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12090157 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22252 BITITR OAK SI' CONI-RACI.OR:WATER QUALITY PERMITNO: 12090157 PLUMBING OWINER'S NANII.: IIEBERT ARLENE F 1860 ALMADEN RD DATE ISSUED:09119/2012 OWNER'S PHONE: 6502691508 SAN.IOSE.CA 95123 PHONE NO:(408).167-9330 ❑ LICENSED COYPRACI'OR'S DECLARATION BUILDING PERMIT INFO: BLDG C ELECT(_ PLUMB Cl License Class e: 3f;, Lic.N3�S�/� - L 1 DIECII r RESIDENTIAL(_J COMMERCIAL r_— Contractor Contractor Dane hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COPPER REPIPE ENTIRE RESIDENCE (commencing with Section 7000)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: 1 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. Sq.R Floor Area: Valuation:$7000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for die performance of the work for which this permit is issued. APN Number:32651029.00 Occupancy Type: APPI,ICA\I'CFR'fIFICA'1'ION I certify that I have read this application and slate that the above information is correct.l agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED. to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupenino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands mid will comply with all non-point so r Wregulafi nsper the Cupertino Municipal Code,Section Issued by: ��,A/� T/llif� Date: �9•�� 9.18. Signature � Date RE-ROOFS: ❑ OWNER-RUILDER DECLARATION All roofs shall be inspected prior to any rooting material being installed.If a roof is installed without first obtaining ran inspection,1 agree to remove all new materials for hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the fullowing two reasons: I,as owner of the property,or my employees with wages as their sole compcnsmion, Signature of Appliaml' Date: will do the work,and the structure is not intended or ollercd for sale(Sec,7044, Business R Prolessions Code) I,as owner of the property,am z.yclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sce.7044,Business&Professions Code). hereby affirm under penalty of perjury one of the following three IIA%ARDOUS MATERIAL S DISCLOSURE declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate ofConscut to self-Insure for Worker's California Health S Safety Code.Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the labor Code,for the compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health performance ofthe work for which this permit is issued Safety Code,Section 25532(a)should 1 store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided fur by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the perfommnce of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain comp Ince with the Cupertino Municipal Code,Chapter 9.1_and the Ilealth S Suf t Code.Sections_5505..5533,and 25531. I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Worker's Owne j� agent: Compensation laws ofCalifomia. If,after making this certificate of exemption,I ^'r Date: •7'�fJ—o�l'L become subject to the Worker's Compensation provisions of the Labor Code,I must Iorthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICA\1'CERTIFIC\TION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.1 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 lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep hannless the City of Cupenino against liabilities,judgments, .\RC1I I'1'FCI"S DECLARATIONcosts,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 1:21 ADDRESS: 22252 Bitter Oak Street DATE: 09/19/2012 REVIEWED BY: Sean APN: BPH: 'VALUATION: $7,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIRIARI' SFD or Duplex PF.NTAIIATION 1RPRP USE: PERMIT TYPE: At WORK e i e entire residence. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe Interior 1PRREPIPE 1 # $13 TOTALS: F $13.00 Nfeeh. Plan Check Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check Afech. Permit Fra: Plumb. Permit Fee: IPPER IfIT raec.Pennit Fee: 0.0 Other,ifech.Imp. Other Plumb Insp. hrs L$45.00 Other Elee.1115P. Aiech.Insp.Fee: Plumb. Inst). Fee: Flee.Insp. Fee: NOTE: This estimate doev not includejees due to other Departments(i.e. Planning, Public Works. Fire,Sanitary Sewer District,School District,etc.). These feav are based on the prelimirtan information available and are adv at estimate. Contact the Delujor addn'I info. FEE ITEMS (Fee Rcsohnion 11-053 E : 711/111 FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. hisp Fee PME Unit Fee: $13.00 PME Permit Fee: $45.00 Consnvction Tar: Administrative Fee: /AW11N $42.00 Work Without Permit? O Yes Q No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA t'DOC $45.00 A Strong Motion Fee: IRSFlSAiICR $0.70 Select an Administrative Item Bldg Stiffs Commission FCC IRCRSC $1.00 SUBTOTALS: 1 $146.70 $0.00 TOTAL FEE: 1 $146.70 Revised: 07/01/2012 IN I 2� � l ( � GENERAL PERMIT APPLICATION M E P 1:21 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M I sc CUPERTINO (408)777-3228•FAX(408)777-3333•buildingocupertino.oro LUMUING MECIiANICAI- ELECTRICAI, MISCELLANEOUS PROJECFADDRESS APN0 OWNERNAME PHONP. _ ISOL GMAII IIIA STREET ADDRESS - CfTY,STATE!-IP' 5 �"'I FAX eA CONTACT NAME n PIIONCq - E-MAIL _ V G� STREET ADDRESS CRY,STA 21P FAX ❑OWNER ❑ OWNER-BURDER ❑ OWNE.RAGENT C'KCONTRACTOR ❑CONtRACTOR AGPM ❑ ARCHRECT ❑ENGINEER ❑ DEVELOPER ❑TENANr CONTRACTOR NAME& IST LICENSE NUMBER O LICENSE TYPE BUS.LICM ,r�� IAO' 1 d COMPANY NAME/ E-MAIL _ - I •nG PAX STREEI'ADDRESS CH Y,STATE,ZIP PHONE 5zn t 4 or�aG7- r h ARCHITF.CUENGINEER NAME LICENSE NUMBER BUS.LIC M COMPANY NAME EMAIL PAX STREET ADDRESS CRY,SFATE,ZIP PHONE USE OF WFDar DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECTIN ❑ YCS ISTiEBIDGAN ❑ YES BUILDING. /0 COMMERCIAL URBANINTERFACEAREA O FLOODZONE NO EICHIER HOME? NO DESCRIPTION OF WORE: , TOTALVALUATION: M00 OD RECEIVED BY: -� By my signature below,1 cennify to each of the following: I am the property owner or authorized agent to act on the property,owner's behalf. 1 have read this application and therein ation l have pro ided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to buil ng cons"etion. 1 authorize representatives of Cupertino to enter the above-idem Fred progeny for iMpection purposes. Signature of Applicant/Agene Date: ql/� SUP EMFNTAL INFORMATION REQUIRED OFFICE USE ONLY W VER-TIIF GOIINTER 6 Y �1 ❑ EXPRESS U m ❑ STANDARD U Z ❑ LARGE a ❑ MAJOR MEPMiscApp_1011.doc revised 06/11/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Tc�epnonel 4Q�-771-3228 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: • 22ry , PERMIT# OWNER'SNAME: }'P \ PHONE ft GENERAL CONTRACTOR: w cr .,�, , BUSINESS LICENSE# ADDRESS: 43(,,� A3 c.-, "R S' CITY/ZIPCODE: S < <J o2Y "Our municipal code requires all businesses working in the city.to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACT RS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 2 1 am not using any subcontractors: g ignature Date Please check applicable subcontractors and complete the following information: -t✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum /Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Rbofing Septic,Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date