10080027CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1141 YORKSHIRE DR
CONTRACTOR: REPIPE 1
PERMIT NO: 10080027
OWNER'S NAME: ELENA V DORABJI
23619 CALABASAS RD STE 691
DATE ISSUED: 08/03/2010
OWNER'S PHONE: 4087258843
CALABASAS, CA 91302
PHONE NO: (818) 533-1778
❑ LICENSED CONTRACTOR'S DECLARATIONr
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BUIL DING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#r
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB 3ESCRIPTION: COPPER REPIPE
**SEI; NOTES**
(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.
Sq. F t Floor Area:
Valuation: $5000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36207019.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date:
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.
RE -ROOFS:
Signature Date
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
inspe -,tion.
❑ OWNER -BUILDER DECLARATION
Signs lure of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I hai a read the hazardous materials requirements under Chapter 6.95 of the
Cali] ornia Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
mair tain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
mate rial. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air c )ntaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will inaintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the I lealth & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:
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
CONSTRUCTION LENDING AGENCY
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
I her ;by 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
Lender's Address
I certify that I have read this application and state that the above information is
correct. 1 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Lice ised Professional
9.18.
Signature Date
CITY OF CUl'ERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS:
FEE ID
DATE:
REVIEWED BY:
BP FEES
APN:
BP#:
*VALUATION: 1$5,000
PERMIT TYPE: Plumbing Permit
1
PLAN CE ECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE: p
,r)7,i1:
V/001", RI_ -i:
APPLICATION 1RPRP
TYPE:
04 00.
$11.00
PME Permit Fee:
3U
_F_T
APPLIANCE / EQUIP TYPE
CAPACITY
FEE ID
QTY
BP FEES
Re -Pipe Interior
1PRREPIPE:
1
PME Plan Check:
$11
PME Unit Fee:
$11.00
PME Permit Fee:
$42.00
_F_T
Work Without Permit? Q Yes E) No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$11.00
{
Plumb. Plan Check 0.0 hrs $0.00
Plumb. Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 Thrs $42.00
Bldg, Stds Commission Fee: IBCBSC
NOTE: These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn 7 info.
FEE ITEMS (Fee Resolution 09-051 E11,'7,,,'1,`09)
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
PME Unit Fee:
$11.00
PME Permit Fee:
$42.00
_F_T
Work Without Permit? Q Yes E) No
$0.00
Travel Documentation Fee: ITRAVDOC
$42.00
Select an Administrative Item
Bldg, Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$96.00
$0.00 TOTAL FEE:
$96.00
Revised: 7/27/2010
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CrfY OF CIUPERTINO
REPIPE/SEN RMAIN SERVICE
PERMIT APPLICATION FORM
APN # CN � (L
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Fee ID
Date -
,Fee
Cron
Permit Typo
Bail AA,ddtess:
Vfwm% Lo(,&
Commercial buildi 4
sewer/sanitary sew Jr
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Owner's Name;
Phone #: rj 7
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Co raclb •
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phone#: 1d6 4,1
ICPRP
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Fax #:
Contact:. �
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1BCBSC
Cal Bldg Standard: Commissim
Fee
B
ALL ,PERMU
TYPES
Cupertino Business Iaceose
Seismic Commezci 4
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Job Description: () g7 P Cie`
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Residential
C immercial ❑
valuaty, �
Pr;qedgize:Pre8St lord Large ET Major
Green Building: Pic complcte relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in pbu set & .the sheet index.
Green Huildiui Paints:
Quautity
Fee ID
Fee Desciaptior.
,Fee
Cron
Permit Typo
IPCSEWER
Commercial buildi 4
sewer/sanitary sew Jr
P
WPM
IBPREPIPE
Commercial rex-pip, per fimum
P
ICPRP
1PGASCOM
commercial Gas P.ping System
1-4 Oattets
P
1BCBSC
Cal Bldg Standard: Commissim
Fee
B
ALL ,PERMU
TYPES
IBSELSMICOM
Seismic Commezci 4
P
Remised 01/07/09
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