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13060170 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10446 VISTA DR CONTRACTOR:WATER QUALITY PERMIT NO:13060170 PLUMBING OWNER'S NAME: ALEC MACLEAN 1860 ALMADEN RD DATE ISSUED:06/20/2013 OWNER'S PHONE: 4082553834 SAN JOSE,CA 95123 PHONE NO:(408)267-9330 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS License Class C3�0 Lic.# © — COOPER RE-PIPE,REPLACE(E)MAIN WATER LINE FROM . Contractor\A 1 Date r FOUNDATION TO METER&WATER HEATER,SAME I hereby affirm that I am licensed un er the provisions of Chapter 9 LOCATION. (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 Valuation:$9500 performance of the work for which this permit is issued. Sq.Ft Floor Area: 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:31633074.00 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 WITIIIN 180 DAYS 99 PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ate: f granting of this permit. Additionally,the applicant understands and will comply with all non-point source regul ions per the CupeM Municipal Code,Secti 9.18. RE-ROOFS: Signatu a Date 2v 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(Sec.7044, Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE I,as owner of the property;am exclusively contracting with licensed contractors to 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 Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505 33,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age Date4ZC))((� 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 I hereby affirm that there is a construction lending agency for the performance of become subject to the Worker's Compensation provisions of the Labor Code,I must work's for which this permit is issued(Sec.3097,Civ C.) forthwith comply with such provisions or this permit shall be deemed revoked. 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 O\ MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building ancupertino.org MISC LUMBING MECHANICAL ELECTRICAL MISCELLANEOUS PROJECT ADDRESS APN# �2 I �j ,stiLl OWNER NAME i PHONE J EJMAIL (-f l G Q�S- Jas-v STREET ADDRESS CITY,STATE,ZIP FAX Of y CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMEI{q � `� LICENSE NUMBER LICENSE TYPE BUS.LIC COMPANY NAME ; I E-MAIL FAXltlAcr - GtG STREET ADDRESS l��Q CITY,STATE,ZIP f h PHONNE _ -735 3 ARCHrMCT/ENGINEER NAME LICENSE NUMBER 0 BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF IfSFD or DUPLEX ❑ .MULTI-FAMILY PROJECT IN WIALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK /°'�, 1 (ifJ 1 -r-- a\e-r k GL TOTAL VALUATION: e-7 5-60, By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is c ave read the Desc tion of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cor represe to ves of Cupertino to enter the ab//over� entified roperty for inspection purposes. Signature of Applicant/Agent: Date: lJ 20 r� SUPPLEMENTAL 19FORMATION REQ D ti ; oieEus�oNrY .� ❑ EJtPRESS M STANDARD LARGE. MAJOR MEPMiscApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10446 VISTA DR DATE: 06/20/2013 REVIEWED BY: MELISSA APN: 316 33 074 BP#: *VALUATION: $9,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION 1 RPDP USE: SFD or Duplex PERMIT TYPE: WORK COOPER RE-PIPE REPLACE E MAIN WATER LINE FROM FOUNDATION TO METER&WATER SCOPE I HEATER, SAME LOCATION. APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Piping,Area 1PREPPIPE 1 # $45 Water Service 1BPWSVCS 1 # $23 Water Heater 1PRWHEATR 1 # $27 TOTALS: $95 00 - ,, Lfech.Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check Mech.Permit Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit Fee: Other l9eeh.Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elec.In 11ech.Insp.Fire: Plumb, hisp.Fee: Elec.Insp.I-ee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These fees are based on the prefimina information available and are onL an estimate. Contact the De t or addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check F'ee: :Suppl. PC/'ee PME Plan Check: $0.00 Permit.F'ee: Suppl. Ins[)Fee PME Unit Fee: $95.00 PME Permit Fee: $45.00 Consir action Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fees: Travel Documentation Fee:. ITRAVDOC $45.00 i Strong:Motion Fee: IBSEISMICR $0.95 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $228.951 $0.00 ( $228.95 Revised: 04/29/2013