Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
11050068
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10501 N PORTAL AVE CONTRACTOR:ABLE SEPTIC PERMIT NO: 11050068 OWNER'S NAME: MURRAY SCOTT&SUSAN H P O BOX 24819 DATE ISSUED:05/11/2011 OWNER'S PHONE: 4082022681 SAN JOSE,CA 95154 PHONE NO:(408)377-9990 L LICENSED CONTRACTOR'S DECLARATIONF / BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class L !q 2 Li,.# b 7 ill Ff— " MECH RESIDENTIAL COMMERCIAL Contractor fl[3L�E 4" c Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 30'SEWER LINE ADD PROPERTY LINE CLEAN (commencing with Section 7000)of Division 3 of the Business&Professions 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: Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. S LL APN Number:31630101.00 c panc ype: APPLICANT CERTIFICATION 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 PERMIT S WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN AYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence 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 Z .......__ Date: 9.18. Issued by: � ' ._._.... > _....._-�-�. Signature _C)(,_,/a Date r 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 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) 1,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 contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. 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,Sections 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 Ow or authorize agent: r� J become subject to the Worker's Compensation provisions of the Labor Code,I must ©1 C L Z Dater 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, r c '- and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION g of this permit.Additionally,the applicant understands and will comply w,..,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 CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31630101. 00 DATE ISSUED. . . . . . . : 05/11/2011 RECEIPT #. . . . . . . . . BS000013423 REFERENCE ID # . . . : 11050068 SITE ADDRESS . . . . . : 10501 N PORTAL AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : MURRAY SCOTT & SUSAN H ADDRESS . . . . . . . . . . : 10501 N PORTAL AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ABLE CONTRACTOR . . . . . . . : GILBERT, GLEN LIC # 21407 COMPANY . . . . . . . . . . : ABLE SEPTIC ADDRESS . . . . . . . . . . : P O BOX 24819 CITY/STATE/ZIP . . . : SAN JOSE, CA 95154 TELEPHONE . . . . . . . . : (408) 377-9990 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1ADMIN HOURS 0 .50 39. 00 0. 00 39.00 0. 00 1BCBSC VALUATION 2, 850 . 00 1. 00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 2, 850. 00 0.50 0. 00 0 .50 0. 00 1PPERMITFE FLAT RATE 1. 00 42 . 00 0.00 42 . 00 0 . 00 1PRSEWER UNITS 1 .00 21. 00 0 . 00 21. 00 0. 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0. 00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 145.50 0 . 00 145.50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 145.50 #16973 --------------- TOTAL RECEIPT 145 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING ( 0 -s C) v,=, � GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CU F E;htT I N O (408)777-3228 - FAX(408)777-3333•building(cDcupertino.org MISC IkPLUTyMING ❑MECHANICAL ❑ELECTRICAL ❑MISSCCELLANEOUS PROJECT ADDRESS. / APN 7 U U 1 �`U V OWNER NAME PHO okS Z E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX CONTACT NAME PHONE .. E-MAIL STREET ADDRESS ; CITY,STATE, ZIP FAX r .�i - R ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME ` ' LICENSE NUMEER LICENSE TYPE BUS.LIC H - /�, 1 CONTANY NAME 1C Z a 7 E-MAIL FAX i STREET ADDRESS CITY,STATE,ZIP PHONE`j, 6% A r VJ ARCHITECTIENOINEER NAME LICENSE NUMBER BUS.LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE -'SE OFor Duplex ❑ Multi-Family PROJECT IN W LOLAND PROJECT IN rRUC1*URE: ❑ Commercial ULAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK C12 I p �� .TOTAL VALUATION: Nasals= ' By my signature below,I certify to each of the following: 1 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 ofApplicant(Agent t Z_ Date: , SUPPLEMENTAL INFORMATION REQUIRED MEPNfucApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10501 portal ave. DATE: 05/11/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$2,850 RIPERMITTYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Du lex PENTAMATION 1 RPSS USE: p PERMIT TYPE: WORK replace 30' sewer line add property line clean out. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $21 TOTALS: $21.00 Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: 1PPERMIT Other Plumb Insp. 0.0 hrs $42.00 NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn7 info, FEE ITEMS.(Fee ee Resolution 09-051 L., 7/1.-10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $21.00 PME Permit Fee: $42.00 F71 Work Without Permit? 0 Yes (D No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strom Motion Fee: 1BSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg, Stds Commission Fee: 1BCBSC $1.00 $39.00 (ADMIN SUBTOTALS: $106.50 $39.00 TOTAL FEE: $145.50 Revised: 04/29/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 "U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Q + ""' PERMIT# � OWNER'S NAME: f PHONE#( 0 GENERAL CONTRACTOR: i L BUSINESS LICENSE# ADDRESS: Z620 J 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: Signature Date Please check applicable subcontractors and complete the following information: V 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