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10010140 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10125 POTTERS HATCH CONTRACTOR:SAN JOSE PLUMBING INC PERMIT NO: 10010140 rv NER'S NAME: DAVID HUNT 1732 HILLSDALE AVE DATE ISSUED:01/26/2010 NER'S PHONE: 4085170416 SAN JOSE,CA 95124 PHONE NO:(408)296-1820 ❑ LICENSED CONTRACTOR'S DECLARATION F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# �` MECH F RESIDENTIAL F COMMERCIAL Contractor ' Date I hereby affirm that I am licensed under t rovisions of Chapter 9 JOB DESCRIPTION:WHOLE HOUSE COPPER REPIPE FROM FOUNDATION VALVE (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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq,Ft Floor Area: Valuation:$8425 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:34235047.00 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-point source regulations per the Cupertino Municipal Code,Section _.__._.. Datv,_ 9.18. / Issued by. Siguure Da V 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) I,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). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE 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. I 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,I f)`l_ u t h �* a gent: a become subject to the Worker's Compensation provisions of the Labor Code,I m t Date: 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 upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address i• unify and keep harmless the City of Cupertino against liabilities,judgments, t. 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-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional S ign2lfure Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34235047.00 DATE ISSUED. . . . . . . : 01/26/2010 RECEIPT #. . . . . . . . . : BS000009617 REFERENCE ID # . . . : 10010140 SITE ADDRESS . . . . . : 10125 POTTERS HATCH SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER DAVID HUNT ADDRESS . . . . . . . . . . : 1025 POTTERS HATCH CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2654 RECEIVED FROM . . . . : DAVID PLEMONS CONTRACTOR . . . . . . . : GARZA, KEVIN N LIC # 14200 COMPANY . . . . . . . . . . : SAN JOSE PLUMBING INC ADDRESS . . . . . . . . . . : 1732 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 8,425 . 00 1. 00 0 . 00 1 . 00 0.00 1BPWATER UNIT 1 .00 42 . 00 0 . 00 42 . 00 0. 00 1BSEISMICR VALUATION 8,425 . 00 0 . 90 0 .00 0 . 90 0. 00 1PPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1PRREPIPE NO OF FIXTURE 12 . 00 132 . 00 0 . 00 132 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 217 . 90 0 . 00 217 . 90 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------- CREDIT CARD 217 . 90 VISA --------------- TOTAL RECEIPT 217 . 90 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ----- 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPS OF PERMIT APPLICATION FORM APN # -,+ Date: If 2, Building Address: Owner's Name: Phone#: 4� ice. 7 Contractor: Phone#: Fax #: 2 C'- Contact: _ Phone#: 1-7 Fax#: Contractor Qricense#: Cupertino Business License#: Job Description: /Z ( - Residential , Commercial ❑ Valuation: Project Size: Expre Standard ❑ Large ❑ Major El 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 Permit Type Group 1 PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1 PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1 BSEISMICOM Seismic Commercial P Revised 01/07/09 NCITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPS OF FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Grou 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1 BSEISMICR Seismic Residential P 1 PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1 PRREPIPE Residential re-pipe per fixture P 1RPRP 1 BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P 1 BPWATER 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 / 1 PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P 1 TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 NN W-12K Telephone(408)777-3228 No CITY O1Fax(408)777-3333 XPEkTINO Building Depart ent JOB AD KESS: PERMIT # OWNER'S NAME PHONE"# , , 2c) GENERAL CONT CTOR: ;,, FAX # any I am not usingsubcontract rs: C:7 Signature Date Please check applicable subcontractors and complete the following information: Fa SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date