13060154CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20010 STEVENS CREEK BLVD
CONTRACTOR: CURRO PLUMBING INC
PERMIT NO: 13060154
OWNER'S NAME: HOR CHEUK
5810 OBATA WAY STE 8
DATE ISSUED: 06/19/2013
OWNER'S PHONE: 4087108054
GILROY, CA 95020
PHONE NO: (408) 847-7704
❑ LICENSED CONTRACTORS DECLARATION
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL ❑
License Classy Ci 0A Lic. # SJ f
VILLAGE FALAFEL- EXTEND LOW PRESSURE GAS LINE
/
VuX�/ r0 �Q
Contractor Date
TO
NEW METER LOCATION
I hereby affirm that I 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.
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
Sq. Ft Floor Area:
Valuation: $5700
performance of the work for which this permit is issued.
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: 36903005.00
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 mentioned property for inspection purposes. (We) agree to save
180 DA F OM LAST 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
7
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -porn source regu tions per the Cupertino Municipal Code, S tion
9.18.
346
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 (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. Twill
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.
I have and will maintain Worker's Compensation Insurance, as provided for by
will maintain compliance with the Cupertino M ipal Code, Chapter 9.12 a
the Health & Safety Code, Secti s 5505, 5 nd 25534.
Section 3700 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
Compensation laws of California. If, after making this certificate of exemption, I
CO RUCTION 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 � MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION u`7
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 L9
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(W-cupertino.org MISC
R1 PLUMBING n MECHANICAL n ELECTRICAL n MISCELLANEOUS
PROJECT ADDRESS e&4
APN #
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OWNER NAME V y
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STREET ADDRESS �6/jrj C
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FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �i„s C9,� /�/////
LICENSE NUMBER, S ��1 /�/,
St-us�,�^�f.&'6*4
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BUS. LIC
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COMPANY NAME U� ��y,-I y�
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STREET ADDRESS 5"q/0 V w
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ARCHITECT/ENGEQEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL+
PROJECT IN WH.DLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
/ I /
DESCRIPTION OF WORK%v�►/�
TOTAL VALUATION.
RECEIVED BY:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property er's behalf. I have read this
application and the inforination I hav provided is correct. I have read the Description of Work and verify it is accurate. I a to comply with all applicable local
ordinances and state laws relating t ilding co ctio audi representatives of Cupertino to enter the above ide 'ed property for inspection purposes.
Signature of Applicant/Agent: Date: ��
6'PLIMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
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OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
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LARGE
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❑ MAJOR
MEPMiscApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FRE ESTIMATOR — BUILDING DIVISION
L1ech. Plan ('heck Plumb. Plan Check 10.0 1 hrs $0.00 Elec..Plan Check
welch. I'errnit Fee: Plumb. Permit Fee: IPPERMIT Llec. Permit Fee:
Other• ;11ech. Insp. Other Plumb Insp. 0.0 hrs$45.00 Usher Elec. Insp.
Hech. Insp. Fee: Plumb. Insp. Fee: I I^;lee. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Pubuc worics, vire, ,5amtary,ewer uasrrtct, acnoot
District, etc). These fees are based on the prefinmdina information available and are only an estimate- Contact the Dept for addn'1 info,
20010 SCB
DATE: 06/19/2013
REVIEWED BY: Mendez
JimADDRESS:
APN:
BP#:
*VALUATION:
1$5,700
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
0.0
PENTAMATION
PERMIT TYPE: 1CPGA
WORK
VILLAGE FALAFEL- EXTEND LOW PRESSURE GAS LINE TO NEW METER LOCATION
SCOPE
L1ech. Plan ('heck Plumb. Plan Check 10.0 1 hrs $0.00 Elec..Plan Check
welch. I'errnit Fee: Plumb. Permit Fee: IPPERMIT Llec. Permit Fee:
Other• ;11ech. Insp. Other Plumb Insp. 0.0 hrs$45.00 Usher Elec. Insp.
Hech. Insp. Fee: Plumb. Insp. Fee: I I^;lee. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Pubuc worics, vire, ,5amtary,ewer uasrrtct, acnoot
District, etc). These fees are based on the prefinmdina information available and are only an estimate- Contact the Dept for addn'1 info,
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/121
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 # Plumbing
$67.00 IBPGAS Piping, Gas >4 Outlets
Suppl. PC Fee: (E)Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. ® OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
("onstr uction :Tax:
Administrative Fee: IADMIN
$42.00
0
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: IBSEISMICO
$1.20
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$134.20
$67.00 �_
,
$201.20
Revised: 04/29/2013
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
DATE
t%tff PLAri,
CHECKD BY
z' -// E7r1/3
,Bt of plans and speCmcaUL)1IS IVIu. - -,- -
STEVENS CREEK E G;ie duriri�construction. It is unlawful to make any PLANNING PT.
FOC nns°s r alterations on same,
v1
P/L — — , , • o ,without approval from el3nildin 9 lcial. DATE
N
Th6q-' p f this plan and , fic gs SHALL NOT PG�tE NOTES BLDG. DEPT
p rmit or to be a a,p ov I of the vioiation
of alI1f ce or State Law. 1. PGBE to design, trench, backfill, pave, Et
\ - replace an existing 1 /2" pl. service with 1" pl. service.
\V14
bY� 1 /2" pl service to be deactivated at main.
\�/I` • i 3 2. Prior to construction the house line is to be plumbed to the new location.
N = 6 House line to be inspected by the city of Cupertino prior to gas meter transfer.
1-1 3. PGEtE to Perform Hot Tie In.
#20010 \� 00 4 4'x4' BELL W 4. PGEtE to Install 70' of 1" PL direct bury with a 1 1/4"
�\ HOLE \ Z NC riser.
5. PGEtE to maintain 3' seperation from a/c unit.
1/2" (3/4" STL.) W 6. Contact GSR after work for relight.
CO Z 7. City of Cupertino permit required.
a.
�Y/6-'ry -z �� s 7 el
70' OF 1" PL HP.
4X4' BELL
HOLE
Ld
LEGEND
G-
EXISTING GAS FACILITIES
N
FACE OF CURB (FOC)
- - - -
PROPERTY LINE (P/L)
- - -
- PROPOSED GAS SERVICE
n
PROPOSED 4' X 4' BELL HOLE
P/L
PROPERTY LINE (PL)
0
EXISTING METER
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FENCE
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EX, WINDOW 111 ELECTRIO METER
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