12090128 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10183 RIEDEL PI, CON TRACTOR:PLUMB-A-WAY PF,RMIT NO: 12090128
OWNER'S NAME,: PAUL MC NULTY 2135A TULLY RD STE 158 DA'Z'E ISSUED:09/142012
OWNERS PHONE: 4089311366 SAN JOSE,CA 95122 PHONE NO:(408)391-0930
❑ LICENSED CONTRACT'OR'S DECLARATION JOB DESCRIPTION: RF,SIDE\PIAL L1 COI\IERCIAL
License ClassC 3� LiIA 7 9J 9-0 3 INSTALL PROPERTY LINE CLEAN OUT
y
Contractor 1 t-(.N^1 "V�'/ Date 1--LO/3
hereby affirm that I am licensed under the provisions of Chapter 9
(commencing will,Section 7000)of Division 3 of the Business&Professions
Code and that any 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 me Labor Code,for the
performance of the work for whichthis permit is issued. Sq.FI Fluor Area: Valuation:$3500
1 have and will maintain Worker's Compensnion Insurance,as provided for by
Section 3700 of the Labor Code,for die performance of Ute work for which this APN Numher:31621057.00 Occupancy Type:
permit is issued.
APPLICANT CER'1'IFICA'I'ION
I ceriifv that I have read this application mid state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
.correct.[agree to complywith all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS M LAST CALLED INSPECTION.
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 mrd will comply Issued b}': Date:
with all non-point scowregu tuns per the Cupertino Municipal Code,Section
9.18.
- Signature' Date RE-ROOFS:
// All roofs shall be inspected prior to any roofing material berg installed If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
hereby'affirm That 1 em cxem lM from the Contractor's License haw fur one of
the following two reasons: ALL ROOF COVERINGS 7'O RF CLASS"A"OR Bf:17ER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,mid the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ILA-LARDOUS MATERIALS DISCLOSURE
construct the project(Sce.7044,Business& Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&Safely Code,Sections 25505,25533,and 25534. ["ill
hereby affirm under penally of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Ilealth&Safety Code,Section 25532(x)should I store or handle hazardous
I have and will maintain a Certificate of Consent to selfinsure'for Worker's material. Additionally should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of die Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District
performance of the work for whichthis permit is issued. will maintain compliance with the Cuperlino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Code,Sections 2 0 25533,and 25534.
Section 3700 of the Labor Code,for the performance of die work for which this
' Owner nr nulhnrized ager Date:
permit isissued
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person many manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LISNDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 1 hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked, work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that 1 have read this application and state that the above information is
correct.1 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 /
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCIIITECf'S DECLARATION
costs,and expenses which may accrue against said City inconsequence of the 1 undersand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-points gulmicns per the Cupertino Municipal Code,Section Licensed Professional
9.18. i
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10183 Riedel Place DATE: 09/14/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $3,500
*PERMIT TYPE: Plumbing Permit PLAN CIIECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1RPSS
USE: PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE,ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $23
TOTALS: $23.00
A/eeh. Plan Cheek Plumb. Plan Check 0.0 hrs $0.00 Fl,,.Plan Check
Atech.Permit Fee: Plumb. Permit Fee: IPPERAHT Elec. Permit Fee:
Other Much.Insp. Other Plumb Insp. 0.0 hrs 1 $45.00 Oder Flee.hup. 7 El
Mach.Insp. Fec: Plumb. heel). Fee: Flee.Insp. Fee:
NOTE: This evinmte does not include fees clue:to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the preliminarl information as ailahle and are anti,an estimate. Contact the De t or addn'I info.
FEE ITEMS (Fee Resolution I1-053 tiff 7111111 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fce:
Supp/. hap Fee
PME Unit Fee: $23.00
PME Permit Fee: $45.00
Construction Tac:
Administrative Fee: IADMIN $42.00
Work Without Permit? O Yes (j) No $0.00
ArPoancecl Planning Fees:
Travel Documentation Fee: ITRA I%DOC $45.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Blcta Stds Commission Fee: IeCBSC $1.00
SUBTOTALS: $156.50 $0.00 TOTAL FEE: $156.50
Revised: 07/01/2012
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPAR-RVIENT• BUILDING DIVISION /
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 1� p p '
CUPERTINO (408)7773228 • FAX(408) 7T7-3333 •buildinc(Do:Derino.orc h �\■/I
sc
PLU-NBING ❑N(ECFLA-vfiCAL ❑ELECTRICAL �E❑NESCELLA.NEOUS
PRor ADnREss
10 t P- -ZE P F L P(4<24 '(� 21 5-7 .c5D
OWNER NA.SL P4VL M N LT PNON@j��I ' I 'n(.0 IE-MAIL
STREET ADDRESS CTTY,STATE IIP FAX
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CONTACT NAME PHONE I E-MAIL
STRUT ADDRESS CITY,STATE, IIP FAX
OWNER ❑ OWNER-RUTIOER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ AR=. -CT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONr�.1CTOR NAME 171 N ^ v L'CENSE NUMBER 7�9 p.A LICENSE TYPE I BUS.LIC a
COMPANY NDNIE 1 UN�
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STREITrADDRESS rTuuyy (LDP/ST1
C} PHO
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ARC" ECTIENGNEER NAME L'CZJSE4UNMER
I HUS.LIC 0 [�
COMPANYNAME' I E-MAM I FAX /
STREET ADDRESS CITY,STATE ZIP PHONE
USEOF Sm0UPLX ❑ MULTI-FAMD.Y I PROTECTw WIL LAND ❑ YES I PROJECT IN El YES I IS ITL BLDG AN YEs
BIIDOwG: ❑COMMERCI.LL URBAN INTERFACE AREA NO FLOOD ZONE [I No ECHLERH= O
DESCRIPTION OF WORK n K •�
0J9'CE S6 rwJ�2 7 / /L10+^-1 144$c-- 7G
2n�ST4-LL CLE q-ni6,t 7 F7-7 HoG15E
PRoP r=12-7' c Z,,1= F071- S py r 7-2-0,1-.' D ;Z-S 7izZC
TOTAL VALUATION: 31SOO I RECEIVEDBY:
By my signanse below,I cardy to each of the lbl!owing: I am[he pmoeay owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is co cc 1110 :rad the Description of Work and verify it is accurate. I agree a comply with all applicable local
ordinances and state laws relating m buildin c' n. I a tizc repruentativcs of Cupertino to enter the above-iidendfiecT ppmpe:-/for inspection pu;i oses.
Sigttnmm ofAppli=VAgene Date: /
SUPPLE: , AL rNFOR.NLAXION REQUIRED OFFICE USE ONLY
,� ❑ OVER.TUE-COUNTER
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- ❑ EXrREss
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❑ STANDARD
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❑ MAJOR
AIEP, ueipp_1011.doc revised 06/21/11