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11030001CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10421 CORTE DE SEVILLE CONTRACTOR: PARKER PERMIT NO: 11030001 PLUMBING OWNER'S NAME: SYLVIA GALLEGOS 24 CHELTENHAM WAY DATE ISSUED: 03/01/2011 !NER'S PHONE: 4083741832 SAN JOSE, CA 95139 PHONE NO: (408)374-1832 ❑ LICENSED CONTRACTOR'S DECLARATION License Class f_—(16 /Lic. #_ Contractor 2 'G[�Md11g Date L1 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. 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 forwhit is permit is issued. 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 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. Signatures/,%�'! / LADate 'l "// LJ 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) I, 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 BUILDING PERMIT INFO: BLDG ELECT PLUMB f— I— F_ MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: NEW WATER SERVICE Sq. Ft Floor Area: I Valuation: $1500 APN Number: 3750501 1.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAY-S-OEFPERMIT ISSUANCE OR 180 DAYS FR, OIV�I ST CALLED INSPE TON. f Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any rooting 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 1 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 2. 505, "3, and 25534. Owner or authorized agent: �9 Date CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I mustI 1 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 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 -.mnify and keep harmless the City of Cupertino against liabilities, judgments, is, 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. Signature Date Lender's Add ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Profess CITY OF CUPERTINO No FEE ESTIMATOR -BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10421 corte de seville DATE: 03/01/2011 REVIEWED BY: bobs. UNITS APN: BP#: *VALUATION: 1$1,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex 7 # PENTAMATION 1 PERMIT TYPE: 1 RPW ; WORK +g -, L, t,ei'+.'C �.:t� i P'— SCOPE slippl, hisi") FCC APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check 0.0 1 hrs $0.00 QTY UNITS BP FEES Water Service 1 BPWSVCS of hc,�l1;r<�.)1t�rp. 1 # $21 Pc°r init FCC' slippl, hisi") FCC T PME Unit Fee: $21.00 PME Permit Fee: $42.00 L ;112,51 °tfC'fiC)11 /7f.t. Icou')Iical /il'ricw Work Without Permit? 0 Yes E) No $0.00 TOTALS: A Travel Documentation Fee: ITRA VDOC $21.00 Strong Motion Fee: IBSEISMICR NnTF- These fens are ha.ced an the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 09-05I Elf. 7i1110Z FEE Plumb. Plan Check 0.0 1 hrs $0.00 r,%��<�. t i�-ztz <���'c k hil, C'r'tcf 1, c�: Phil, Plumb. Permit Fee: 1PPERMIT eft Other Plumb Insp. 0.0 hrs $42.00 of hc,�l1;r<�.)1t�rp. �1 It',(h JJi ti'Il. 1`�-v. PME Plan Check: $0.00 NnTF- These fens are ha.ced an the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 09-05I Elf. 7i1110Z FEE QTY/FEE MISC ITEMS hil, C'r'tcf 1, c�: Phil, upp/. PC Fec F—] PME Plan Check: $0.00 Pc°r init FCC' slippl, hisi") FCC T PME Unit Fee: $21.00 PME Permit Fee: $42.00 L ;112,51 °tfC'fiC)11 /7f.t. Icou')Iical /il'ricw Work Without Permit? 0 Yes E) No $0.00 Ph,11111i17 r FCC A Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldp Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $106.50 $0.00 TOTAL FEE:, $106.50 Revised: 01/15/2011 CITY OF CITY OF CUPERTINO 191 REPIPE/SEWER/MAIN SERVICE CUPERTINO PERMIT APPLICATION FORM /0-5000 l APN # 3-75r. 05- O //.0C— Date: Fee Description Fee Group Building Address: 1PCSEWER Commercial building sewer/sanitary sewer P 1CPSS Owner's Name: r Phone #: Aef --�y Contractor: Phone #: z-10 4 rt Fax #: Contact: Phone #:4r©.0 ., IK'� .�-- .. /,c Fax/e-mail: Contractor License #: (',3 t✓,5O 4 B Cupertino Business License #: Job Description: e j 1, w L,,o«� ez Se- 2,v1G r_ Seismic Commercial Residential 2K] Commercial ❑ Valuation: Project Size: Counter f2] Express ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points: ,. Quantity , Fee ID Fee Description Fee Group Permit Type 1PCSEWER Commercial building sewer/sanitary sewer P 1CPSS 1 BPREPIPE Commercial re -pipe per fixture P 1 CPRP 1PGASCOM Commercial Gas Piping System 1-4 Outlets P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICOM Seismic Commercial P Revised 12/06/10