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12080209CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10396 ANSON AVE CONTRACI'OR: SMART PLUMBERS & PERMITNO: 12080209 1 ROOTERS OWNER'S NAME: SMITH DONALD W AND BERTHA M TR 2112 SANTA CRUZ AVE DATE ISSUED: 0820P_012 OWNER'S I'IIONE: 4082551795 SANTA CLA RA, CA 95051 PHONE NO: (408) 247-24OU ❑ LICENSED CONTRACTOR'S DECLARATION License Class_r-3-_�4 Lic.N Contractor 1 hereby alarm that I am licensed under the provisions of Chapter 9 (commencing with Secon 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. hereby affirm under penalty of perjury one of the following nvu 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 orthe Labor Cade, for the performance or Ute work for which this permit is issued. APPLICAiN I' CERT'IFICAT'ION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances mid 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 indemnity and keep harmless Elie City of Cupertino against liabilities, judgments, costs, and expenses which may accp& against said City in consequence of die granting of this permit. Additioyefily, the applicant understands mid will comply with all non -point source re ations per the Cupertino Municipal Code, Section 9.18. Signature Date rpIkoloy ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Cmuractor's License Law for one of the following ncu reasons: 1, as owner of the property, or nmy employees with wages as their sole componsation, 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 cxclusiven• contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). hereby norm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to,self-insure for Worker's Compensation, as provided for by Section 3700 ol'the Labor Code, for the performance of the work for which Otis permit is issued. I have and Evill 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. I certify that in the performance or the work for which this permit is issued, I shall not employ any person in any numner so as to becoinc subject to the Worker's Compensation laws of California. If, after making this certificate ofexemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances mad 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Sectlat 9.18. Doc BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r NIECll r RESIDENTIAL r CODIMERCIAL r J O B D ESC R I PT I ON: REPLACE MAIN LINE FROM HOUSE TO EASTER Sq. PI Floor Area: I Valuation: &1600 APN Number: 32641054.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: �I / / c- Date: VVVJJ/ RE -ROOFS: All roofs shall be inspected prior to any roofing material beiig installed. Ira roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature ofAppli©nt: Date: ALL ROOF COVERINCSTO BE CLASS "A" OR BETTER HAZARDOUS \IAT ER1A1S DISCLOSURE have read the hazardous materials requirements under Chapter 6.95 of the California Ilcalth & Safety Code, Sections 25505, 25533. and 25534. 1 will maintain compliance wish the Cupertino Municipal Code Chapter 9.12 and the Ilcalth & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should 1 use equipment or des ices which emit hazardous air contaminants as defined by the Ray Area Air Quality Management District 1 will maintain compliance ,fill the Cupertino Municipal Code, Chapter 9.12 and the leaRIE & Safe(3 Code, Sections 25505. 25533. and 25534. 0o 11 a�izrJ rot: ` Dnic� � CONSTRUCTION LENDING AGENCY I hereby off irm that there is a construction lending agency for the performance of vork's for which this permit is issued (Sec. 3097, Civ C.) Lender's None ARCHITECT'S DIiCLARATION I understand my plans shall be used as public records. Licensed F" CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION APPLIANCE/ EQUIP TYPE ADDRESS: 10396 Anson Ave. DATE: 08/20/2012 REVIEWED BY: jsg \ APN: BP#: 'VALUATION: 1$4,600 *PERMIT TYPE: Plumbing Permit PLAN CIIECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAQ4YTION 1RPWS 1'ERtrll'r'1•Y'PE: WORK Replace main line from house to meter SCOPE SuppL lnsp Pee APPLIANCE/ EQUIP TYPE FEE ID Plumb. Plan Check 0.0 1 hrs $0.00 QTl' UNITS BP FEES Elec. Permit Fee: Water Service 1BPWSVCS Other Elce. Insp. 1 # $23 Permit Fee: SuppL lnsp Pee PME Unit Fee: $23.00 PME Permit Fee: $45.00 Construction Tax Administrative Fee: I,IDM/N $42.00 Work Without Permit? C) Yes Q No $0.00 TOTALS: Travel Documentation Fee: ITRAI'DOC $23.00 Strove Motion Fee: IBSEISMICR A'OTE: This ectiutate does not include feat due to other Departments (i.e. Planning, Public B'orks, Fire, Sanitary Server District, School District. etc.). These tees are based on the nrelintinam information aw dlable and are onit• an estimate. Contact the Dent for addn'I into. FEE ITEMS (Fee Resolution /1-053 EfJ' 7/1/11) Slech. Plan Check Plumb. Plan Check 0.0 1 hrs $0.00 Flec. Plan Check Mech. Permit Fee: Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: Other Mech. Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elce. Insp. Hach. hup. Few: Plumb. luxe. Fee: Elce. Insp. Few: A'OTE: This ectiutate does not include feat due to other Departments (i.e. Planning, Public B'orks, Fire, Sanitary Server District, School District. etc.). These tees are based on the nrelintinam information aw dlable and are onit• an estimate. Contact the Dent for addn'I into. FEE ITEMS (Fee Resolution /1-053 EfJ' 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: SuppL PC Fce PME Plan Check: $0.00 Permit Fee: SuppL lnsp Pee PME Unit Fee: $23.00 PME Permit Fee: $45.00 Construction Tax Administrative Fee: I,IDM/N $42.00 Work Without Permit? C) Yes Q No $0.00 Aelvancecl Planning Fees: Travel Documentation Fee: ITRAI'DOC $45.00 Strove Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 131de, Stds Commission Fee. IBCBSC 1 $1.00 SUBTOTALS: 1 $156.50 $0.00 TOTAL FEE: $156.50 Revised: 07/01/2012 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 05014-3255 (408) 777-3228; FAX (408) 7777-3333 • buildinc(acuoer`dno.oro Ii; IN nuxruA nrnr n.TFt At n crnrnucnt,c ?ROIEC7 ADDASS o I AFN» • / ' _ O l OWNER N ?HONE E -MAL STRETADD O IL:SS I CITY, STAT, ZI? ; 10 L -1 - FAX CONTACT CONTACT NAM. PHONE I --MAL ST E£TADDRESS I CiTY.STATE Z*P FAX ❑OwNER ❑OWNER-BUBDER 0 Q AGY 11 CONTRACTOR ❑CONTRACTORA= ❑ ARCH�TcCT ❑ENG-� ❑ DEVELOPER ❑T-q,NT CONTAACTORNA.ME PA -I LC ' E, I LC^NSE TY?E I Bus. LIC COMPANY NAME I E-MAIL I FAX T E -T ADDRESSCA ftf'o , STATE, IIP PMO. ` — L ARG�lEJGLVEZ NAME LICENSE NUMBER I BUS. LIC A COMPANY NAME ' ` I E-MAIL FAX STREET ADDRESS I CITY. STA I -ZIP I ?HONE USE OF ED SF ar DUP= BIMDINC: COMMERCIAL 13 MULft, FAMILY PROJECT IN WBDLIND 0 YES PROJECT IN ❑ YEs URBAN BNTERFACc` AREA NO FLOOD ZONE ❑ NO I is THE SLOG AN ❑YES ECHLEI HOMET ❑ ND DESCRIPTION OF WORX < C TOTAL VALUATION: I RECEIVED BY: By my signature below, I cerd.f to each of the full wy-g: I am the propery owner or authorized agent m act an the property owner's behalf. I have [cad this application and the information I have provide , cosec. I have d the Description of Work and verify is is accurate I ag: ee w comply with all applicable local ordinance and state relating to buildi sav<tion. I r'z- represntadves of Cuoer:iac x ^ur;, abo ea mopes—,� :arZ ection pu:�oses. Sign== of Applicant/Ageeu L/ Dam: SIOPPLENIENTA.I, INFORNLATi ON REQUIR_FD OFFICE USE ONLY y u V ❑ OVER-THE-COUNTER ❑ E?1'RESS - ❑ STANDARD ❑ LARGE ❑ MAJOR AE-PMLsc4pp_2011.d6c revised 0621/11