Water Service PRIMARY Residential PENTAMATION 1CPWS USE: I I PERMIT TYPE: WORK Re lace the water service from the meter to the house with type "L" copper piping. SCOPE APPLIANCE/EQUIP TYPE FEE ID BP FEES Water Service Unit Fee: 1BPWSVCS $22 Xfrch. Plan C'hcck Plumb,Pion Chcck lilt,:. Plan(3wek l eah. Pernril Fee: Plumb. Permit Fee: IPPERMIT I linin. Peonil Fee: Ol6rr.11erh,hi,11 Olht•r Plumb Insp. $44.00 Usher/ilcr. /n.rp. Li ,I/,ash. la'p. Frc: Phuuh, Girl). Fte: Flcr.Inez Fec. NOTE: This estimate does not includejees due to other Departments(Le. Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the Prefintina in ornm tion available and are only an estimate Contact the Dept for addn'I info. FEE ITEMS(Fce Resolution 11-053 E1T 7/l/l1) FEE QTY/FEE MISC ITEMS Plan Check Fee: .Supp/. PC Fee l'lrnnh,/A•loch./li l ec Permil Fee. .Supp/. hup Fre PME Unit Fee: $22.00 PME Permit Fee: $44.00 C'onstrurtion Tins: Admiai.cnrrtice Fe C: Work Without Permit? Yes (j) No $0.00 ,ldvooiced Planing Fees: Trurcl Dncummdrrtion Fuel: T At Groep itlo/iou Fce. Select an Administrative Item 131d,, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $67.00 $0.00 TOTAL FEE: $67.00 Revised: 04/01/2012 CITY OF CUPERTINO 4 ITEMS OF 28 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36230064 . 00 DATE ISSUED. . . . .. . : 05/03/2012 RECEIPT #. . . . . . . . . : BS000016695 REFERENCE ID # . . . : 12050039 SITE ADDRESS . . . . . : 20728 GARDEN PLACE CT SUBDIVISION . . . . . . . CITY . . . . . . . ... . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ERIK IE ADDRESS . . . . . . . . . . : 20728 GARDEN PLACE CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5065 RECEIVED FROM . . . . : WILLIAM DEMPSTER CONTRACTOR . . . . . . . : WILLIAM DEMPSTER LIC # 31263 COMPANY DEMPSTER PLUMBING ADDRESS . . . . . . . . . . : 1639 POMONA AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95110 TELEPHONE . . . . . . . . : (408) 295-3911 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- -------- ---- 1BCBSC VALUATION 200. 00 1. 00 0.00 1 .00 0. 00 1BPWSVCS WATER SERVICE 1.00 22.00 0.00 22 .00 0.00 1BSEISMICR VALUATION 200.00 0.50 0 .00 0.50 0. 00 1PPERMITFE FLAT RATE 1 ..00 44.00 0.00 44 . 00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 67.50 0. 00 67.50 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- - --------------------------- -------- ---------------------------- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 I CUPERTINO,� (408)T77-3228 • FAX(408)777-3333• buildinalrDcuoertino.ora ( sc � �r��Cy� FTPLUMBING //��`\❑MECHANICAL 7r 7=ICAI- '^ ❑MLS[Frr/e^77i=OTJS �� PROlF11'ADDAESS UF1 L/`c✓�/�16-Le AFNI l(l� o OIY� OWNER NAME 3._.� I G PHONE EMAIL CR STREET ADDRESS Y.STATE,ZIP F NO FAX iYJ� fI tYC GY - G CONTACTNAn¢ // iGBcF SSRFETADDRES9 // LA /J // D FAX ",log c'?�J t�/ ❑OWNER ❑ OWNER-BtID Mt . 11 OWHFRAcENr '�cmit ❑cowrucmn AGENT ❑ AROUTECr ❑EHGtNEER ❑ DE PER ❑TENANT CONTRACTOR NAME �(`1(1�f/ UMSENU14BEFL FjSol TuaaISETy--34.) BLS LIC0 COMPANY NAME tl,.J'Ntll VaL�I�I'n 1 E-MAII&,rA JC�v 'G� Llls Com•/,&41r. FAX(lip zga�l�7/ sTREErwnREss�(GJ'c/ Tore q �� aTY.srA> ,_I �O$r` �fO7E�lo85`77 5��7 AACFDTEC77PNGINEER NAME LICENSE NUMBER BUS.LIC W COMPANY NAME' E-MAIL FAX SFRW ADDRESS CrTY,STATE.ZIP PRONE USE OF .DUPLEX [I MULTI-FAMILY FRO1FLTiNWIDLAND ❑ YES PROJECT 01 0Y6 6THE HUJG AN ❑YES BUOYING: cc� ^ URBAN RITYRFACE AREA NO I FLOOD Z(IIJE 3R NO (C/ EBER ROM/E'// �VO DESCRIPTION OF WORX Q lC`c-L'. W�tta- Se�I ick Td'o,^'. WeTcl /o Ie o�se r.I e L e. TOTAL VALUARON: 2oO Q `e' RECETYED BY: ^/ By my signage below,I certify to each of the following: I am the property owner or artharized agent to act w the property Dorneds behatE I have read this application and the hdarmation I have provided m j have reed the Desmiptim of Work and verify it is accmare. I agree to comply with all applicable local ord ru aces and state laws relating to bail5ling tructiozU I aer4ori=represem Lives of Capertmo to cater the above-idemrified property for inspection pu@oses. Sipanae of AppGeantlAgeut Daze. 1J SUPPLEYE NTAL INFORMATION REQU= OFFICE Use ONLY m OVER-TRF-COUNTER a ❑ EXPREM ❑ srANDARD U 3 ❑ LARGE 6 ❑ MAJOR AEPMucApp 2011.doc revised 06121111