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11080209CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10381 MEADOW PL CONTRACTOR: SAN JOSE PLUMBING INC PERMIT NO: 11080209 OWNER'S NAME: LOUGHLIN J GORDON& CAROL TRUST 19970 MCKEAN RD DATE ISSUED: 08/29/2011 OWNER'S PHONE: 4083953556 SAN JOSE, CA 95120 PHONE NO: (408)296-1820 L. LIC{EENSED CONTRACTOR'S DECLARATION License Class✓Lic. Contractor Date I hereby affirm that I am licensed under t provisi ns of C apter 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. 1 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 permit is issued. APPLICANT CERTIFICATION 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18�ure Sig / —�� Dat9 %4� �4 f OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 Section 3700 of the Labor Code, for the performance of the work for which this 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, c, — and expenses which may accrue against said City in consequence of the ig of this permit. Additionally, the applicant understands and will comply w.... all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date BUILDING PERMIT INFO: BLDG I— ELECT r– PLUMB MECH F_ RESIDENTIAL r– COMMERCIAL f— JOB DESCRIPTION: DUPLEX(A&B)- COPPER REPIPE FROM METER Sq. Ft Floor Area: I Valuation: $13400 APN Number: 34229019.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued k Date: �Zp,G RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 Health & Safety Code, Sections 25505, 25533, and 25534. agent: � Dat j_l,:�9 //I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of mrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professiona CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408):777-3228 - FAX (408) 777-3333 - buildingCcDcupertino.org 7 NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROTECT ADDRESS �J/ Y APN #C� , [ /7 OWNER NAMED f PHO } E-MAIL O ( r` STREET ADDRES 71, CITY, STATE, ZIP FAX CONTACT N PHO E E-MAIL a Y' D STREET ADDRESS CITY ATE, EIP—AFAX � Q gc� 6 - C] OWNER ❑ OWNER -BUILDER ❑OWNER AGENTCONTRACTOR ❑ CONTRACTOR AGENT 1:1 ARCHITECT 13 ENGINEER 11 DEVELOPER ❑TENANT CONTRACTOR NAME LI S ER LICENS BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS ZI�o1_ H e ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE N DESCRIPTION OF WORK r L EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (5) ARE AEA 0 R DEMO AREA fOTAL NEI' AREA// A E� UQ �OR !Jv BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION ❑ YFS IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REBY- TOTAL VALUATION: PLANNING APPL # ONO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO71 - D V By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the p ,9perty owner's behalf. I have read this application and the information I have .ded is correct. I have read the Description of Work and verify it is accurate. I a ee to c ly with all applicable local ordinances and state laws relati buil g co truc ' authorize representatives of Cupertino to enter the ab id tified p erty for inspection purposes. Signature of ApplicandAge t: !/ b Date: SUPPLE AL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP OVER_THE-coUNT ER Tr sUII DING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPREss ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUSLIC 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. ❑ ENVIRONMENTAL HEALTH Bldg 4pp_2011.doc revised 06/21/11 -�� CITY OF CUPERTINO FF.F. FSTIMATOR — BUILDING DIVISION im,ADDRESS: 10381 meadow pl. DATE: 08/29/2011 REVIEWED BY: bobs. UNITS APN: BP#: VALUATION: 1$13,400 —� ,-PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION 1 RPWS PERMIT TYPE: WORK sfd re -pipe, no fixtures relace water main. SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Water Service 1 BPWSVCS 1 # $22 Piping, Area 1PREPPIPE 1 # $44 PME Unit Fee: $66.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes No $0.00 TOTALS: A Travel Documentation Fee: ITRA VDOC $66.00 Strong Motion Fee: ]BSEISM[CR Plumb. Plan Check 10.0 1 hrs $0.00 Plumb. Permit Fee: IPPERMIT Other Plumb Insp. 1 0.0 1 hrs 1 $44.00 7VnTC. TL. nen fnn n /%Dani/ — ihnroiimi""ry i"Mrmnhnn mwitni/i0 a"d nr0 nn1v an e.Q unite_ 1-nntart the Dent for Qddn 7 info. FEE ITEMS ('ee Resolution 11-053 Lff.. ';'1.;111 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $66.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes No $0.00 A Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: ]BSEISM[CR $1.34 0.5 hrs Admin./Clerical Fee $41.00 ]ADMIN Bldg Stds Commission Fee: ]BCBSC $1.00 SUBTOTALS: $156.34 $41.00 TOTAL FEE: $197.34 Revised: 07/04/2011 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: too PERMIT # Z62 OWNER'S NAME: 4-L'. PHONE # 7 GENERAL CONTRACT � ,,, ti BUSINESS LICENSE # ADDRESS: 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 subcontract rs: — i Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date 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