13080016 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7886 BELKNAP DR CONTRACTOR:WATER QUALITY PERMIT NO:13080016
PLUMBING
OWNER'S NAME: SU-MEI CHEN 1860 ALMADEN RD DATE ISSUED:08/02/2013
OWNER'S PHONE: 4088078768 SAN JOSE,CA 95123 PHONE NO:(408)267-9330
❑ LICENSED CONTRACTOR'S-DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class C,7t COPPER RE-PIPE,BENEATH ENTIRE SFD
Contractor Date '
I hereby affirm tl. I am license under the provisions of Chapter 9
(commencing wit 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
yofformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$6500
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:36210039.00 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 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 FRO LED 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
L-Z 11-3
granting of this permit. Additionally the applicant understands and will comply Iss ate:
with all non-points ce regulations er the Cu rtino Municipal Code,Section
9.18.
RE-ROOFS:
Signature r 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.
❑ O ER-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 th Cupertino M n'cipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 25505,2553
Section 3700 of the Labor Code,forthe 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 CONSTRUI ION 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 01 MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �0
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINQ (408)777-3228•FAX(408)777-3333•building6_cupertinoxL O misc
PLUMBING DMECHANICAL ELECTRICAL MISCELLANEOUS
PROJECT ADDRESS \ APN#
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OWNER NAME t' C-;
I C HeN PHONE tICO_uO_7- 76 0 E-MAIL
STREET ADDRESS V CITY, STATE,ZIP V I`I FAX
CONTACT NAME 1 11 26 7-9 --T-
PHONE E-MAIL
STREET ADDRESS II CITY,STATE,ZIP FAX
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❑OWNER ❑ OWNER-BUHAER ❑ OWNERAGENT 212oNTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER n _ LICENSE TYPE G`,, BUS.LIC#
COMPANY NAME n' E-MAIL ( ojFAX
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STREET ADDRESS ` CITY,STATE,ZIP l PHONE
17SIP15 '/68 7-9 3
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF j%FD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WH.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING. ❑COMMERCIAL URBAN INTERFACE AREA a NO FLOOD ZONE 9 NO EICHLER HOME? fi;�NO
DESCRIPTION OF WORK r
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i
TOTAL VALUATION: OO GU RE
By my signature below,I certify to eac dle following: I am property er or authorized agent to act on the prope er's behalf. I have mead this
application and the information I have�ro ided is connect. I hav r escription of Work and verify it is accurate. I agree to com ly with all applicable local
ordinances and state laws relating to build g co ction. I au o representatives of Cupertino to enter the:1-ideled o for inspection purposes.
Signature of ApplicanVAgent: Date:
SUPP MENTAL INFORMATION REQUIRED
2M C-11 rJSE oNLY
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MEPMiscApp_2011.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
{ ADDRESS: 7886 BLKNAP DR DATE: 08/02/2013 REVIEWED BY: MELISSA
APN: 362 10 039 BP#: I ''VALUATION: 1$6,500
%PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION
USE:
p PERMIT TYPE: 1 RPDP
WORK COPPER RE-PIPE BENEATH ENTIRE SFD
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Piping,Area 1PREPPIPE 1 # $47
TOTALS: $47.00 d
-
In
9K _
Xlech.Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec-Plan check
;'Wch.Permit Fee: Plumb.Permit Fee: 1PPERMIT Elee.Permit Fee:
Ether Alech.Insp. Other Plumb Insp. 0.0 hrs $47.00 Other Elec.Insp. Li
11ech.Insp.Fee: Plumb. Insp.Fee: Elec.Insp. 1,ee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0.00
Permit.Fee:
Suhpl. Insp Fee
PME Unit Fee: $47.00
PME Permit Fee: $47.00
Consn-fiction Tax:
Administrative Fee: /ADMIN $44.00
Work Without Permit? 0 Yes (E) No $0.00
Advane-ec/Planning Fees:
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
Bldg Stds Commission Fee:. IBCBSC 1 $1.00
Munum $186.65 $0.00 - $186.65
Revised: 07/01/2013