11100056 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19500 PRUNERIDGE AVE CONTRACTOR:SANCO PIPELINES INC PERMIT NO: 11100056
OWNER'S NAME: IRVINE APT COMMUNITIES 368 E CAMPBELL AVE STE 200 DATE ISSUED: 10/07/2011
OWNER'S PHONE: 4088738800 CAMPBELL,CA 95008 PHONE NO:(408)377-2793
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG T_ ELECT PLUMB r
License Class A Lic.# 14 0 3 2 Z
MECH RESIDENTIAL COMMERCIAL
Contractor &"e-0 /0 Q i Dt_�i NC S J,.l�ate ! Q r
I hereby affirm that I am licensed under the provision of Chapter 9 JOB DESCRIPTION: 1,000FT E OF WOLFE RD-REPLACE SEWER LINE&ADD
(commencing with Section 7000)of Division 3 of the Business&Professions NEW PROPERTY LINE CLEAN OUT
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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$2 00
Section 3700 of the Labor Code,for the performance of the work for which this A}
permit is issued.
APN Number:31606037.00 Occupa Tyy :
APPLICANT CERTIFICATION 7.1 a,
..:b
1 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 r �
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IFWA
S` OT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save +r'
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAY , tEA1VII"f ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FRO LED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the upertino Municipal Code,Section
9.18.
�
� �� Issued by: ' � �- Date:
Signature Date
OWNER-BUILDS DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I nereby 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 two reasons:
inspection.
I,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)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS 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 Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)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 Bay 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 the work for which this permit is issued,I shall Health&Safety Code,Secti s 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 certificate of exemption,I Owne r a rized t:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date: I I
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION 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.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,
c—ts,and expenses which may accrue against said City in consequence of the
ng of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
9.18.all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31606037. 00
DATE ISSUED. . . . . . . : 10/07/2011
RECEIPT #. . . . . . . . . : BS000014986
REFERENCE ID # . . . : 11100056
SITE ADDRESS . . . . . : 19500 PRUNERIDGE AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : IRVINE APT COMMUNITIES
ADDRESS 550 NEWPORT CENTER DR
CITY/STATE/ZIP . . . : NEWPORT BEACH, CA 92660
RECEIVED FROM . . . . : SANCO PIPELINES, INC
CONTRACTOR . . . . . . . : DAVID SCHRADER LIC # 26702
COMPANY SANCO PIPELINES INC
ADDRESS . . . . . . . . . . : 368 E CAMPBELL AVE STE 200
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 377-2793
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
-ADMIN HOURS 1 . 00 41. 00 0 . 00 41 .00 0. 00
1BCBSC VALUATION 20, 000 .00 1. 00 0. 00 1 .00 0. 00
1BSEISMICR VALUATION 20, 000 . 00 2 . 00 0. 00 2 .00 0. 00
1PPERMITFE FLAT RATE 1. 00 44 . 00 0. 00 44 .00 0. 00
1PRSEWER UNITS 1 . 00 22 . 00 0. 00 22 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 154 . 00 0. 00 154 .00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 154 . 00 #16048
---------------
TOTAL RECEIPT 154 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 19500 prunderidge ave. DATE: 10/07/2011 REVIEWED BY: bobs
APN: BP#: "VALUATION: 1$20,000
PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPSS
USE: PERMIT TYPE:
WORK replace sewer line add new property line clean out
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Building 1 PRSEWER 1 # $22
TOTALS: 1 $22.00
Plumb.Plan Check 0.0 Thrs $0.00
- Plumb.Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 hrs $44.00
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelinina information available and are o'nly an estimate. Contact the De t or addh 7 info,
FEE ITEMS (l=ee Resolution 11-053 E.jf.' 7/1%11) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $22.00
PME Permit Fee: $44.00
Administrative Fee: 1ADMIN $41.00
Work Without Permit? Yes (E) No $0.00
Travel Documentation Fee: ITRA VDOC $44.00
Strong Motion Fee: 1BSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $154.001 $0.00 TOTAL FEE: $154.00
Revised: 10/01/2011
GENERAL PERMIT APPLICATION
MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildingCcDcupertino orq MISC
PLUMBING Ej MECHANICAL ELECTRICAL El MISCELLANEOUS
PROJECT ADDRESS ' kS00 P� C' C V �►NO 45 I-4 # 3k 6O C O 37
OWNER NAME C�NC%S PHO °149
E-MAIL
q!�- c+vl- C..M 720-35p bre Icv' Co•ti q... .
STREET ADDRESS CITY, STATE,ZIP FAX
b S/VNov0.{':ON Srv:n. GA 92G 17 q 72.0- 5466
CONTACT NAME PHONE E-MAIL
M: uy
STREET ADDRESS CITY,STATE,ZIP
V ZoC C�AO a FA 08 37 —7 O
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE /�_ BUS.LIC#
COMPANY NAME E-MAIL
Sq�C(> 'P: �G� C_ e�� FAX�Og 377 -� a5
STREET ADDRESS / L CITY,STATE,ZIP Q jJ o
[BUILDING
G 6ClI V Sf. A-e16 ( ��C'�O� PH os {ZI-OkO3
GINEER NAME LICENSE NUMBER BUS.LIC#
ME E-MAIL FAX
ESS CITY,STATE,ZIP PHONE
❑SFD or DUPLEX MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
❑COMMERCIAL URBAN INTERFACE AREA •NO FLOOD ZONE '�NO EICHLER HOME? �NOF WORK
/✓. �..J i e Oma/ I:V r
a �
TOTAL VALUATION: 'U O D b RECEIVED BY:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b mg5q.35Rion. I e representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Appl icant/Agent: Date: —
LEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
W
ElOVER-THE-COUNTER
❑ EXPRESS
U
❑ STANDARD
U
a ElLARGE
a
❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: q SOO �r..,K�r�d� e Ave_ PERMIT# �
OWNER'S NAME: j v;nie, Ap&-r4- PHONE# N6
GENERAL CONTRACTOR: Sot.vG�, p, c- :N G. BUSINESS LICENSE#
ADDRESS: 6�l Sw�c Zoo CITY/ZIPCODE: c.l Cil- $ 00
*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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
D
I am not using any subcontractors: ate
ig ature
Please check applicable subcontractors and complete the following information:
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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date