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11050026 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10430 WUNDERLICH DR CONTRACTOR:ALLSTAR PLUMBING PERMIT NO: 11050026 OWNER'S NAME: LINDA LAIRD 326 PHELAN AVE DATE ISSUED:05/04/2011 ('"'VER'S PHONE: 4082217747 SAN JOSE,CA 95122 PHONE NO:(408)230-5569 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r License Class L-J 4 Lic.# 7 3 Z rc » MECH RESIDENTIAL COMMERCIAL Contractor V 1 e Y l 1 a Date JOB DESCRIPTION:REPLACE 10'OF MAIN SEWER LINE ONLY I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. *4 I hereby affirm under penalty of perjury one of the following two declarations: 1 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:$2700 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 #PSI- INA, permit is issued. APN Numbere,3417 Occupancy Type: rr X APPLICANT CERTIFICATION mri_,�,PQ 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 PERMI1 TXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS ST CALLED INSPECTION. 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 Issued Date: 9.18. y Signature Date �— ^ r / RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this 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 p Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or authorized agent: Compensation laws of California. If,after making this certificate of exemption,I Date: 7 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of wrk's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ng of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. wnn all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37517001. 00 DATE ISSUED. . . . . . . : 05/04/2011 RECEIPT #. . . . . . . . . BS000013376 REFERENCE ID # . . . : 11050026 SITE ADDRESS 10430 WUNDERLICH DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER LINDA LAIRD ADDRESS 10430 WUNDERLICH DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JAVIER ESTUDILLO CONTRACTOR . . . . . . . : DUARTE TADEV LIC # 22189 COMPANY ALLSTAR PLUMBING ADDRESS 326 PHELAN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95122 TELEPHONE . . . . . . . . : (408) 230-5569 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 700. 00 1. 00 0. 00 1 .00 0. 00 1BSEISMICR VALUATION 2, 700 .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 106 .50 0. 00 106 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 106. 50 VISA --------------- TOTAL RECEIPT 106 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING j 0 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildingQcupertino.org misc CUPERTIINO PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS A' O U.0 n DiL a-L,C� APN# /��� /� OC OWNER NAME � ri (-A -n lJ`Ca� Y-) P70% NEO 2(') - 7 2—'r E-MAIL STREET ADDRESS r? CITY, STA ZIP 7 FAX 1©�13c� tNu�Y n-✓r�cN C� .y4 %;t C14- 9S701`� CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NJ\C LICENSEE N ZR/ LICENSE TYPE BUS.j ft t COMPANY NAME E-MAIL FAX (ls YL- PLU fv) STREET ADDRESS �1 q � CITY,STATE,ZIP A / ARCHTTECT/ENGIIYHER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE SE of f SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO DESCRR'TION OF WORK TOTAL VALUATION: 2 1 0U C e By my signature below,I certify to each of the following: I am the property owner or authorized agent to act an 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 ` x. Wkuw �:- MEPMiscApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION CUADDIRESS: 10430 Wunderlich dr DATE: 05/04/2011 REVIEWED BY: Mendez BP#: 'VALUATION: $2,700 "PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPSS USE: PERMIT TYPE: WORK re PIC -exl S t�c U-4-e v 11 SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Building 1PRSEWER 1 # $21 TOTALS: $21.00 Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT Other Plumb Insp. OA hrs $42.00 NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info, FEE ITEMS (Fee Resolution 09-051 Iff 7;'1.;"10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $21.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg S€, 'tris Commission Fee: 1BCBSC $1.00 SUBTOTALS: 1 $106.501 $0.00 TOTAL FEE: 1 $106.50 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: •10 130 (-YoNv ErL is tl b e- PERMIT# OWNER'S NAME: LIND4 L t ti-9 PHONE # 0 ! 75-/- 6°`tC GENERAL CONTRACTOR: AIJSTjq& PLjfvi bi n BUSINESS LICENSE# ZZ IS 9' ADDRESS: 326 d ela"l CITY/ZIPCODE: TS 1/ Z *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 subcontractos 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