13060199 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10673 PEBBLE PL CONTRACTOR:GENMOR PLUMBING PERMIT NO: 13060199
OWNER'S NAME: GROVER JILL E AND GAYLEN T TRU 2552 SEABOARD AVE DATE ISSUED:06/25/2013
OWNER'S PHONE: 4087392075 SAN JOSE,CA 95131 PHONE NO:(408)855-8348
❑
LICENSED CONTRACTO,pR'SD.E�C�LjARAT11ON JOB DESCRIPTION: RESIDENTIAL El COMMERCIALL
License Class��`n��/ i Lic.# O J 1 REPLACE MAIN WATER LINE
Contractor( 1� `� 1 L� Dat �l
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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2340
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:32643049.00 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 DAY M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue ag ' st said City in consequence of the Issued b Date:
granting of this permit Additionally, plicant understands and will comply y'
with all non-poi ou a regulations a Cu a Municipal Code,Section
9.18.
CC RE-ROOFS:
Signature Date 713 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. 1 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 25505,25533,a 5534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: A
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
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
CONSTRUCTION PERMIT APPLICATION r ��
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONU
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10300 TO
RREIAVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinq(a cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT AD,pq.lS y� ^/ �S APN#
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STREET ADDRESS �/�� CITY,STAT ,ZIP ,_^_J^ n '
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STREET ADDRES9< CITY,STATE,ZIP ��r��)7� F X (!�U
❑OWNER �❑ OWNER-BUILDER ❑ OWNER AGENT ( 12QNTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CO ACTO AME 1 _ - `^ LICENSE NUty E -7.,n ` LICENSE TYPE •�� FAX
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ARCHITECT/ENGINEER NAME �V Y LICENSE NUMBER V"" ` I BUS.LLIC�`#�`svC v
COMPANY NAME E-MAIL
FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK �/'1, k� -
EXISTING USE PROPOSED USE CONSTR.TYPE N STORIES
USE TYPE OCC. SQ-FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA .AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL.AREA REMODEL AREA REMODELAR E A
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
❑ATTACH
4 DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑YES
BEING ADDED? []NO ADDITION? [:]NO
PRE-APPLICATION ❑YES IF YES.PROVIDE COPY OF Is THE BLDG.AN E]YES RECEIVED � :TOTAL VALUATION:
PLANNING APDL# []NO PLANNING APPROVAL LETTER EICHLER HOME? C]NO
By my signature below,I certify to each of the following: I am the property owner or authorized a entact on the property owner's behalf. 1 have read this
application and the information I have provided is correct. I have read the escription f ork and ve y it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to build co Struction. I autho res ti es f upertino to enter the abpv -idecnti led roperty for inspection purposes.
Signature of Applicant/Agent: Date: 2 J
SUPPLEMENTAL R ON REQUIRE PLA HECKTYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit forOVER-THE COUNTER El BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of buildin
permit for new building. ❑ EXPRESS ❑. PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to 1771 MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑. ENVIRONMENTAL HEALTH
BldgApp_201 Ldoc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10673 PEBBLE PL DATE: 06/25/2013 REVIEWED BY: MENDEZ
APN: I BP#: "VALUATION: 1$2,340
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION 1RPRP
USE: p PERMIT TYPE: i
WORK REPLACEMENT OF MAIN WATER LINE
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Re-Pipe Interior 1PRREPIPE 1 # $13
TOTALS: - 4i $13.00 µ
llech.Plan Check Plumb.Plan Check LLO hrs $0.00 Elec.Plan Check
illech.Permit Fee: Plumb.Permit Fee: IPPERMIT Dec.Permit Fee:
r/",'h1
llech.Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Dec.Imp.
Insh.Fee: Plumb. Inap.Fee: Flee,Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.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 LFee Resolution 11-053 Eff. 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check F'ee:
.Supp/. I3C F"(-,e
PME Plan Check: $0.00
.f erinit Fee:
.Su/apt. hasp Fee
PME Unit Fee: $13.00
PME Permit Fee: $45.00
Consouction :Tax.
Administrative Fee: IADMIN $42.00
Work Without Permit? 0 Yes 0 No $0.00
�Idvanced Planning t;'ees:
Travel Documentation Fee: 1TRAVDOC $45.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$146.50 $0.00 - g° TAkFE $146.50
Revised: 04/29/2013