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11080032 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10249 AINSWORTH DR CONTRACTOR:GOGO ROOTER PERMIT NO: 11080032 OWNER'S NAME: MITCHELL LUANA H 2530 BERRYESSA RD STE 509 DATE ISSUED:08/03/2011 r NER'S PHONE: 4085940626 SAN JOSE,CA 95132 PHONE NO:(408)282-7026 L LICENSED CONTRACTOR'S DECLARATION r— r F_ �,77 G2 G� �^` BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class L7 Lic.# ! l I v3 �/ f— I— r ,,+ - �p MECH RESIDENTIAL COMMERCIAL Contractor ��t Tc4d e"1 Date 'n /� / ' I I hereby affarm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: COPPER RE-PIPE (commeneft 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:$7200 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 whic his APN Number:32613131.00 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 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 F�OM LAST CALLED INSP C ION. 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 and will comply Issued by: �R1_ Date: with all non-point source regulations per the Cupertino Municipal Code,Section l/ 9.18. RE-ROOFS: Signature �i� 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 lj inspection. 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 the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Owner or authorized agent r Section 3700 of the Labor Code,for the performance of the work for which this L�� - Date: /� 1 permit is issued. _ I certify that in the performance of the work for which this permit is issued,I shall G 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 CONSTRUCTION LENDING AGENCY, become subject to the Worker's Compensation provisions of the Labor Code,I must I 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 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, :ts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. .nting of this permit.Additionally,the applicant understands and will comply .aith all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32613131 . 00 DATE ISSUED. . . . . . . : 08/03/2011 RECEIPT #. . . . . . . . . : BS000014294 REFERENCE ID ## . . . : 11080032 SITE ADDRESS 10249 AINSWORTH DR SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . OWNER MITCHELL LUANA H ADDRESS 10249 AINSWORTH DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1001 RECEIVED FROM . . . . : JEFF GARCIA CONTRACTOR . . . . . . . : DUARTE TADEU LIC # 28801 COMPANY . . . . . . . . . . : GOGO ROOTER ADDRESS . . . . . . . . . . : 2530 BERRYESSA RD STE 509 CITY/STATE/ZIP . . . : SAN JOSE, CA 95132 TELEPHONE . . . . . . . . : (408) 282-7026 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- lADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00 1BCBSC VALUATION 7, 200 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 7, 200 . 00 0 . 72 0 . 00 0 . 72 0 . 00 1PPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 1PRREPIPE NO OF FIXTURE 1 . 00 12 . 00 0 . 00 12 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 142 . 72 0 . 00 142 . 72 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 142 . 72 visa --------------- TOTAL RECEIPT 142 . 72 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CU P E RTI NO (408)777-3228 - FAX(408)777-3333 - buildinq(acupertino.orq l� 00 ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERNIIT# PRO.IECT ADDRESS boa�� /- A1111$ OWNER NAME /0 U /vI<r f� PHONE( / / V/�y E-MAIL STREETADDRESS x 61110 f _ CITY, STATEI l./ q) "l FAX CONTACT NAME PHONE 1 E-MAIL �v1/l►i !Ft✓I d�Quo v,\ 2 q a—702 Co' STREET ADDRESS CITY,STATE, ZIP FAX 3 7 (p,► A-i/ S a i�-To�e , °l n 2 I ❑OWNER 11 OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR M1C0_ RACrORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT J CONTRACTOR NAME 6 O 6o 12 w'/ (- I LICETjSE NUMBF,$.&� LIC IS ➢YPE BUS.LIC O COMPANY NAME L , E-MAIL FAX STREET ADDRESS / CITY, "ATE,ZIP P , 3d & io�e(u Ave I 'a V1Tos{, rf- 9�/Z I I OO)Zee2-70U ARCHITECT/ENGINEER NAME I LICENSE NUMBER I BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 'SSCRIPTION OF WORK r T EXISTING USE PROPOSED USE CONSTR.TYPE I #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA I TOTAL DECKIPORCH AREA I GARAGE AREA: �DETACH #DWELLING UN= IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY- TOTAL VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO I —2 ^ �0`0 c / L 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 building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. Cl memss ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVMONNMYTAL HEALTH BldgApp_2011.doc revised 06121111 Building Department City Of Cupertino is 10300 Torre Avenue Cupertino, CA 95014-3255 C U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: q y �,`�s a-�[� C PERMIT# 1l o �OU,32 OWNER'S NAME: /,,,4 Gil, 1,�1� PHONE# GENERAL CONTRACTOR: �C �� vcPr _ BUSINESS LICENSE_# _ ADDRESS: f"a,,,,,e CITY/ZIPCODE: *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. I am not using any subcontractors: IV5 Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation i 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 O /Contractor Signature Date