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12080148 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21598 ROSARIO AVE CONTRACTOR:AMERICAN RESIDENTIAL PERMIT N0: 12080148 SERVICES or CA OWNER'S NAME: CONNELI-YT'ROMAS J AND DOROTIiY 965 RIDGE LAKE BLVD SIT:201 DATE ISSUED:08/14/2012 OWNER'S PRONE: 4 08996 13 74 M EMPI IIS.TN 38120 PI IONS NO:(408(982-0405 ❑ LICENSED CONT'RACFOR'S DECLARATION 2/ � BUILDING PERMIT INFO: BLDG r ELECT r PLUMB(- License Class C—,3& Lic.q S7 .�� Contractor f!F� �65 CU�'�Q)ate a �� 2 NIECII r RESIDENTIAL r COMMERCIAL r hereby affirm that I ani licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL I"PRESSURE REGULATOR;INSTALL (commencing with Section 7000)of Division 3 of the Business S Professions EXPANSION Code and that my license is in full.force and effect. TANK ON WATFRIiGTER;REPLACE 140 P'f OP 3/4"'fYPF L COPPER PIPE 17OR OUTSIDE DOSE BIBS AND IRRIGATION hereby affirm under Petmlo of perjury one of the follom'ing 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 theLabor 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 permit is issued. Sq.Fl Flour Area: Valuation:55268 ,\PI'I.ICAN'I'CER'1'IF'IC,\'1'IO,N I certify that I have read this application and state that the above information is APN Number:35619017.00 oecupancy'rype: correct.I agree to comply with all city and county ordinances.md state laws relating to building construction,mid hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indeninify and keep harmless the City otCupertino against liabilities,judgulentS, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accme against said City in consequence of the granting of this permit. Additionally,the applicant understands andwill comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR widm:dl non-point source regulations per the Cupertino Municipal Code,Section 9.18. Igo DAYS FROM LAST CALLED INSPECTION. / Q /, p Signature _. Date u �� fZ Issued bv: r/qGfy��,/y r7/li Date: p '/y'Ja— ❑ OAVNER-BUILDER DECLARA'T'ION 1 hereby affirm(lull 1 ani exempt from the Contractor's License.Lim for one of RF--ROOFS: the following two reasons: All roofs shall be inspected prior to env roofing material being installed.Ifa roof is I,as owner of property,or Illy employees with wages as their sole compensation, installed without first obtaining an inspection,1 agree to remove all nese materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,atm exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sce.7044,Business& Professions Code). I Lerebv affirm under penalty of perjury ane of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BEErER declarations: I have and will maintain'a Certificate of Consent to self-insure for Worker's IIA--/.ARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,far the performance ofthe work for which this permit is issued I have read(he hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance.as provided for by California Ilealth&Safety Code.Sections 25505,25533,and 25534, 1 will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth& Safety Coda Section 25532(x)should 1 store or handle hazardous material. permit is issued Additionally,should 1 use equipment or devices which emit hazardous air I certify that in the,performance of done work forwhich this permit is issued,I shall contaminants its defined by the BapArea Air Quality Management District 1 still not employ any person in may manner so as to become subject to the Worker's maintain compliance with the Cupertino\I unici pal Code.Chapter 9.12 and the Compensation laws of California. If,,after making this cenilicute of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must m mar 1 oriuda P forthwith comply with such provisions or this permit shall be deemed revoked. Date. AI'I'LIC.\\T CI?IfI'1I IGVI'ION CONSTRUCTION[,ENDING AGENCY I cenifv that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances mrd state laws relating I hereby affirm thin there is a conswetion lending agency for the perl'onnance of swrk's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon Elie above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, casts,and expenses which may accrue against said City in consequence of Lender's Address 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. ,\RCI I I'1'FCI"S DECLARATION I understand my plans shall be used as public records. Signature Dale Licensed Professional • CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION :121 ADDRESS: 21598 Rosario Ave DATE: 08/14/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: 1$5,268 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY 1'ENTAMATION USE: SFD or Duplex PERMITTYPE: 1RPR.4 WORKInstall 1" pressure regulator; r install expansion tank on water heater; replace 140 ft of 3/4" Type L SCOPE copper pipe for outside hose bibs and irrigation. APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe Interior 1PRREPIPE 1 # $13 Piping, Water Treatment 1PREPPIPE 1 # $45 Vacuum Backflow 1PATMOBF 1 # $67 TOTALS: $125.00 rt/ech. flan Check Plumb. Plan Check 0.0 hrs $0.00 F.lec. Plan Check b/eclt. Permit Fee: Plumb. Permit Fee: IPPERMIT L•lec•.Permit Fee: Other,ifech.Imp. Other Plumb Insp. 0.0 hrs $45.00 Odher Elve.Insp. E17- MCC&hup. Fee: Plumb. losp.Fee: Fleas bup.Fee: NOTE: This cctimate does not include feat due to other Departments(i.e. Planting, Public Works, Fire,Sanimn'Sewer District,School District etc). These eev are baser/on the prelintinan information available and are only at ectiuutte. Contact the De t or acldn'I info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS Phan Check Fee:: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Supp/. Insp Fee PME Unit Fee: $125.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: IdD,tnty $42.00 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITR.IVDOC $45.00 i Strone Motion Fee: IBSFISMICR $0.53 Select an Administrative Item I31da Stds Commission Fee: IRCBSC $1.00 SUBTOTALS: $258.53 $0.00TOTAL FEE: $258.53 Revised: 07/01/2012 c4 e GENERAL PERMIT APPLICATI N MEP EllCOMMUNITY DEVELOPMENT DEPART MIENi• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 950143255 � Is C CUPERTINO (408)7Tr-3228 • FAX(408)777-3333 • building( ouoer5no.orG [�?LLMaLNc ❑ cz�vic,�L I_l_LEc�R;ca.L ❑reset AN-,0 U S X PRorsTADDRESS 215 QCJSAE>SD QU�c I A-Fr4i� - 92 -7 lE ' OWNERNANDo2OT C�OnIN PHONE -fog R _C) fO ?' sMarz /x 57=ADDRESS Z1S9 g ROSPR�a CITY. STA,�-=.21P 4�1 FAX CONTACT NAME. PHONE I E.Nr e.e STREET ADDRESS CITY.STATE. 11T I FAX ❑OWNER ❑ OWNER-B=Et ❑ OWNER AG'c1'T �'COh'2RACro0. ❑CONTRAC ORAGEN'T ❑ ARC�3 ,, ❑c G? - ❑ ONE1Z?M ❑ —ANT CONTRACTOR NANtE /� L'C SE NLTflER CENSE TYPE UC 0 p QS �ESCJE F f 5 1 LIBUS.I 210 t/ We/ "r,> I E MAH. FAX 7(" J STA1_TT ADDRe_SS CRY,STATE Z? PRONE EL C-92 -r A eua2A C S'O - ARL��lENGIN=NAME I LICENSE NUMBERI BIS.UC 0 COMPANY NAME' E-MAIL FAX STREET ADDRESS Cil',STA-.E,ZL^ PHONE USE OF UP ffXM DLZX El MULTI-FAMILY I PROPECTW WD,DLAND C YES I PROR:CTN El1zs ( IS THE BLDG AN ❑ ❑ YES B=NG: CONIMEtC URBAN INTERFACE AREA NO FLOOD ZONE ❑NO MCHLEt HOME? ❑NO DESCRIPTION OF WORK ^ A Vj 3iVSTA -c 3 (J Uhl WA-7EK T E Lr O 5-&" T' 3 It L` v 2 mo s 2 s z TOTALVALUATION: �oZlp$ ,°� I RECEIVED BY: By my signature below,I crdvy to each of the following: I am the pmper, owner, or authorized agent b act on die property owner's behalf I have read this application and the information.Ihave provided is correcL 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building consm:cti thor'ze repm=.tarives of cuneri_c:c a^.Cr the abov--identie?prope.—./:or inspection pr:posu. Signature of ApptieantlAgenn Dam; 102, UPPLE-MEN'TAL.INFOR-kLAT i0N REQUL2FD OFFICE USE ONLY y OVER-THE-COUNTER ❑ EXPRESS U ❑ STANDARD U z ❑ LARGE ❑ MAJOR MEPMLrc4pp-2011.doc revised 06/21/11