The URL can be used to link to this page

12050048 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10036 SPANISH OAK CT CONTRACTOR:FARBEX PERMIT NO: 12050048 CONSTRUCTION SERVICES OWNER'S NAIVE:.RUSSELL ELENA B TRUSTEE 1093 KELLY DR DATE ISSUED:05/032012 OWNER'S PHONE: 4083736656 SAN JOSE,CA 95129 PHONE NO:(408)590-5410 I ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL CO\UfERC1AL❑ License Class .q ?02S Lic0 2 bd� REMOVE AND REPLACE 5 FAUCETS,5 SINKS& 1 GARAGE Commclory_A9_fbF_k COaJMDate Q I DISPOSAL I hereby affirm that I am licensed under the provisions o Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 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 whichthis permit is issued. Sq.FI Floor Area: Valuation:$1000 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:34232077.00 Occupancy Type: permit is issued. Q APPLICANT CERTIFICATION I certify that I have read this application and state 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 ISO DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM L ST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, r� costs,and expenses which may accrue against said City in consequence of the 3 granting of this pe 't. Additionally,the applicant understands and will comply Issued by: Date: with all non-point o rce regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature-- T—Date - All roofs shall be inspected prior to any roofing material bcug installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for IJ inspection. ❑ OWNER-BUILDER DECLARATION : I hereby affirm that I am exempt from the Contractor's License Lew for one of Signature of ApplicantDale: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,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 I 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(x)should I store or handle hazardous I have and will maintain a Certificate 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 I performance of the work for which this permit is issued. will maintain compliance with the Cu r 'no Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code.Sections 25 ,25533,and 25534. Section 3700 of the Labor Code,for Ane performance of the work for which this - Owner orauthorized agent: rDate: permit is issued. l t 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 lax s of California. If,after making this certificate of exemption,I CONSTRIICTI .EN DING AGENCY become subject to the Workers 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. w'ork's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 1 certify that I have read this application and stale 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 fm inspection purposes.(We)agme to save ARCHITECT'S DECLARATION and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue 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 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34232077. 00 DATE ISSUED. . . . . . . : 05/03/2012 RECEIPT #'. . . . . . . . . : BS000016700 REFERENCE ID #. . . . : 12050048 , SITE ADDRESS . . . . . : 10036 SPANISH OAK CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT-AREA . . . . . . . OWNER . . . . . . . . . . . . : RUSSELL ELENA B TRUSTEE ADDRESS . . . . . . . . . . : 10036 SPANISH OAK CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED "FROM . . . : FARBEX CONSTRUCTIO CONTRACTOR . . . . . . . : GREGORY WNOROWSRI LIC # 29686 COMPANY . . . . . . . . . . : FARBEX CONSTRUCTION SERVICES ADDRESS . . . . . . . . . . : 1093 KELLY DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95129 TELEPHONE . . . . . . . . : (408) 590-5410 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 1BPFIXTURE NO OF FIXTURE 5. 00 45 .00 0 . 00 45 . 00 0 .00 1BSEISMICR VALUATION 1, 000 .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 175 .50 0. 00 175. 50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 175.50 me --------------- TOTAL RECEIPT 175.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------ ------------------- ---------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR ,SHOWER 502 FINAL PLUMBING ENERGY - 506 GAS TEST 507 FINAL PLUMBING 512 FINAL HANDI-CAP CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10036 Spanish Oak Dr. DATE: 05/03/2012 REVIEWED BY: jsg APN: BP#: 'VALUATION: $1,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD Or Duplex PENTAMATION 1RPFIX USE: PERMIT TYPE: USE": new faucets 5 new sinks 1 new arae disposal SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixture or Trap 113PFIXTURE 5 # $45 TOTALS: $45.00 11"1'. /v,r„r'h..r t: Plumb. Plan Check 0.0 hrs $0.00 acre. /$m cd, 4 I!.•,.-!r. /'rrnrit Far: Plumb. Permit Fee: IPPERMIT P:Irc. I'r:mif ,vra6. 1>„qOther Plumb Insp. 0.0 hrs $44.00 U�hr•, lila. /r,,,/�. ET .li,'<h. lr�•p. Fcc PlunrL. Lvp. 6r,c liltr. Giol�. Fm': NOTE: This estimate does not includejees due to other Departments(ie. Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelhWwna information available and are onlp an estimate Contact the Dept for addn7 info. FEE ITEMS (Ice Resolution ll-053 Ell' 71111/) FEE QTY/FEE MISC ITEMS Ph 117 (_'hrck hCc: 4uppl. VC l (v PME Plan Check: $0.00 M-nnil l .- . Supp/, 112.,1. Fey: PME Unit Fee: $45.00 PME Permit Fee: $44.00 ( mislo lei Ile e Tar: Administrative Fee: IADMIN $41.00 Work Without Permit? O Yes 0 No $0.00 Travel Documentation Fee: ITRAVDOC $44.00 Stron>_ Motion Pec: IBSEISMICR $0.50 Travel Documentation 4r 41.00 131da Stds Commission Fee: IBCBSC $1.00 $44.00 /TRIVDOC SUBTOTALS: $175.50 $44.01 TOTAL FEE: $ Revise . 04/01/2012 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 950143255 M I /� CUPERTINO (408)777-3228•FAX(408)777-3333•buildinO(WcuoerlinD.ota /v' 120Ss0oyrro AsnUMBING NECHANICAL ELECTRICAL ❑MII�CULILNEOOUSS PROJECT ADDRE/SS� (QV 36p ( P N► O APN# ,3H2. OWNER NAME // 7f�`/� n -665b E. STRF 1DRESS 10036 SS72'�MI•SJ DR`,. A£ ) NO A FAX CONTACT NAME ` C tl)I�C Cc o'Sh, C a PRONE �Ctp'OI q' E MAD. STREEITTADORES9 �1b5 So�Rfl^1T`, WAS! 11 11 N'��7 1 /1 c� o c FAX 13owNER 13 OtVN ,But om ❑.OWNER AGEXT xmNrmAcroR 13OONTRACIOR AGENT 13 AaacTa1T ❑ENOINIDI ❑ DEVELOPER ❑TmwA CONCRACTORNAMN— GN 'fl@14BNUXBER8?.2� n((''/� r LR}Z7 BUS.tic COMPANY NAME �1 PpIVCppa B-MALL p}o�ICR E.L}y(IV}'bQ.�C.S�`YUI��S.�O FAX STRF]TT ADDRESS Ot 69 S�Js;I�N �-A (� tI QTY A I la 9424 o -99 -.222 ARQHTECOENGTNEER NAME SE NUMBER BUS TLC R CONFANYNAME E-MAIL FAX STREETADDRESS QTY,STATE.Zo- PHONE USE OF ❑SFDwDUPTFX ❑"MULTLFAMD.Y PROIELTBIWEDLAND ❑ YER PROTECTW ❑YES ISTREBLEGAN ❑YES BUDDING: ❑COMMERGAL URBAN BRFRFACEAREA ❑ NO FLOOD ZONE ❑NO EIC OFR HOM ❑NO DESCRIPTION OF WORK. BUJA c�-, -S5 N SIN LS 2 UW C, AkbSgt, TOTAL VALUATION: O RECFJVED BY: Hy my signature bel ,I certify m each of the Ilawiag I am the property owner or mtborized agent to act ou the property owner's behalf 1 have read this application and the iin'armation I have pmvide correct have read the Dmaipdm of Work and verify it is azearam. I agree to comply with all applicable local ordinances and smte Taws relating to bidldm I a¢dtor=' representatives of Cupertiao to inter the above=dmd property far inspecoom poses. SigDattne of Applicaat/AgrnC Dam: O2 'OkSUPPLErWTAL INFORMATION REQUMED OFFICE Use ONLY m ❑ OVER-THFCOUNTER d ❑ EXPRESS Y u u ❑ STANDARD 'u 3 ❑ TARGE 6 ❑ MAJOR MEPA&cApp 2011.dac revised06121111