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12100113
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10592 JOHANSEN DR CONTRACFOR:SHADOWFAX ROOFING PERMITNO: 12100113 OWNER'S NAME: ABUBAKA WAWDA 1366 SANTA PE DR DATE ISSUED: 10/15/2012 OWNER'S PIIONF,: 31091305 SAN JOSE,CA 95118 PDONF.NO:(4081265-2490 ❑ LICENSED COYfRACI'OR'S DECLARATION BUILDING PERMIT INFO: BLDG _ ELECT J PLUMB 0- License Class Lie.q MECIi C. RESIDENTIAL❑ COMMERCIAL J Contractor Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING ROOF AND GUTTERS AND REPLACE (commencing with Section 7000)of Division 3 of the Business A Professions WITI I COMPOSITION MATERIALS AND NEW GUTTERS 24 SQ Code and that my license is in full force and effect. hereby affirmunder penalty of perjury one of the following boo 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 Sq.Ft Fluor Arca:0 Valuation:$21000 Section 3700 of the Labor Codc,for the performance of One work Ibr which this permit is issued APN Number:37536014.00 Occupancy Type: Al'1'LICAN'I'CF.R'1'IFICA'1'ION I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state Imus relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep hasonless the City of Cupertino against liabilities,judgments. WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City inconsequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. Issued by: Date: Signature Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following("a 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 Appli©nt: Date: Business R Prolcssions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business K Professions Code), ALL ROOF COVERINGS TO BE CLASS"A"OR RE'TTER hereby affirm under penalty of perjury one of the following three declarations: DAZARDOUS 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 die Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 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 25.532(x)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Ray Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of doe work fonvhich this permit is issued,I shall Ilealth S Safety 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 Califamia. If,infer making this certificate of exemption,I Owner or authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must -.Date: forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY \PPI-ICAN'I'CF'R'1'IFICA'1'10N I hereby affirm that there is a construction lending agency for the performance of work's I certify That I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.1 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 b indemnify and keep hammless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the .\RCIIITF.CI"S DECLARATION granting of this permit.Additionally,the applicmu 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 CITY OF CUI'ERTINO BUILDING PERMIT BUILDING ADDRESS: 22702 I,Il3FRTY OAK LN CON' RACMIZ:CUPERTINO PLUMBING PERMIT NO: 12100103 OWNEAUSNAME: 11ONGPIAN 1300 DELI,,\VE S1'FC DATE ISSUED: 10/122012 OWNER'S PHONE: 4085099589 CAMPBELL,CA 95008 PHOSENO:008)253-0618 ❑ LICFS'SE/D CCINTRACI'OR'S DECLARATION BUILDINC PERMIT INFO: RLDC r ELECT r PLUMB r License Class_ I,ic.0 r r r /` / MFCI3 RESIDENTIAL COMMERCIAL Contractor e c< O P•/�`'Y� 1 here[),affirm than 1 am licensed under the provisions of Cha liter 9 .1013 DESCRIPTION:GAS LINK RIiPAIH (tun inencing with Section 7000)j of Division 3 unlit Business& Professions Code and I11:11 mr license i,in full force and effect. I hereby affirm under penally of perjury unc 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. Sy. Ft Ploor Area: Valuation:SI800 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the stork for which this permit is issued. MIN Number:34232039.00 occupanev Type. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is corrcct. lagree to comply with all city and county ordinances and sale laws relating PERMIT EXPIRES IF WORK IS NOT STAR"T"ED to building construction,and hereby atnhorize representatives of this city to enter upon the above mentioned property for inspcctionpurpuscS. (We)agree 10 save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indernnityand keep harmless the City ol'Cupertino against liabilities,judgments, 1811 DAYS FROM LASTCALLED INSI'EC"KION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply nn_ with all non-point source regulations per the Cupertino Municipal Code,Section Issued bra�>✓' �7/ G Date: 16-IF-119 9.18. Signature Date /0 1`2 124-ROOFS: ❑ OWMilt-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed withoul fust obtaining an inspection.I agree to remove all tics,materials for 1 hereby affirm that 1:un exempt from the Contractor's License Lan,file one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant Date: will do the work,and die structure is nor intended or offered for sale(Sec.7044, Business 3 Professions Code) I,as owner of the property,tun exclusively contracting with licensed contractors ro %1,1,ROOF CONTRINGS'I'O BE CLASS"A" OR til•;FI'ER construct the project(Sec.7044,Business._Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS>IATE'tIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California I lealth&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 Ute Collection Municipal Code.Chapter 9.12 and the health 8 performance of the work for which this permit is issued. Safety Cute.Section 25532(:)should I store or handle hazardous material. I have and Brill maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment ur de,ices which emit hazardous air Section 3700 ofthe Labor Code,for the performance of the work for which Ill: contaminants as defined b,the Bay Area Air Quality Management District I will trail is issued. maintain compliance with the Cupertino Municipal Code.Chapter) 12 and the P Health S Safe(,Code.Scctions 25505,25533,and 25.,34- 1 certify that in the performance of the stork for which this permit is issued.I shall not employ any person in any manner so as to became subject to rhe WorkersCh, nr out tud Compensation laws of California. If,after looking this certificate ofesemprion I Date: become subject to the Worker's Coll,pcnsill ioil provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTItlIC110S 1,I7,NDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's AI'1'I-ICANT CERTIFICATION for which this permit is issued(See.3097,Cir C.) I certify that I have read this application and state that the above information is Lender's Name correct. I agree to compiv with all city and county ordinances and stale(:nes 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 harmless the City of Cupenino against liabilities,judgments, ,\ItCI l I'I'ICCI"S I1FCL.UL\'('ION costs,and expenses which may acerae 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 GENERAL PERMIT APPLICATION M E 1 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 950143255 w A ' A CUPERTINO (408) 777-3228• FAX(408)777-3333•buildinGnccuoenino.orD v\ PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PR07t ADDRESS � I APN'. � h OWN AME ICi//, E-MAIL ' U STRE-7 ADDRESS CITY, ST.4T�IIP tri CO R 4 E PHONE 4d Q-�^�_3e °MM. STREE'TADDRESS CfiY,STATEp Er. ..G� J T FAX ❑ OWNER ❑ OWNER-BUTIDER ❑ OWNERAGE?r CONTRAROR ❑CONTAACI9RAGa'T 0 AROv-'IF ❑ENGI),= ❑ DEVE]APvR ❑ 9�JAM yyROR NAME � I Ll SE. Eq� fICCETYP HUS.IJCp COWAN-Y NAAa ✓�I E-MAM FAX C� STREET ADDRESS/3� CITY,STATE, ARCHI-MCVENGINEE t NAME / /� LICENSE Nl1TEER G!� BUS.LC# COWANY NAAE' K E-MAZ FAX STREET ADDRESS CITY,STATE IIP PHONE USE OF ASM.DIPIJ( ❑ MIRTLFAMTLY PROTECT P'WED(.V+b El Yes PR=CTN YES IS TRE BLDG AN YES BUTI-DING: COMMERCIAL URBAN LVT'ERFACE AA&� NO FLODD LANE NO EICHLER HONM NO DESCAIMON OF WORX r \ TOTALVALUATION: / DO ^ RECEIVED BY: By my signaa:re below,I cenify to each of the followi g+�zvi• cry owner or x thori ted agent to act on the property owner's behalf. I have read[his application and the in: I have provide 's a d the Descipdon of Work and vmy it is accurate. I a,n-e_-,to comply with all applicable local ordinances and state laws ung m c^ .rg c tion autho ' ntatives ` o to enter the above-identified prope:,y.`or inspec:ioa pul;oses. Signature of Applica^dAgent: Date: 1C.� — 12 PI-ENMNr INFORMATION REQUIRED OFFICE USE ONLY y, OVER-THE-COUNTER ❑ EXPRESS u J ❑ STANDARD U Z ❑ LARGE ❑ MAJOR AE'PMue4pp_ 011.docrevued.06/2]/71 ' CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 22702 Liberty Oak Ln DATE: 10/12/2012 REVIEWED Bl': Sean APN: BPH: OOH 3 'VALUATION: $1,800 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARYPENTAMATION USE: SFD Or Duplex PER1fITTYPE: 1RPGA WORT: Gas Line Repair. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTl' UNITS BP FEES Piping, Gas <=4 Outlets 1PGASRES 1 # $67 TOTA LS: F $67.00 Mech. Plan Check Plumb. Plan Check 0.0 hrs $0.00 Fl,,.Plan Check Mesh. Permit Fee: Plumb. Permit Fee: IPPERMIT Flec.Permit fee: Other Mech. Insp. Other Plumbinsp. E hrs $45.00 Other Elec.Insp. .Ilech.Lup.Few: Plumb. hop.Fee: Elce.Insp. fec:. NOTE: This evtimate does not inclurlefees due to other Departments(i.e. Planning, Public 11'ork.c, Fire,Sanitap,Server District,School District, etc. . Thesefees are based on the prelintinan information available and are atilt,an estimate. Contact the Dept for addm'I info. FEE ITEMS fce Resolwion 11-053 ER' 711112) FEE QTY/FEE MISC ITEMS Plan Check Fce: Suppl. PC Fce PME Plan Check: $0.00 Permit Fee: Supp/. /nsp Fee PME Unit Fee: $67.00 PME Permit Fee: $45.00 Construction Tar: Administrative Fee: IdD,tfly $42.00 Work Without Permit? O Yes Q No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA VDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 131de Stds Commission Pee: IBCBSC $1.00 SUBTOTALS: $200.50 $0.001 TOTAL FEE: $200.50 Revised: 10/01/2012