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10090012 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10640 CORDOVA RD --ONTRACTOR:SAN JOSE PLUMBING INC PERMIT NO: 10090012 OWNER'S NAME: DUNN WARREN J AND ELVIRA LTRU 1732 HILLSDALE AVE DATE ISSUED:09/02/2010 IER'S PHONE: 4082520681 3AN JOSE,CA 95124 PHONE NO:(408)296-1820 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB r License Class t. Li,# (�S MECH RESIDENTIAL COMMERCIAL Contractor- a 0ge 11 Date d JOB DESCRIPTION:NEED TO REPLACE ABOUT 160'OF WATER MAIN LINE I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions OPEN TRENCH 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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$7850 permit is issued. APPLICANT CERTIFICATION APN Number:34217052.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source gulations per the Cupertino Municipal Code,Section 9.18. `r/ � Issued bx' d� � Date: �✓��G.� Signature4f, < Date �� Li OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. 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 Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 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 permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 Owneror guth ed a en 0 I p p �1�LW �h�g� Date: � -�Z" forthwith comply with such provision or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save inify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 34217052 .00 DATE ISSUED. . . . . . . : 09/02/2010 RECEIPT #. . . . . . . . . BSC00011365 REFERENCE ID # . . . : 1OC90012 SITE ADDRESS 10(40 CORDOVA RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER DUNN WARREN J AND ELVIRA L TRU ADDRESS 10640 CORDOVA RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3912 RECEIVED FROM . . . . : SAN JOSE PLUMBING I CONTRACTOR GARZA, KEVIN N LIC # 14200 COMPANY SAN JOSE PLUMBING INC ADDRESS 17:32 HILLSDALE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95124 TELEPHONE (408) 296-1820 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ----- 1BCBSC VALUATION 7, 850. 00 1. 00 0. 00 1. 00 0 . 00 1BPWSVCS WATER SERVICE 1 .00 21 .00 0 .00 21. 00 0 .00 1PPERMITFE FLAT RATE 1. 00 42 .00 0 .00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1.00 42 . 00 0. 00 42 .00 0 .00 - --------- ---------- ---------- ---------- TOTAL PERMIT 106 .00 0 .00 106 . 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 106 .00 #19123 --------------- TOTAL RECEIPT 106 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING 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: (o 'O PERMIT# '� G�je� OWNER'S NAME: 0/ Yin PHONE # �D 2.q -182-0 GENERAL CONTRACTOR: h 1 BUSINESS LICENSE# ADDRESS: .Z /A ve' _ Q, J CITY/ZIPCODE: SojA C *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 SUBCON FACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: -- q ~, ,-% Si mature Date Please check applicable subcontractors and complete the following information: 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 D Date 2ner /Contractor Signature ��-� CITY OF C.UPERTINO �= REPIPE/SEWEZ/MAIN SERVICE CUPEkT1NO PERMIT APPLICATION FORM APN # -:�i, Date: Building Address: 1 (�L1 Q C 0,r C/o v CL 076operitno CQ Q.,r Owner's Name: Phone#: t�Ua re n 2,Y,2- Contractor: Pone#: �O it Fax #: Contact: �U l S GO`?Fa 44Z Phone#: z Q-/0 14 O Fax #: Contractor License 1. IP jvrn6 ,vi 1 C4 0-t') Cupertino Business License#: Job Description: Nee +0 )Ze-p ld Ce a b0 1 �� ' F-"--en u PY r", I C Residential Commercial ❑ Valuation: Project Size: 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& :he sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary s-wer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Ga, Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission., B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic CommfTcial P Revised 01/07/09