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13040122 CITY OF.CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10010 PHAR LAP DR` CONTRACTOR:EAGLE PLUMBING INC PERMIT NO: 13040122 OWNER'S NAME: KLINKOWSKI KENNETH AND MARIANN 3532 BOEGER LN DATE ISSUED:04/16/2013 OWNER'S PHONE:,:4084460604 SAN JOSE,CA 95148 PHONE NO:(408)270-2279 13 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL License Class Lie,.# $9:I DS COOPER RE-PIPE FROM METER&THROUGHOUT HOUSE Contractor. ]= (-):LF—: 21 �I 3 Date I hereby affirm.thatI.am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. SANITA Ry I hereby affirm under penalty of perjuryone 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 thispermit is issued. Sq.Ft Floor Area: Valuation:$6300 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 APN Number:32618035.00 Occupancy Type: 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 irtentione4 property for inspection purposes.'(We)agree to save 180 DAYS FR CALLED INSPECTION. indemnify and keep harmless the City:of Cupertino against liabilities,judgments, costs,and expe which may accrue against said City in consequence of the I Date granting opills permit. dditionally;'the applicant understands and will comply with all non point sour regulations',pgr the Cupertino Municipal Code,Section 9.18 f RE-ROOFS: Dater,= p p Y g g Signature All roofs shall be inspected prior to an roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature 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'Anicture isnot 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: - I 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 air contaminants as defined,,be y Area Air Quality Management District I performance of the work,for which this permit,is issued. will maintain compliance With the Cu ertino Municipal Code,Chapter-9.12 and. I have and will maintain Worker s Compensation Insurance,as provided for by the Health&Safety Code,S ions 50 23333;- nd 25534. Section 3'700 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 Workers Compensation provisions of the Labor Code,I must I 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. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that l have'readit�►is,apphcatiol and;state thatthe',above information is correct,I agree to comply,with all city and;countyordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter U pon thee 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 Licensed Professional 9.18. I . Signature Date n`/V ' V GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION .10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 0 CUPERT IFE© (408)777-3228• FAX(408)777-3333-buildingQCUDertino.org MISC \� PLUMBING []MECHANICAL []ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS �\ I APN,. 3 — t -9 - a 3 S OWNERNAME V ` HONE q n S © E-MAII. STREET ADDRESS CnY,MkTE,ZIP FAX �7�/� E-MAIL `t CONTACT N D C P 4b -b `13-- ''l]? �ri C7 L S ��O�• i STREET ADDRESS `. CITY,STATE,ZIP ! _ C} -,IDS FAX t ❑OWKM ❑ OWNER-BUILDER ❑ OWNERAGMIT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGAIEER ❑ DEVELOPER ❑TETAI.'T CONTRACTOR N LICENSE NUMBER LICENSE TYPE BUS.LIC# - n n COMPANYNAME G A G L 1-: L IN `-) EMAIL L E 7 N. FAX 7 STREET ADDRESS CITY,STATE,ZIP f PHONE ARCHITECT/ENGINTEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTT-FAMII.Y PROJECT IN WILDLAN 3 ❑ YES PROJECT IN ❑YES IS TIM BLDG AN ❑YES BUILDING: q COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK fJ c TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner o authorized agent to act on the prope o:;• s behalf. I have read this application and the information L' cogect. I have read the Description of\Mork and verify it is accurate. I agree to com�ly with all applicable local ordinances and state laws relatita tp ui] g ctit oti':I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofAppkaiWAgent:--", Date: `7 16 - Z3 SUPPLEMEAL INFORMATION REQUIRED OFFICE USE ONLY OVER-THE-COUNTER ❑ EXPRESS U ❑ STANDARD U ❑ LARGE ❑ MAJOR MEPMiscApp_2011.doc revised 06121/11 $178.63 $0.00 -- $178.63 Revised: 04/01/2013 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10010 PHAR LAP DR DATE: 04/16/2013 REVIEWED BY: MELISSA APN: 326.18 035 BP#: *VALUATION: $6,300 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair USE: PERMIT SFD or Duplex PENTAMATION PERMIT TYPE: 1 RPD WORK COOPER RE-PIPE FROM METER&THROUGHOUT HOUSE SCOPE APPLIANCE I EQUIP TYPE FEE ID QTY UNITS BP FEES Piping,Area 1PREPPIPE 1 # $45 TOTALS: $45.00 )kfech.Ilan Check' Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check kfecb:.Pc:rnait Fee; Plumb.Permit Fee: IPPERMIT Flee.Permit Fee: Other A1eeh.'Insp... Other Plumb Insp. 0.0 hrs $45.00 Other Elec.Imp. 1�ch InsP.,Fee Plumb.Insp.Fee: Elec.Insp.Fee., NOTE:This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School District, 'etc.). These ees are based on the relimina in ormation available and are onl an estimates Contact the Dept or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7ff 11112) FEE QTY/FEE MISC ITEMS Plan Check Fee: SuPPI. PC Fee PME Plan Check: $0.00 Porrnit.F'ee: suppl. lnsP Fee PME Unit Fee: $45.00 PME Permit Fee: $45.00 C,r�nattzictaon Tcrr: Administrative Fee: IADMIN $42.00 Work Without Permit. O Yes (j) No $0.00_ advanced Planning Fees. Travel Documentation Fee:: ITRAVDOC $45.00 i Strom.M.otion Fee: IBSEISMICR $0.63 Select an Administrative Item Bldg StdsCommissiorFee: IBCBSC $1.00 rim $178.631 $0.00 _ x $178.63 Revised: 04/01/2013