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10060155 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10460 TULA LN CONTRACTOR:EAGLE PLUMBING INC PERMIT NO: 10060155 OWNER'S NAME: TOM TANIGUCHI 544 HASSINGER RD DATE ISSUED:06/23/2010 NNER'S PHONE: 4082852431 SAN JOSE,CA 95111 PHONE NO:(408)281-0583 JZ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTI;k COMMERCIAL License Class Lic.4 REPLACE 1" WATER MAIN FROM METER TO HOUSE Contractor L=lib jam& —Date b- ,4:3-- I - ,4:3I hereby affirm that I am licensed under the provisions of Chapter 9 4 (commencing with Section 7000)of Division 3 of the Business&Professions Ar_ Code and that my license is in full force and effect. ANI a' 1 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.Ft Floor Area: Valuation:$4900 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 for which this %PN Number:35913084.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 94 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 INSPE TION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and exp ich may accrue against said City in consequence of the granting of is permit.Vdditionally,the applicant understands and will comply Issued by: Date: ✓ with all n -point sourc regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: SDate 0 10 411 roofs shall be inspected prior to any roofing material being installed. If a roof is f nstalled without first obtaining an inspection,I agree to remove all new materials for nspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain 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 material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the rir contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. All maintain compliance with a ertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by he Health&Safety Code,S s• 55_33`and 25534. Section 3700 of the Labor Code,for the performance of the work for which this 4 permit is issued owner or authorized agent.- - Date: 3–o)DI 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must 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. vork's for which this permit is issued(Sec.3097,Civ C.) �ender's Name APPLICANT CERTIFICATION ender's Address 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 iemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ,sts,and expenses which may accrue against said City in consequence of the 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 icensed Professional 9.18. Signature Date CITY OF CUPERTINO 4 ITEMS OF 12 PERMIT RECEIPT OPERATOR: SylviaM COPY # : 1 Sec: Twp: Rng: Sub: Blk: :jot: APN 35913 )84 . 00 DATE ISSUED. . . . . . . : 06/23 /2010 RECEIPT # . . . . . . . . . BS000310702 REFERENCE ID # 10060155 SITE ADDRESS 10460 TULA LN SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER TOM ZANIGUCHI ADDRESS 1046C TULA LN CITY/STATE/ZIP CUPEF.TINO, CA 95014-2936 RECEIVED FROM EAGLE PLUMBING CO CONTRACTOR RODR-:GO ARZATE LIC # 25400 COMPANY EAGLE PLUMBING INC ADDRESS 544 IASSINGER RD CITY/STATE/ZIP SAN JOSE, CA 95111 TELEPHONE (408 281-0583 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC -NEW-BAL- ___ ---- ---------- 1 . 00 0 . 00 1 . 00 21 . 00 0 . 00 21 . 00 0 . 00 1BCBSC VALUATION 4, 900 . . 1. 00 0 . 00 1BPWSVCS WATER SERVICE 0 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00 1 . 00 42 . 00 0 . 00 42 . 00 -- -- 0_00 1TRAVDOC FLAT RATE ---------- ---------- ---------- TOTAL PERMIT : 106 . 00 0 . 00 106 . 00 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ----- _ - ------ --------- --------- - -- -------- __ 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING Building Department City Of Cupertino LM 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: PERMIT# f OWNER'S NAME: PHONE # 0 GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: ' 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 U ONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. Cl ._ I am not using any subcontractors:------`"- --' rrM 6 -513 - °9010 Signatuj•e 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 - 33 - (9-010 0w r/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10460 tula lane DATE: 06/23/2010 REVIEWED BY: building APN: BP#: R�PERMIT *VALUATION: $4,900 11 TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair TION PRIMARY r F =1 APPLICA USE: SFD or Duplex �.t��t;tz .s �z:,f TYPE: �4w as 3 � APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES Water Service 1 BPWSvc;S 1 $21 TOTALS: $21.00 Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $42.00 T --1 NOTE: These fees are based on the preliminary in ormation avaijable and are on1v an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 09-051 Eff 7"T."09) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $21.00 PME Permit Fee: $42.00 Travel Documentation Fee: ITRA VDOC $42.0 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $106.01 $0.00 TOTAL FEE. $106.00 Revised: 5/27/2010 CITY OF CU.PERTINO REP IPE/SEWER/MAIN SERVICE CITY OF CUPEkT1NO PERMIT APPLICNTION FORM APN # 3550 Date: L' J V a3 - aoiD Building Address: , I ! Owner's Name: Phone#- (—q - Asa - 313 Contractor: Phone#: (q ")6 ) L,AG �. � P � � M6jNG Fax #: r -dq3,5 Contact: Phone#: (:�0 S) U 9 3 -?y 7 Fax#: Contractor Licens #: f ll60x Cupertino Business License#: a 5 Job Description: J Residential ,� Corunercial ❑ Valuatio � C)O Project Size: Express 0 StandardZ Large ❑ Major Green Building: Please complete relevant portion of tb a 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 ICPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P ICPRP 1PGASCOM Commercial Gas Pip ng System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CITY OF CIUPERTINO REPIPE/SEWER/MAIN SERVICE FEE SCF[EDULE CUPERTINO Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary se 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage DiEposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+Outlets P I 1 PPERIVIITFEE Plumbing Permit F-,e Issuance P 1 PLMBLNCK Plumbing Plan Che ck P 1PLMBINSP Other Plumbing/ga3 Insp. P 1 TRAVDOC Travel &Documer.tation Fee B 1 BUSLIC Business License B