The URL can be used to link to this page

11010035 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10643 GASCOIGNE DR CONTRACTOR:H&H CO PERMIT NO: 11010035 OWNER'S NAME: GAYLA ALTHOFF 13990 MURPHY AVE DATE ISSUED:01/06/2011 C" NER'S PHONE: 4085823912 SAN MARTIN,CA 95046 1 PHONE NO:(408)224-7777 d LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB r License Class Lic.# :7 16-577 5 MECH r- RESIDENTIAL 1 COMMERCIAL r Contractor j/�C.. Date I hereby affirm that I am licensed under the provisions of Cl apter 9 JOB DESCRIPTION:TRENCHLESS SEWER LINE REPLACEMENT&ADD PROPERTLY (commencing with Section 7000)of Division 3 of the Business&Professions LINE CLEANOUT(60FT TO PROPERTY LINE) 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 b __ X . Section 3700 of the Labor Code,for the performance of the work for, "" t permit is issued. j `�, Sq.Ft Floor Area: %*,;V'S4580 APPLICANT CERTIFICATION Type: I certify that I have read this application and state that the abo�einforrnation is APN Nu 37 Occuarc.0 P Y yp : correct.I agree to comply with all city and county ordinancesstate 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, PERT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the 0pplicpt understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the,CCupe o Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature f Date Issued 1 Date:/—ds,—// OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) Signature of Applicant: Date: I,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: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sectio 505 23,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or t r' _ forthwith comply with such provisions or this permit shall be deemed revoked. Date•4�.1� APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby a correct.I agree to comply with all city and county ordinances and state laws relating affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, 's,and expenses which may accrue against said City in consequence of the Lender's Address k ,ting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: /t>6 y" ;.� �f;'v►c� PERMIT# { OWNER'S NAME:&,vL3 PHONE# L�$ �C GENERAL CONTRAC OR: BUSINESS LICENSE# f3-77 ADDRESS: 139CIO i✓t � CITY/ZIPCODE: /l�r{,h stile *Our municipal code requires all usinesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECT,ION(S) WIL.,L BE .SVHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SURE CTQRS HA VAIN,D 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 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10643 gascoigne dr. DATE: 01/06/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $4,580 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPSS USE: PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $21 Sewer, Building 1 PRSEWER 1 # $21 TOTALS: $42.00 l t�<h Plan t'/ir�c°h Plumb.Plan Check 0.0 hrs $0.00 Fw 1';'<�}�t h�c1c W"cil. Plumb.Permit Fee: IPPERMIT (;«-f- t't�rrrit/`11� Other Plumb Insp. 0.0 hrs $42.00 oih"'T i"IC". Li 1Ic"h. h?"p. Fac: 111"w,J,. h3"p, Ff"" Oc( ltw'). F c NOTE: Theseees are based on the preliminaryin ormation available and are onlyan estimate. Contact the De t or addn'1 info. FEE ITEMS (1W Resolution 09-051 E(f. 7/1/10) FEE QTY/FEE MISC ITEMS Plan Check F c f,. Supp/. P(`FCC PME Plan Check: $0.00 Sir/)/')/. F isp F't°< PME Unit Fee: $42.00 PME Permit Fee: $42.00 ("ons11'llcilort /t7:1 lcouslic:al Rc'i4eiv F`c Work Without Permit? 0 Yes No $0.00 Plartiib <>Fces: Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 131dy,Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $127.50 $0.00 TOTAL FEE: ` $127.50 Revised: 12/07/2010 CITY OF CUPERTINO 5 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37528018 .00 DATE ISSUED. . . . . . . : 01/06/2011 RECEIPT #. . . . . . • • • : BS000012410 REFERENCE ID # . . . : 11010035 SITE ADDRESS . . . . . : 10643 GASCOIGNE DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GAYLA ALTHOFF ADDRESS : 10643 GASCOIGNE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RODDIE INCORPORATED CONTRACTOR . . . . . . . : ROD HERRICK LIC # 22876 COMPANY H & H CO ADDRESS : 13990 MURPHY AVE CITY/STATE/ZIP . . . : SAN MARTIN, CA 95046 TELEPHONE . . . . . . . . : (408) 224-7777 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ____ --- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 4, 580 . 00 1 .00 0 . 00 1. 00 0 .00 1BSEISMICR VALUATION 4, 580 . 00 0 .50 0 .00 0 . 50 0 .00 1PPERMITFE FLAT RATE 1. 00 42 .00 0 .00 42 . 00 0 . 00 1PRSEWER UNITS 2 . 00 42 .00 0.00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1 . 00 42 .00 0 .00 -----42_00 ------ 42 . 00 ---------- ---------- TOTAL PERMIT 127 .50 0 . 00 127. 50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --- CHECK 242 .50 #9135 --------------- TOTAL RECEIPT 242 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CITY OF CUPERTINOLug f REPIPE/SEWER/MAIN SERVICE CUPERTINO PERMIT APPLICATION FORM APN# Date: 6 9 0 l Building Address: Owner's Name: Phone#: Contr ctor: I I Phone :ff v13' 6`6 Z - 3c-)IZ I Z t-I Lo�+� �� Fax#: pg - 055 Contact: Phone#: l C Fax/e-mail: Contractor License#: �-57P77> Cupertino Business License#: 712- Job 2Job Description: T(e Pq,�-k C::�-U0 1--,r VA e- AM Residential �._ Commercial ❑ C�c+�� -� Valuation: ( �� Project Size: Counter xpress ❑ 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 Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1 BPREPIPE Commercial re-pipe per fixture P 1 CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 12/06/10