12060089 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11.18 SCOTLAND DR CONTRACTOR:NELSON PLUMBING PERMIT NO: 12060089
OWNER'S NAME: RADWIN MARTIN D AND HOM ELIZABETH T 2071 MAIN ST DATE ISSUED:06/14/2012
OWNER'S PHONE.: 4082571572 SANTA CLARA,CA 95050 PHONE NO:(408)280.5311
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class L-3/P Lic.4 47Z to I ?-10
MECH r RESIDENTIAL r COCOMMERCIALr
q/
Contractor_/P 60n PIm 5 Date %-i/ —1 a
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:WIiOI,I:HOt1SE Rh-PIPIT INCI.UDI:S COPPER ANI)SOWER
(commencing with Section 7000)of Division 3 of the Business&Professions LINE
Code and that my license is in full force and effect. RE-PIPE
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.
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 Sq.Ft Floor Area: Valuation:$8300
pemtit is issued.
APPLICANT CERTIFICATION APN Number:36228011.00 Occupancy Type:
I certify that I have read[his application and slate 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify dexpend nses hick inyas[lie crueaty fCnst sato against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which mag accrue against said City inconsequence of the
granting of this pen L Addi(i0t the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-po� so rec reg ins r(he Cupertino Municipal Code,Section
9.18.
c �� —r Issued by: Datelj Lr--( '1_
Signal Date
❑ OW'NER-BUILDER DECLARATION
RF:ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall he inspected prior to any roofing material bcitg installed If a roof is
the following two reasons: installed without first obtaining an inspection.I agree to remove all new materials for
1,as owner orthe properly,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
L as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec 7044,Business&Professions Cade). ALI.ROOF COVERINGS TO BE CLASS"A"OR BVITER
1 hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE;
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Ilealth&Safely Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the labor Code,for the performance of the work for which this Safely Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
pennant is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the C lino Municipal Code,Chapter 9.12 and the
not employ any person in my manner so as to become subject to the Worker's Ilealth afety Cod Sections . 5,25533,and 25534.
Compensation Imus or California. II',aller making this certificate of exemption.I
become subject to the Worker's Compensation provisions of the Labor Code,I must Ow er sulhori enc
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANTCERTIFICATION CO ST' ACTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affurn that there is construction lending agency for the performance of work's
connect. 1 agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned properly for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of(his pemtit-Additionall),the applicant understands and will comply
with all non-point source regula(iau per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . . 36228011.00
DATE ISSUED. . . . . . . : 06/14/2012
RECEIPT # . . . . . . . . . : BS000017078
REFERENCE ID # • • • : 12060089
SITE *ADDRESS . . . . . : 1148 SCOTLAND DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT `AREA . . . . . . .
OWNER RADWIN MARTIN D AND HOM ELIZAB
ADDRESS .-. . : . . . . . . : •1148 SCOTLAND DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED •FROM . . . . : NELSON PLUMBING
CONTRACTOR RICHARD LEE .NELSON LIC # 23330
COMPANY . . . . . . . . . . : NELSON PLUMBING
ADDRESS' . . . . . . . . . . : 2071 MAIN ST
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050
TELEPHONE . . . . . . . . : (408) 280-5311
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 8, 300 . 00 1 . 00 0. 00 1.00 0. 00
1BSEISMICR VALUATION 8,300.00 0. 83 0.00 0 .83 0 .00
1PPERMITFE FLAT RATE 1. 00 44 . 00 0.00 44 . 00 0 .00
1PREPPIPE FLAT RATE 1.00 44 . 00 0.00 44 .00 0 .00
1PRSEWER UNITS 1. 00 22.00 0.00 22 .00 0 .00
1TRAVDOC FLAT RATE 1.00 44 .00 0 .00 44 .00 0 . 00
TOTAL PERMIT 196.83 0 . 00 196 . 83 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 196. 83 NELSON PLUMBING
---------------
TOTAL RECEIPT 196. 83
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106
-------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
.301 ROUGH PLUMBING 302 TUB & OR SHOWER
506 GAS TEST 507 FINAL PLUMBING
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 1148 Scotland dr. DATE: 06/14/2012 REVIEWED BY: bobs.
APN: BP#: 'VALUATION: $8,300
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1RPDP
USE: PERMIT TYPE:
WORK whole house re-pipe includes copper and sewer line re-pipe.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Piping, Area 1PREPPIPE 1 # $44
Sewer, Building 1PRSEWER 1 # $22
TOTALS: $66.00
Plumb. Plan Check 0.0 hrs $0.00 Elr;r- /'Irm Ucrk
l i•c/r. /'.v'roi,Fi•�' Plumb. Permit Fee: IPPERA11T l r,.--
ud;;•; lfr,iv_b,vp Other Plumb Insp. 0.0 hrs $44.00 Odn•r/;ler l,n/. El
:1 l,tii. Lnp. Frr: l'hunL. Irnp. Fe'. faar.
NOTE: This estimate does not includejees due to otter Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'I info.
FEE ITEMS (Fee Resolulion 11-053 E : 711111) FEE QTY/FEE MISC ITEMS
flan C7rrrk 1''1ac
Rnppl. PC l r,r
PME Plan Check: $0.00
.Supp/. hrcp l r�
PME Unit Fee: $66.00
PME Permit Fee: $44.00
Liozen ciuw Tn.
Administrative Fee: (ADMIN $41.00
Work Without Permit? O Yes Q No $0.00
.I rlrnx',rrl l'k uo,inl' lcrr:�_
Travel Documentation Fee: ITRAVDOC $44.00 A
Saone Motion Fce: IBSEISMICR $0.83 Select an Administrative Item
131dlI Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $196.83 $0.00 TOTAL FEE: $196.83
Revised: 06/05/2012
000
GENERAL-PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 950143255 MIS C
CUPERTINO (408)M-3228•FAX(408)777-3333•buildina(cDcupertino.org
[]PLUMBING / ❑MECHAMCAL ❑ LE
ECTRICAL ❑MISCELLANEOUS
PROIECTADDRESSJ9 SlO,f lana 4R.. APNI
OWNE0.NAME �IIZp /[�/ Hong -T �y'0_ Z5 -157 EMAIL
STAEETADDRES1 /Ia'l elj SCDl'lghe(' �.Q-. CITY. STATE.ZIPFAX
w
� of ( 350o,
CONTACT NAME PHONE E-MAIL
STRPETADDRESS CITY,STATE. ZIP FAX
❑OWNER ❑ OWNER-BUDDER ❑ OWNBRAGFM ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMEUCENSENUMBER LICENSE TYPE BUS.LIC0
Rr2 rra eISunl. 1621o)7to G -3L, x3330
COMPANY NAME•%/S oi, n/Mj . E- bCWLjf� FAX
STREET ADDRESS CRY,STATE,IIP PH
/272 CcfsiliMul avl , Sa Yost Ca 9S/2 S � i3-2x1-5
�(l
ARC ITc'CTIENGIJEER NAME LICENSE NUMBER BUS.LIC R
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ZKmar DUPIEX ❑ MULTI-FAMILY PROJECTINWD.DLWD ❑ YES PROIECTW ❑YES ISTHESLDGAN ❑ YES
BUILDING: EjCOWAERCIAL URBAN INTERFACE AREA NO FLOOD ZONE EI NO EICHLER HOME. 0N
DESCRIPTION OF WORT(
Whole /Roust co c 12c- ' � c . Q� laces KTfclle�
TOTAL VALUATION:9,300 L!3— RECEIVED BY:
By my signature below,I certify to eat the following:''I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I ha 'tied is co a read the D 'prion of Work and verify it is accurate. I agree to comply wilt all applicable local
ordinances and state laws relatin 'ng con etion.'1 thoriu tatives of Cupertino to enter the a//b�ove-idcrn/tifiedpropeci Tor inspection pui' cses.
Signature of ApplicanUAgrn Data: I(P / /2-
UPPLEMENTAL INFO O REQUIRED OFFICE USE ONLY
yR OVER-THE-COUNTER
F
Y ❑ EXPRESS
U
w ❑ STANDARD
U
L ❑ TARGE
5
❑ awoR
MEPMur�4pp_2011.doc revised 06/21111
Community Development
4 10300 Torre Avenue
r4 Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: /i4'6 Scof/a h d 44 . PERMIT #
Z06
OWNER'S NAME: 61 t'za b:o f-ti PHONE # "Z C-D
GENERAL CONTRACTOR t " n /�,, FAX #
I am not using any subcontractors:
ignature Date
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, Date