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10040095CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21580 EDWARD WAY CONTRACTOR: GREAT AMERICAN PERMIT NO: 10040095 PLUMBING CO INC 'NER'S NAME: BEYDA WILLIAM J AND CATHY S P O BOX 26942 DATE ISSUED: 04/15/2010 OWNER'S PHONE: 4089738215 SAN JOSE, CA 95159 PHONE NO: (408)279-1515 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r— PLUMB License Class C-3 Lic. # SD tin COMMERCIAL I— MECH RESIDENTIAL n Contractor �12b'Q'14r�G2[G9^, NtrGttlt%!/11 to Lf —Ig—I d I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE APPRX 20FT OF KITCHEN WASTE LINE UNDER (commencing with Section 7000) of Division 3 of the Business & Professions HOUSE Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: to self -insure for Worker's 't I have and will maintain a certificate of consent Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. TIN Sq. Ft Floor Area: +, aldtion: $2100 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 " + t permit is issued. APN Number: 35CI80 7.00`;,, Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We) agree to save 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 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally, the applicant understands and will comply with all non- oint source regulations per the Cupertino Municipal Code, Section _ ' 9.18. Issued by:, `�`J�'— Date: i c' - Date f! f �� atur ❑ OWNER -BUILDER DECLARATION RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection, I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER construct the project (Sec.7044, Business & Professions Code). HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the Compensation, as provided for by Section 3700 of the Labor Code, for the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I have and will maintain Worker's Compensation Insurance, as provided for by Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code, for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued, I shall Health & Safety Code, Sections 25505, 25533, and 25534. 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, IO er r a rize ge Date:44— LlJ become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued (Sec. 3097, Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction, and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes. (We) agree to save Lender's Address .mify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit. Additionally, the applicant understands and will comply with all non om source regulations per the Cupertino Municipal Code, Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signatu Date NIM 5 ITEMS OF 5 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35618017.00 DATE ISSUED.......: 04/15/2010 RECEIPT #........-: BS000010194 REFERENCE ID # ...: 10040095 SITE ADDRESS .....: 21580 EDWARD WAY SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER BEYDA WILLIAM J AND CATHY S ADDRESS 21580 EDWARD WAY CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4765 RECEIVED FROM ....: THE GREAT AMERICAN CONTRACTOR CORPORATION LIC # 18061 COMPANY GREAT AMERICAN PLUMBING CO INC ADDRESS P O BOX 26942 CITY/STATE/ZIP ...: SAN JOSE, CA 95159 TELEPHONE (408)279-1515 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC -------------------- NEW BAL ---------- 1BCBSC ------------- VALUATION ---------- 2,100.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 2,100.00 0.50 0.00 0.50 0.00 1PPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1PRSEWER UNITS 1.00 21.00 0.00 21.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 106.50 ---------- 0.00 106.50 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 106.50 --------------- 106.50 VOICE ID DESCRIPTION -------- ---------------------------- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING REFERENCE NUMBER -------------------- #114295 VOICE ID DESCRIPTION -------- ---------------------------- 202 UNDERFLOOR PLUMBING 400 SEWER/LATERAL �-' alill CITY OF CUPEkTINO CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE PERMIT APPLICATION FORM N `4v� APN # i � , --- � � Date: Fee Description Fee Group Building Address: a1S E�w�2.b w Owner's Narry�:C L /1. rr�� Phone #: q73 - �a 1 Contractor: Phone #: ;7 1 -1 S/ S� Fax #: o2'7'i -1 4a3 Contact: Phone #: 1CPRP Fax #: Contractor License #: �j Q Commercial Gas Piping System 1-4 Outlets Cupertino Business License #: PESQ Job Description: p�L►� c � i4�o x o'�U �f' ��' �� TG's roc/ t>v.��s�� ✓�� VALIP Ot PGuSC Cal Bldg Standards Commission Fee Residential ' K Commercial ❑ Valuation: U v Project Size: Express Standard Large Major Seismic Commercial 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 11CPSS 1BPREPIPE Commercial re -pipe per fixture P 1CPRP 1 PGASCOM Commercial Gas Piping System 1-4 Outlets P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 -� CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPERTiNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential P i• 1PRSEWER Residential building sewer/sanitary sewer P 1RPSS 1 PRREPIPE Residential re -pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System 1-4 Outlets P 1 BPGAS Gas Piping System 5+ Outlets P 1 PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P l 1TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B