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13080052 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1658 JAMESTOWN DR CONTRACTOR:GREAT AMERICAN PERMIT NO:13080052 PLUMBING CO INC OWNER'S NAME: CHRISTINA MEI-HSUAN CHAO P O BOX 26942 DATE ISSUED:08/07/2013 OWNER'S PHONE: 4084462664 SAN JOSE,CA 95159 PHONE NO:(408)279-1515 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALEI License Class Li..#��M 16 6 S REPLACE(E)SEWER LINE&INSTALL(N)BUILDING& -„7`13 PROPERTY LINE CLEANOUTS Contractor�,°�l�✓r1 ei2(01W AA y+�(�rAate 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. CA Ihereby affirm under penalty of perjury one of the following two declarations: %J1"""""`%N1TARY 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:$4500 S1 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:36610063.01 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 O + T 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 AS L indemnify and keep harmless the City of Cupertino against liabilities,judgments, g costs,and expenses which may accrue against said City in consequence of the I Date: O granting of this permit. Additionally,the applicant understands and will comply with all non-p int source regulations per the Cu ertino Municipal Code,Section 9.18. RE-ROOFS: Signatu Date 3 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) 1,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 wit the Cuperti o Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se ions 2 5 553 ,an Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ag Dater 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 UCTION 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 4 GENERAL PERMIT APPLICATION o MEP 13 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 4O 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 0 misc CUPERTINO (408)777-3228•FAX(408)777-3333•buildin-gOlcupertino.oro �� PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MIISCELLANEOUS PROJECT ADDRESS V �, ,^A )Ole APN# 3 OWNERNAME S?7 '�/v 'V I PHQN C E-MAIL C STREET ADDRESS � �� CITY,STATE,,'IP FAX viee2T-iA/ 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 LICENSE NUMBER 7LICENSE TYPE BUS.LIC# ,a2�Ai v7i�2J�q+tl (at /� —0 S US COMPANY NAME E-MAIL `C FAX 3 C STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SM or DUPLEX ❑ MULTI-FAMILY PROJECT IN WH DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK > l l s g ()`v N Ti4 t 7—W4 N 4NA1 j CAL k7- TOTAL VALUATION: l `J o 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 prop Wner' al£ I have read this application and the information I ve provided is correct. I have read the D scription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating bu'din tmct�n. h�e esentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: LEMENTAL INFORMATION REQUIRED OFFICE USE ONLY W QOVER-THE-COUNTER x EXPRESS VV r a ❑ STANDARD V a ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1658 JAMESTOWN DR DATE: 08/07/2013 REVIEWED BY: MELISSA APN: 366 10 063 BP#: "VALUATION: 1$4,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Du lex PENTAMATION 1 RPSS USE: p PERMIT TYPE: WORK REPLACE E SEWER LINE & INSTALL N BUILDING & PROPERTY LINE CLEANOUTS SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $24 Sewer, Building 1PRSEWER 1 # $24 $48.00 TOTALS: F7 I t tech. Flan Check. Plumb.Plan Check 0.0 hrs $0.00 Elec:..Plan Check tech. Pennit Fee: Plumb.Permit Fee: 1PPERMIT flee. Permit Fee: [1'f,"' Alech.Insp. Other Plumb Insp. 0.0 hrs $47.00 OtherElec.Insp. L]ch.Insp.fee: Plumb. hasp.Fee: Elec.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&es are based on the prelimina information available and are only an estimate. Contact the Dept for addh7 info. FEE ITEMS (Fee Resolution 11-053 E . 7ff 11112) FEE QTY/FEE MISC ITEMS Plan Check Fees: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $48.00 PME Permit Fee: -T-T- $47.00 ConSlY7.MOn Kf. Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldiz Stds Commission Fee: 1BCBSC 1 $1.00 $187.50 $0.00 _5 $187.50 �� t Revised: 07/01/2013 \v