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13040010 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7523 DE LA FARGE DR CONTRACTOR:CURRO PLUMBING INC PERMIT NO:13040010 OWNER'S NAME: ALEX TIEN 5810 OBATA WAY STE 8 DATE ISSUED:04/02/2013 OWNER'S PHONE: 4089738339 GILROY,CA 95020 PHONE NO:(408)847-7704 ❑ LICENSED CONTRACTOR'S DE TION JOB DESCRIPTION: RESIDENTIAL 11COMMERCIAL0 License Class ic.# 5 7e ROUTE LOW PRESSURE GAS LINE FOR NEW GAS METER .,yam LOCATION OUT FROM STAIRS Contractor Date I hereby affirm that I am lice d.under the.provisi s Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force,and.effect: I 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: Sq.Ft Floor Area: Valuation:$1000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35926024.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WIT�IIN 0 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 DAY OM 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 2 granting of this permit. Additionally,the applicant understands and VY111 Comply Issued by: Date: ai� with all non-point source r t s per the Cupertino Municipal C de ection 9.18. RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. 1-13 — OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with t e Cuper' o73nd ipal Code,Chapter 9.12 n I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec' s 2550 , 25534. I Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date permit is issued. 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 Compensation laws of California. If,after making this certificate of exemption,I CONftUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is 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 I have read this application and state that:the;above information is correct.I 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against' aid,City inconsequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date- GENERAL PERMIT APPLICATION MER COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION . 10300 TORRE AVENUE•CUPERTINO,CA 950143255 CEI PERTFPE© (408)777-3228•FAX(408)777-3333•building cuDertinO.Org 0 1 misc [:]PLUMBING ❑MECHANICAL ❑ELECTRICAL �)q PROJECT ADDRESS �f Q� yJ/ APN#,.35 ci ec, n/ 4 OWNERNAME J/�f LSI/�7-s6/4 T PHO'Wo G 2� I!/� / EMAII. C/ STREET ADDRESS ��/ CITY, STATE,ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ ONNTERAGENTT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICEI.TSE TYPE BUS.LIC Y COMPANY NAME jJ E-MAIL FAX STREET ADDRESS 1+ f� CITY,STATE,IIMZIP/ ) �"� PHOTS / ARCHITECTIENGJTEER NAME LICENSE NUMBER �!/ BUS.LIC## COMPANTY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMII..Y PROJECT IN WtLAND ❑ YES PROJECT IDN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK �f�_�L7� /N V�yLJ �j�� TOTAL VALUATION: �C%T/vj RECEIVED By my signature below,I certify to each of the following: I am the property owner or authorized agent to act onroperty owner's behalf. I have read this application and the information I hav provided is correc I have read the Description of Work and verify it is acc te. agr to comply with all applicable local ordinances and state laws relating t undine ttu I au orize representatives of Cupertino to enter the above ent' ed propefry for inspection purposes. Signature of ApplicantlAgent: Date: EMENTAL INFORMATION REQUIRED OFFIC SE ONLY OVER-THE-COUNTER r' ❑ EXPRESS r U u ❑ STANDARD U ❑ LARGE r- ❑ MAJOR MEPMiscApp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7,523 de la farge dr DATE: 04/02/2013 REVIEWED BY: mendez APN: BP#: *VALUATION: j$1,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1RPGAS USE: PERMIT TYPE: wORK route low pressure gas line for new gas meter location out from stairs SCOPE nnc ..z ;L1ech. Plan Check Plumb.Plan Check 0.0 1 hrs $0.00 Elec..Plan(.heck iFlech.lyertztit Fee: Plumb.Permit Fee: 1PPERMIT 171"% t'ermit Fee: Other;k1ech.In.sp. Other Plumb Insp. 0.0 hrs $45.00 Ocher Elec.Insp. Tech,Imp.Fee: Plur17b. hrsp.Fee. Elec.Insp.Fee: NOTE.This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer.District,School District,etc). These.fees are based on the prefinmdina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS(Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Plumbing Suppl.PC Fee: Q Reg. '0 OT 0.0 1 hrs $0.00 $67.00 IPGASRES Piping,Gas<=4 Outlets PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-.0 Reg. ® OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Constaztction Tax: Administrative Fee: 1ADMIN $42.00 Work Without Permit? ® Yes (F) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fee: 1TRAVDOC $45.00 1 Building or Structure i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $133.501 $67.00 $200.50 Revised: 04/01/2013