12060017 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20686 RODRIGUES AVE CONTRACTOR:COUNSIL PLUMBING PERMIT NO: 12060017
OWNER'S NAME: ONER KORAY AND YANG EMILY S 1127 SOMERSF-T DR DATE ISSUED:06/04/2012
OWNER'S PHONE: 4089227140 SAN JOSE-.CA 95132 PHONE.NO:(409)272-2272
LICENSED CONTRACT'OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C-3 C Lie.N (�7�10�J CQ r r r
MECH RESIDENTIAL COMMERCIAL
Contractornu rni) PILIMbiMDate L/91 P_
I hereby affirm that I am licensed underde e provisions of Cbapler9 JOB DESCRIPTION: INSTALL NEW GAS LINE AT REAR YARD FOR FUTURE
(commencing with Section 7000)of Division 3 of the Business&Professions OUTDOOR KITO IEN
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[his permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.FI Floor Area: Valualion:S1595
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35911014.00 Occupancy Type:
APPLICANT CERTIFICATION
I 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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned propcny for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN Igo DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Addionally,the appli understands and will comply
with all non-point source reg I lions per the C pert o Municipal Code,Section ��>��/�
9.18. Issued Uy: / Date: �
Signature Dale
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any rooting material being installed.If a roof is
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an inspection.I agree to remove all new materials for
the following two reasons: inspection.
I,as owner of the property,or my employees with wages as[heir sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044. Signature of Applicant Date:
Business&Professions Code)
h as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Cade), ALL ROOF COVERINGS TO BE:CLASS"A"OR BETTER
I hereby affirm under penally of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE:
I have and will maintain a Ccnilicate 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 maintain
performance of the work for which this permit is issued. compliance with the Cuperlino 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 1 store or handle hazardous material.
Section 3700 of[he Labor Code,for the performance of the work for which this Additionally,should 1 use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the C erlino Municipal Code,Cho pier 9.12 and the
I certify that in(he performance of the work for which this permit is issued,I shall Health&Safely Cade,Sectio s 2. 05,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Cumpensat ion laws of Cal ifomia. If aller making this certificate of exemption,1 r 16d d P
become subject to the Worker's Compensation provisions of the Labor Code,I must Dale:
I'onhwith 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 work's
I certify that I have read(his application and slate that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.1 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 liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCIIITF.CT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupenino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec:. Twp,: ,Rng: Sub: Blk: Lot :
AM . . . . . . . . : 35911014.00
DATE ISSUED. . . . . . . : 06/04/2012
RECEIPT #. . . . . . . . . BS000016986
REFERENCE ID # . . . : 12060017
SITE ADDRESS 20686 RODRIGUES AVE
SUBDIVISION . ... . . . .
CITY . . . . . . . . . . . . . t CUPERTINO
IMPACT AREA . . . . . . .
OWNER :.. . . . . . . . . . . : ONER KORAY AND YANG EMILY S
ADDRESS . . . . . :"20686 RODRIGUES AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
.RECEIVED FROM' . . . . : COUNSIL PLUMBING
CONTRACTOR . . . . . . . : VALARIE COUNSIL LIC' # 30754
COMPANY . . . ... . . . . . . : COUNSIL PLUMBING
ADDRESS . ... . . . . . . . : 1127 SOMERSET DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95132
TELEPHONE .. . . . . .,. . : (408) 272-2272
FEE ID UNIT - QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- --- ----- -------
-ADMIN HOURS1.00 41. 00 0. 00 41.00 0. 00
1BCBSC VALUATION 1, 595.00 1.00 0. 00 1 .00 0. 00
1BSEISMICR VALUATION 1, 595..00 0.50 0 .00 0 .50 0 .00
1PGASRES OUTLETS 1 .00 65 .00 0 . 00 65. 00 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 195.50 0.00 195.50 0.00
METHOD OF PAYMENT - AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 195.50 #1747
---------------
TOTAL RECEIPT 195.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ------=--------------------- -------- ----------------------------
202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING '
506 GAS TEST 507 FINAL PLUMBING
Community Development
10300 Torre Avenue
1 Cupertino CA 95014
Telephone(408) 777-3228
CffY OF Fax(408)777-3333
CUPERTINO
Building Department
JOB ADDRESS: PERM TPL 06'co
i Ve-
OWNER'S NAME: m, PHONE # -
CONTRACTOR bstipthm #
I am not using any subcontractors: —�y Z—
SignatureD' ate
Please check applicable subcontractors and 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
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor, ignature Date
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
12 ADDRESS: 20686rodriguez ave. DATE: 06/04/2012 REVIEWED BY: bobs.
APN: BP#: 'VALUATION: $1,595
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1RPGAS
USE: PERMIT TYPE:
WORK install new gas line at rear yard for future outcoor kitchen.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Piping, Gas <=4 Outlets 1PGASRES 1 # $65
TOTALS: $65.00
Xle,.h. Han Cheek 'Plumb.Plan Check TO.0 hrs $0.00 Elea. Plan Check
P"niir Fee. Plumb. Permit Fee: /PPERM/T F.lec Permit Fee:
Oilier Hech. ln.cp, Other Plumb Insp. 0.0 hrs $44.00 Other/'ler. /nap.
.hleen. /mp. F'r: Pluwh. hup. Fee: lilec hraP. Peo.
NOTE: This estimate does not includejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc).. Thesefees are based on the prelimina in ormation available and are only an estimate Contact the Dent for addh 7 info.
FEE ITEMS (lice Resahaion 11-053 Ef. 711111)' FEE QTY/FEE MISC ITEMS
Plzen Check Fee:
Sapp/. PC Fee
PME Plan Check: $0.00
Permit Per:
suppl. lrnsp Feu
PME Unit Fee: $65.00
PME Permit Fee: $44.00
Gui<lruction Ta.c: ..
Administrative Fee: IADMIN $41.00
Work Without Permit? 0 Yes (E) No $0.00
Ar/rrmrerl Plurminp hens:
Travel Documentation Fee: ITRAVDOC $44.00
Strong Motion Fcc: IBSEISMICR $0.50 Select an Administrative Item
Bide Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $195.50 $0.00 TOTAL FEE: $195.50
Revised: 05/01/2012
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M I
sc
CUPERTINO (408)777-3228-FAX(408)777-3333•buildino(a)cupertino.om
LUMBAJG MECRAMCAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS /�.e `�R �� IQ - ( ( ,O(
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ONER NAME o lJ E-MAIL
STREET ADDRESS O MT
TA ffiat ( _24
FAX
CONTACT NAMEPHONE E-MAIL
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STREET ADDRESS =.STATE, ZIP FAX
❑OWNER ❑ OWNER-BUDDER ❑ OWNERAGEM PCIONTFLACTOR ❑CONTRACTORAGENT ❑ ARQBTEcr ❑ENGLNEFR ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME m i LICENSENIIMBER ('� C/ LICENSE TYPE 3/ BUS.LICK
COMPANY NAME I ' 7 j I E-MAIL
MAL �_Iu nS1IJ(p O�IIO e�
STREET/yeDSS 1^ r CITY,STATE,ZIP PHO
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ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC X
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE ZIP PHONE
USE OF A9195 w DUPLEX ❑ MULTI-FANMY PROJECT IN WI DLAND ❑ YES PROPER N ❑YES IS THE BLDG AN ❑ YES
BUIIDWG: �AL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICNLpI HOME'. ❑NO
DESCAIPr10N OF WORK ,/,
L I-
TOTAL VALUATION: RECEIVEDBY:
By my signature below,I certify to each of the following: I am doe prop er or authorized agent m act on the property owner's behalf. I have read this
application and the infonnaton I have provided is co L-I have read Do pion of Work and verify it is actuate. I agree to comply with all applicable local
ordinances and state laws relatin building cons t I a Drize tatves of Cupertino to cnwr the ab ve-i ntfi d pmp.ry for inspection puiposes.
Signature of ApplicanVAgrnt Dare:
SUPPLEMENTAL INFORMATION'REQUIRED OFFICE USE ONLY
y OVER-THE.COUNTER
❑ EKPRESS
u
❑ STANDARD
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