13060010 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10778 E ESTATES DR CONTRACTOR:GENMOR PLUMBING PERMIT NO: 13060010
OWNER'S NAME: NORMA EVANS TRUSTEE 2552 SEABOARD AVE DATE ISSUED:06/03/2013
OWN R'S PHONE: 4085178797 SAN JOSE,CA 95131 PHONE NO:(408)855-8348
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALS
License Class Lic.# �J �-� NEW DESIGNATED GAS LINES TO CLOTHES DRYER&
y�w II�`Yl KITCHEN OVEN/STOVE.REPLACE 2" SEWER/DRAIN
Contractor. Date ' LINE
I hereby affirm that I am licensed unde the provisions'of Chapter 9 FROM BATHROOMS TO LAUNDRY
(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. Sq.Ft Floor Area: Valuation:$4850
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:36922014.00 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 D 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 D OST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the f;
te:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point so re lations the CupMunicipal Code,Section
9.18.
RE-ROOFS:
Signature Date All roofs shall be inspected prior to any 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 structure is not intended or offered for sale(See.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 air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Mun' ipal.Code, hapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 5505,2553 d 255
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater
permit is issued. 6
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 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 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 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.
Signature Date
GENERAL PERMIT APPLICATION MER '.1.,
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O�
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
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Bymy slgnatute Ibelow,I certify topch of the following: I am the property owner or authorized agent t e p riy owner' e f. I have read this I
application and t�Ie Information I have provided is correct ve read the Descri tion of Work and verify it is accurate. I agree ply'with atl applicable locat,
ordinances andstate laws relating to b ' cons io 07
re es ives f Cupertino to enter the above-identified property for inspection purposes
SlgnatureofAplibantlAgent I Date:
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cAPP_201 1.doc revise
d06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10778 E ESTATES DR DATE: 06/03/2013 REVIEWED BY: MELISSA
lls APN: 369 22 014 BP#: "VALUATION: $4,850
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPGAS
USE: p PERMIT TYPE:
WORK NEW DESIGNATED GAS LINES TO CLOTHES DRYER& KITCHEN OVEN/STOVE. REPLACE 2"
SCOP I SEWER/DRAIN LINE FROM BATHROOMS TO LAUNDRY
APPLIANCE/EQUIP TYPE FEE ED QTY UNITS BP FEES
Piping, Gas <=4 Outlets 1PGASRES 1 # $67
Piping,Area IPREPPIPE 1 # $45
TOTALS: - $11200 c '
Xfech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec—Plan Check
Flech. Perwit Fee: Plumb.Permit Fee: 1PPERMIT I Elec.Permit Fee:
FlJther 0.0 Hech.Insp. Other Plumb Insp. hrs $45.00 Other Elec.Insp.
Alec"h.In.sp. Fee: Plumb. Irish.Fee: Elec.Insp,Fee:
NOTE:This estimate does not include fees due to other Departments(ie.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prelimina information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Sulppl. .PC Fee
PME Plan Check: $0.00
Pennit.l`ee:
Suppl. Insp Fee
PME Unit Fee: $112.00
PME Permit Fee: $45.00
Construction:Torr:
Administrative Fee: IADMIN $42.00
Work Without Permit? ® Yes (E) No $0.00
Advaneed Planning Fees:
Travel Documentation Fee: ITRAVDOC $45.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldp,Stds Commission Fee: IBCBSC $1.00
�` � �' . •- - $245.50 $0.00 � _ �� �m
$245.50
Revised: 04/29/2013