The URL can be used to link to this page

09110129 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10381 MALVERN CT CONTRACTOR:AQUA FLOW PLUMBING PERMIT NO:09110129 OWNER'S NAME: MIKE RINGER 565 N 6TH ST DATE ISSUED: 11/23/2009 ER'S PHONE: 4084022388 SAN JOSE,CA 95112 PHONE NO:(408)265-9504 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT PLUMB License Class — Lic.# MECH r— RESIDENTIAL r— COMMERCIAL Contractor A Q f Pte_Date I hereby affirm that I am licensed under the.rovisions of�Chapter 9 JOB DESCRIPTION:COPPER REPIPE HOME&WATER SERVICE TO METER, (commencing with Section 7000)of Division 3 of the Business&Professions PARTIAL REPLACEMENT OF KITCHEN&LAUNDRY DRAIN. INSTALL NEW WATER HEATER Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1 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. 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 Sq.Ft Floor Area: Valuation:$1500 permit is issued. APPLICANT CERTIFICATION APN Number:36912026.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the li nt understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-poi so ce regulatio p r tl�e 4 ertino Municipal Code,Section 9.18. / Issued by:-" ��-i�� - Date://l 5,-L Signature to 41 r Q G OWNER-BUILDER DECLARATION ,l RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the stricture is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to constrict the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 1 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 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 Own ' th i agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: (CO&STRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a constriction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save i• nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Add;ess C. and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 10 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36912026 . 00 DATE ISSUED. . . . . . . : 11/23/2009 RECEIPT #. . . . . . . . . : BS000009257 REFERENCE ID # . . . : 09110129 SITE ADDRESS . . . . . : 10381 MALVERN CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER MIKE RINGER ADDRESS . . . . . . . . . . : 10381 MALVERN CT CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4526 RECEIVED FROM . . . . : AQUA FLOW PLUMBING CONTRACTOR . . . . . . . : GREGG, DAVID LIC # 21162 COMPANY . . . . . . . . . . : AQUA FLOW PLUMBING ADDRESS 565 N 6TH ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 265-9504 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 500 . 00 1. 00 0. 00 1 . 00 0 . 00 1BPWATER UNIT 1. 00 42 . 00 0. 00 42 . 00 0 . 00 1BPWSVCS WATER SERVICE 1. 00 21 . 00 0. 00 21. 00 0 . 00 1BSEISMICR VALUATION 1, 500. 00 0 .50 0. 00 0 . 50 0 . 00 1BUSLIC FLAT RATE 1. 00 114 . 00 0. 00 114 . 00 0 . 00 1PPERMITFE FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0 . 00 1PRREPIPE NO OF FIXTURE 8 . 00 88 . 00 0 . 00 88 . 00 0 .00 1PRSEWER UNITS 1 . 00 21 . 00 0 . 00 21. 00 0 .00 1PRWHEATR UNITS 1. 00 25 . 00 0 . 00 25. 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 .00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 396 .50 0 . 00 396 .50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 396 .50 #3664 --------------- TOTAL RECEIPT 396 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO ' REPIPE/SEWER/MAIN SERVICE CUPE�TiNO PERMIT APPLICATION FORM APN # Date: � :�(0 C? o �P U Building Address: i �UCA oiw Owner's Name: Phone#• Contractor: Phone#: cy _ Z S_ S�y A F Fax #: Contact: Phone Fax #: Contractor License#: Z-�0 sa Cupertino Business License#: Job Description: C)Ppe 0 ol P- (-Q- 0' M 0(-Q vylp- lv� (J-� /Z-4 ChP LA i)V �-1 1 -9) A A)k [ q P Residential ;4,— Commercia ❑ Valuation• Project Size: xpress Standar Large ❑ Major 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 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping 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 CUPERTINO REPIPE/SEWER/1VIAIN SERVICE CITY of CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Grou 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential p / 1PRSEWER Residential building P 1RPSS / sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or IPPRSEWG Private Sewage Disposal System P 1RPWS I PCESS Cesspool p 1 BPWATER Install/alter Water Pipe p 1 BPFIXTURE Plumbing Fixture p IP ASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P ` IPPERMITFEE Plumbing Permit Fee Issuance P IP qBLNCK Plumbing Plan Check p I PLMBINSP Other Plumbing/gas Insp. p 1TRAVDOC Travel & Documentation Fee B I BUSLIC Business License B 13 w �� Community Development \ 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .:UPEkTINO Building Department JOB ADDRESS: MCI ^��fT � PERMIT # OWNER'S NAME: i`�I v 4' r PHONE # 0 7 tv GENERAL CONTRACTOR: r ( 1=i- I FAX # I am not using any subcontractors: Signature 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contracto gnature Dat