13080102 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21240 GARDENA DR CONTRACTOR:ONE DAY COMPLETE PERMIT NO: 13080102
REPIPE
OWNER'S NAME: Z F P COMPANY 662 N 12TH ST DATE ISSUED:08/14/2013
OWNER'S PHONE: 4082452795 SAN JOSE,CA 95112 PHONE NO:(408)603-0554
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALU
License Cl L�7 Lic.# Rn q f, COPPER REPIPE FORM WATER METER THRU UNIT
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:$6392
I have and will maintain Worker's Compensation Insurance,as provided for by
tion 3700 of the Labor Code,for the performance of the work for which this APN Number:32640006.00 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 OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, L!
costs,and expenses which may accrue against said City in consequence of the �/`j��
granting of this permit. Additionally,the applicant understands and will complyIssued by: Date: •
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with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date.6—// All roofs shall be inspected prior to any roofing material being installed.If a roof is
1001— 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 isnot 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,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date _ 7
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 in 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
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:
:GENERAL PERMIT IT A
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COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
{4A8)777-3228 FAX(408)777-3333•building
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By jm slgnatuie Ibelow,IP certl tpjeactl of the following: I am the property owner or authorized agent to act on the property owner's behalf I have read this
applicatio>a and, }e uI£ormatlon!I,have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all,applicable local:
ordJrtances and estate laws,Ietatmgjto g construction. I authorize representatives of Cupertino to enter thea ove-Identified property for inspection purposes.
Si liban�Age I' Date:
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MEPMiscApp
_201 1.doc revised 06/21/11
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CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: Gardena Dr _ DATE: 08/14/2013 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$6,392
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 RPR
WORK co er re i e form water meter thru unit
SCOPE
Gtech. Pkrn Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Pian(:heck
;Ltech.Perrrul Fete: Plumb.Permit Fee: IPPERMIT Ekc. Permit Fee:
Other.,Wech.Imp. Other Plumb Insp. 0.0 hrs $47.00 Other Cleo.Insp. Ll
13ech.Insp Fee: Pluinb. hisp.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 fees are based on the prellinina information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS(Fee Resolution 11-053 Eff. 7/1112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 0 # Plumbing
Suppl.PC Fee: (E) Reg. 0 OTT0.0 hrs $0.00 $14.00 1PRREPIPE Re-Pipe Interior
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee: Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Co nsh-action :Tax:
Administrative Fee: 1ADMIN $44.00
Work Without Permit? ® Yes 0 No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential E
Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure
i
Strong Motion Fee: IBSEISMICR $0.64 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
`
$139.641 $14.00 �m $153.64
Revised: 07/01/2013