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13070056 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7940 FALL CT CONTRACTOR:MARTI'S PLUMBING PERMIT NO:13070056 OWNER'S NAME: HAGAN JAMES R AND LINDA J TRUS 171 BRANHAM LN STE 10418 DATE ISSUED:07/09/2013 OWNER'S PHONE: 8582534817 SAN JOSE,CA 95136 PHONE NO:(408)375-3190 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL[] License Class C 3 D Lic.# 4',51�7 27 o o INSTALL(1)GAS LINE FROM METER TO DRYER Contractor V I City C AAA WE&, '7_-?'"/3 **SEE NOTES** 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:$200 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:36213006.00 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 DAYS F LED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, Q costs,and expenses which may accrue against said City in consequence of the / '3 granting of this permit. Additionally,the applicant.understands and will com a -mate: with all non-point source regulations pe the Cupertino Municipal Code,Sec IT 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(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. 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,Sect' s 25505,257 5 33,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 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 inconsequence 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 I GENERAL PERMIT APPLICATION d . MEP . . .. COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �V 10300 TORRE'AVENUE•CUPERTINO,CA 95014-3255 O misc (408)777-3228•FAX(408)777-3333•buildinclCEDcupertino.org CUPBRTINO PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS Cl) t'(�///v O APN# OWNER NAME b!� 1 � PHONE V�� 353-49 � E-MAIL STREET ADDRESS r�/L�f�i� /� r �GjJ�O L6VST TE,ZIP � FAX �.:. PHO D 8 1 YJ S E-MAIL LZZ :CONTANAME l' n 14 �J.t tri.!'- M AFT7N 2 3 STREET ADDRESSCTTY,STA FA ZIP X �d2CP0: V.VIPeQ1At Avg 0 , iva `/ ❑ OWNER ❑ QWNER-BUILDER. ❑OWNER AGENT m CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT . CONTRACTOR NAME LI ER CENSE E BUS.LIC# V l4'NfZ AA,4P\'P NP Z a �.�M N 2 ,7 c�1t �'t 5 �'LUM f l y I� ErMnn PLUM B GMft J L ` C`p!� FAX 3 B- �4 5e> STREET ADDRESS I CITY STATE,ZIP O 1'02 M, vd)�-t\n�� all ��Y �� ARCHITECVENGINEERNAME LICENSE NUMBER BUS.L C 0 t C MPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PLO 3 f U 6J y"S,0 'd \-MR:(LPSl VE; COP �271A,v . s-00 -1 USB of sFD&DUPLEX ❑ MUI.Tt-FAMILY PROJECT INWBALAND ❑ YES PROTECT IN ❑ IS THE BLDG AN ❑YES BUILDING ❑COMMERCIAL ' - URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER HOME? �NO DESCRIPTION OF WORD': a U ��►�V CJI 5 LIN!V E �a/%" � /l-r I ': I ii l l III P.` In�ll I I�III I,;� II it i rpm TOTA' � LVA D�TO By my signature Jbelow;I certify tp each of the following: I am the property owner or authorized agent to a e property ehalf. I have read this application and the Information I•have provided's correc a read the Description of Work and verify it is accurate. I agree to comply'with all applicable locat' ordinances and state laws retatin ' 7ding c ctio Mize representatives of Cupertino to enter the above-i entified roperty for inspection purposes. I �A Signature ofAp�liGant/.Agentl i! ;' Date: `[ 3 'i I I .': �' �' �;SUPPLEMENTAL INFORMATION REQUIRED ��F.�„S_ I,II p I I I MEPMiscApp_2011.doc revised 06/21/11 Ii I I - I III CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 7940 FALL CT DATE: 07/09/2013 REVIEWED BY: MELISSA APN: 362 13 006 BP#: *VALUATION: $200 FPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION 1 RPGAS USE: SFD or Duplex PERMIT TYPE: i WORK INSTALL N GAS LINE FROM METER TO DRYER SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Gas <=4 Outlets 1PGASRES 1 # $70 TOTALS: ° e $70.00 WOW * '€ L9E<c7r. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec'-plan(:heck ALlech. Permit Pec:: Plumb.Permit Fee: 1PPERIIIIT Elec. Permir Fee: Other Alech.Raj). ED-1— Other Plumb Insp. 0.0 hrs $47.00 Other Elec.Insp. Li tle&Insp.Fee: Plumb. 111q).Fee: Elec.Insp.Fire: 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 prelinddna information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit.Fee: Suppl. Insp Fee PME Unit Fee: $70.00 PME Permit Fee: $47.00 Consiruction .Tax: Administrative Fee: IADMIIV $44.00 Work Without Permit? ®Yes (E) No $0.00 Aclvcarced Planning Fees: -T-= Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 MIR, $209.50 , $209.50 $0.00 � ��, �\ Revised: 07/01/2013