1308015912
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7612 RAINBOW DR
CONTRACTOR: GREAT AMERICAN
PERMIT NO: 13080159
PLUMBING CO INC
OWNER'S NAME: LEWIS HELEN L TRUSTEE
P O BOX 26942
DATE ISSUED: 08/22/2013
OWNER'S PHONE: 4082534443
SAN JOSE, CA 95159
PHONE NO: (408)279-1515
❑
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
LICENSED CONTRACTOR'S DECLARATION
License ClassC5_r Lic. #� SD l 06 S
REPLACE (E) SEWER LINE FROM FOUNDATION TO
Contractor CWt fn1VJ1 CAN �t~ate '9 P2 � -3
PROP
LINE!IANtTARY
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
Sq. Ft Floor Area:
Valuation: $5950
performance of the work for which this permit is issued.
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: 36611036.00
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 INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
�STALLED
costs, and expenses which may accrue against said City in consequence of the
l 22 L 13
granting of this permit. Additionally, the applicant understands and will comply
Is Date:
with all non -p int sourcoregbilations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signa a 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. 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 t e Cuper ' unicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health &Safety Code, Sect' ns 5 33 34
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized age hDate:
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
CON RUCTION 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
CUPERTINO
GENERAL PERMIT APPLICATION
vJ�
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
o`
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 0
(408) 777-3228 • FAX (408) 777-3333 • buildingAcupertino.org \�
Im PLUMBING ❑ MECHANICAL n ELECTRICAL n MISCELLANEOUS
MEP
misc
PROJECT ADDRESS
APN #
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OWNERNAME vN
PHONE
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E-MAIL
STREET ADDRESS -z rk
CITY, ISTtATE, ZIP 11
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FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
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7LICENSE
TYPE
3
BUS. LIC #
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COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CI Y, S ATE, ZIP
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PHONE �2 S -1s
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WH.DLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
)4Q vs e -r- ,,u :
xi w 90
LCA -ve9 tC—)
00
TOTAL VALUATION:sqsn
Y:
94' 1111
By my signature below, I certify to each of the following: I am the property owner or authoriz ent to act on the PANAY owner's behalf. I have read this
application and the information I ha a pro is orrect. I hav escription of WdfE and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating t u' I uthorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: CK—Z
LEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
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*OVER-THE-COUNTER
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❑ EXPRESS
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❑ STANDARD
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❑ LARGE
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❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEW u FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
'RAINBOW DR
DATE: 08/22/2013
REVIEWED BY: MELISSA
IlaADDRESS:
APN: 36210 053
BP#:
"'VALUATION: 1$5,950
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
#
PENTAMATION
PERMIT TYPE: 1 RPS
WORK
REPLACE E SEWER LINE FROM FOUNDATION TO PROPERTY LINE & INSTALL 2 N
SCOPE
CLEANOUTS
APPLIANCE / EQUIP TYPE
FEE ED
QTY/FEE
QTY
UNITS
BP FEES
Sewer, Sanitary
1PRSEWER
1
#
$24
Permit .Fee:
.Suppl..Insp Fee,
PME Unit Fee:
$24.00
PME Permit Fee:
$47.00
Construction :Tar:
Administrative Fee: IADMIN
$44.00
Work Without Permit? ® Yes (j) No
$0.00
TOTALS:
�
$24.00
� 4
;L1ech. Plan Check Plumb. Plan Check 0.0 1 hrs $0.00 1 Elec. Plan Check
Lfech, Permit Fee: Plumb. Permit Fee: IPPERMIT laec. Permit Fee:
Other Alech. Insp. I I I I Other Plumb Insp. 10.0 1 hrs I $47.00 1 Other Elec. Insp.
IAlech. Insp. Fee: I Plurnb. Insp. Fee: I I:lee. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
ni.ctrirt_ otr_ )_ Thnco fooc aro hacnd on tho nroliminary infarmation availahle and are only an estimate Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
xSuppl. PC Fee
PME Plan Check:
$0.00
Permit .Fee:
.Suppl..Insp Fee,
PME Unit Fee:
$24.00
PME Permit Fee:
$47.00
Construction :Tar:
Administrative Fee: IADMIN
$44.00
Work Without Permit? ® Yes (j) No
$0.00
A,dvancecl Planning Fees:
Travel Documentation Fee: ITRAVDOC
$47.00
Strong Motion Fee: IBSEISMICR
$0.60
Select an Administrative Item
Bldg Stds Commission .Fee: 1BCBSC
$1.00
$163.60
$0.00 y O A N" gin E
$163.60
A Revised: 07/01/2013