12090007 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1497 JAMES TOWN DR CONTRACTOR:QUICK PLUMBING INC PERMIT NO: 12090007
OWNER'SNAME; BINKLEY WANDA B TRUSTEE d ETA 104.1 MARTIN AVE DATE ISSUED:09/042012
OWNER'S PIIONF-: 4084461639 SAYI'A CLARA,CA 95050 PHONE NO:(408)732-1220
❑ LICENSED CO\FRACTOR'S DD-F-CLARA'1'I0N BUILDING PERMIT INFO: BLDG C ELECT I_ PLUMB r
License Cl4Sec
Lie.9n
�+ MECH r RESIDENTIAL r� COMMERCIAL r
ContactoDatc / —Ll`�GZ
hereby sed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALLATION OF PROPERTY LINE CLEANOUT
(commen0)of Division 3 of the Business S Professions
Code and that my license is in full force and effect.
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. t�
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuarion;_SZ 00
Section 3700 of the Labor Code,for the performance of the work for which this �E1SLGG`Ga
permit is issued.
APN Number:36610090.00 '0ccup9pcsrTy e: V
APPLICANT CERTIFICATION
I certify that I have read this application and stale that the above infomtation is
correct.I agree to comply with all city and county ordinances and state laws relating A
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES,I F\ RLI_ NOT STARTED
`
upon the above mentioned property for inspection purposes. (We)agree to save i
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 D � � EMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of 1 HO DAYS• L��T CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non- a source regulations per the Cupertino Municipal Code,Section �'�
9.18. Issued by: /!�' 2i Date: /
Signature Datcl-L/ `
❑ OW'NF-R-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
1 hereby affirm that I am exempt from the Contractor's License Law fur one of installed without forst obtaining an.inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,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, Signature of Applicant: - Date:
Business.@ Professions Code)
1,as owner of the property,am exclusively contracting with licensed contactors to
construct the project(Sec.7044,Business&Professions Code), ALI,ROOF COVERINGS TO BE CLASS"A"OR BE ITER
hereby affirm under perudty of perjury one of the following three
declarations: IIA%ARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate 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 Ilealth S Safety Code,Sections 25505,25533,and 25.174. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth S
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 the Labor Code,for the perfomnance of the work for which this Additinmdh',should I 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 Cupertino Municipal Code,Chapter 9.12 and the
1 certify that in the performance of the work for which this permit is issued,I shall IlPttk&Safely Code.Sections 25505.25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this cerlifncate of exemption,I Oner r au o zed a ant: p �`
become subject to the Worker's Compensation provisions ofthe Labor Code,1 must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION 1-ENDING AGENCY
API'LICAN'1'CF:R'1'IFIC\'1'ION I hereby affirm that there is a construction lending agency for the performance of work's
I cenify that I have read this application and state that the above infomnalion is for which this permit is issued(Sec.3097,Civ C.)
correct.I 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-CI"S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
E2 L
GENERAL PERMIT APPLICATION MEP
E-Z—
COMMUNFFY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) r rr-3228 • FAX(408)7-77-3333 t buildine0Guoerino.orG
pLLT43ING ❑V---G_A-MCAL. EIELECTRXAL ❑WSCELLANEOUS
�.
-""'2227
Rorr,ADDR_;s J/77' cJ %1l PN
STU ul, • I .Aa .3660 /O - U D
X OWNER NAME r�, 1 t� 13 K 1 1
X-PH" tvtI6 9 I E-MAZ
ST R=ADDRESS STATS_
FAX
CONTACT NAME I PHONE I E.MALr
STR—,ADDRESS I ter t STA-. aF
I FAX
❑OWNER ❑ OWNE4-BUt Et ❑ OWNER AGEVi ❑ CON,-;i ACTOR CONTRACTOR ACIENF ❑ ARC=CT ❑EVGW-,Ei ❑ D-�kR ❑ T=y,WT
CONTaAC70R NAMELTC-_NSE NU7dBER I U E TYPE I BUS.LIC
cIC PI Mbii U o Co p
COMPANY NAME ,. I I E-MAIL I FAX ,
S'R.c-T ADDREss �/ [�l' -Ari PHONc
�/`-1 ./+N-t- I Ar'�19 I y! 13 Z -/Z z Q
ARCHPi !]`1GT t tiAMB LICEVSE NUNMER I BUS.llC N
COMPANYNAME' EMAII. I FAX
SIREFi ADDRESS I C^',STAT°Z-
PHONE
USE OF SFU V DUPLEX ❑ M LTI-FAMD.Y PROMS as WT10L ❑ Y=S PROJECT N ❑ YES IS T}=BLDG AN ❑-y1YYE
B=NG: ❑WO Rct L URBAN NTERFACE AR'_A NO FLOOZON
D E j2'NO ( EIC Lm HOME? 'C! N'D
DESCAIFTION OF WORK
4v -e- /1'�-e.
TOTAL VALUATION: ` /�/�O v I RECEIv' BY:
ay c y sig a below,I'crvyl0 o-I me`ollowiug: I am-;be pro ervy owner or=horized ag n!w ac;on;he property owner's behalf I bavc rad this
application and the iaforvnatien I her a n, 'dee is L I he V.read the Descncon o:Work znd verify i;is ace=zle. [ag:ec a cornpiy wits all applicable local
ordinances and sate laws mating m uvdt g can y cd . I Norm mpresecadves of Cerner-=:n^:e:;.he c-'�ovegjdcti5e3 pipe `or insoecdon pu:pcses.
Signamze o`ApolicanJAg=er / Da¢: 2( / �'-2(,' /Z
SUPPLElv¢N'T-4LORNLST-tON REQUIRED
OFFICE USE ONLY
y OVER-THE-COUNTER
r
- ❑ EXPRESS
u
J ❑ STANDARD
U
Z ❑ LARGE
❑ NWOR
ACE'ld+scJpp_1011.doc revised 06P1/71
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 1497 Jamestown Dr DATE: 09/04/2012 REVIEWED BY: Sean
APN: 366-10-090 BP#: 'VALUATION: $2,000
*PERMIT TYPE: Plumbing Permit PLAN CIIECK TYPE: Alteration /Addition / Repair
PRIMARYSFD Or Duplex PEN"1'AMATION 1RPSS
USE: PERMIT Tl'PE:
WORK Installation of ro ertline cleanout.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $23
TOTALS: $23.00
I
I
Meeh. Plan Check Plumb. Plan Check 0.0 hrs $0.00 Flee.Plan Check
btech. Permit Fee: Plumb. Permit Fee: 1PPERMIT Flec.Permit Pee:
Other dlech.Imp. Other Plumb Insp. 0.0 hrs $45.00 Odrer Flee.Insp.
He.ch.limp. Fee: Plumb. htvp. Fee: Flec.Insp.Fee:
NOTE: This estimate sloes not include jecv due to other Departments(i.e. Planning, Public{Narks, Fire,Sanitary Sewer District,School
District, etc.). These feav are based on the prelinzinan information mailable and are onhv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Revolnlion 11-053 E/L 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Sapp/. PC Fee
PME Plan Check: $0.00
Permit Fee:
.Suppl. Imp Fee
PME Unit Fee: $23.00
PME Permit Fee: $45.00
Construction Tar:
Administrative Fee: IADAHN $42.00
Work Without Permit? Yes Q No $0.00
A(lvanceil Planting Fees:
Travel Documentation Fee: ITRA VDOC $45.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bide Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $156.501 $0.001 TOTAL FEE: $156.50
Revised: 07/01/2012