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13090103 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21343 DEXTER DR CONTRACTOR:PREFERRED PLUMBING PERMIT NO:13090103 &DRAIN OWNER'S NAME: KWAN LARRY I AND HELEN H 1980 OLIVERA RD STE F DATE ISSUED:09/13/2013 OWNER'S PHONE: 4082529119 CONCORD,CA 94520 PHONE NO:(925)676-2143 ❑ LICENSED CONTRACTOR'S DECQLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALII License Class Lic.# ���'f� REPLACE(E)MAIN WATER LINE FROM PROPERTY LINE " � TO Contractor �'� �--''K 'C��, Date � � FOUNDATION 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:$2280 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:32641085.00 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 DA 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 DA M L LLED 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 granting of this permit. Additionally,the applicant understands and will comply Date: 3 l with all non-point so rce regulations per the Cupertino Municipal Code,Section 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,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 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,Section 5505,25533,and 25534. Section 3700 of the Labor Code,for the 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 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 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 MEP ELI] COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUp19RTIN0 (408)777-3228•FAX(408)777-3333•building al(408) MISC PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESSAPN# 3 I� O's OWNER NAME `` 1 � n �Q^ PHONE , , STREET ADDRESSn (�� � CITY, STATE,ZIP CONTACT NAME J v - PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX OWNER ❑ OWNER-BUILDER ❑OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME 10 LICENSENUMBE t, LICENSETYPE BUS.LIC# COMPANY NAME E-MAIL (J FAX STREET ADDRESS (L P Q "1J !h n CITY,STATE,ZIP J�1,1 It PHONE 17\CO ARCHITECT/ENGINEER�NJ`AM/E L.ICENSE NUMBER 1 \ ` BUS.LIC# J COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMB.Y PROJECT IN WB-DLAND ❑ YES 7PRJ,7cT1NO ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO OOD ZONE NO EICHLER HOME? ❑NO DESCRIPTION OF WORK (� TOTAL VALUATION: ��©' By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's bAdr I ha ad this application and the information I have prod ed is correct. I have read thes cription of Work and verify it is accurate. I agree to co all applicable local ordinances and state laws relating to bui n ction. I authorize re tives upertino to enter the abo -ide i I d property for inspection purposes. Signature of Applicant/Agent: Date: S ELEMENTAL INFORMATION REQUIRED MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21343 DEXTER DR DATE: 09/13/2013 REVIEWED BY: MELISSA APN: 326 41 085 BP#: *VALUATION: 1$2,280 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPWS USE: I I PERMIT TYPE: WORK REPLACE E MAIN WATER LINE FROM PROPERTY LINE TO FOUNDATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Service 1BPWSVCS 1 # $24 TOTALS: $24.00 Xk,ch. Plan Check Plumb.Plan Check 0.0 his $0.00 flee.Plan Check -Vkch. Permit Fee: Plumb.Permit Fee: IPPERMIT glee. Permit Faze: Other Afech.Insp. Other Plumb Insp. 0.0 hrs $47.00 Other Elec.Insp. ldech. Cnslt.L'ee: Plumb. Insp.Fee: Elec.Insp—Tee: ire: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the relimin information available and are on an estimate. Contact the Dept-for addn7 info. FEE ITEMS (Fee Resolution 11-053 Ems) FEE QTY/FEE MISC ITEMS Plan Check Fee: Supp/. PC:'.Fee PME Plan Check: $0.00 Permit Fee: ,Supp/. In:sf)Fee PME Unit Fee: $24.00 PME Permit Fee: $47.00 Construction Tar: Administrative Fee: /ADMIN $44.00 Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 s�t $163.50 $0.00 F� $163.50 Revised: 08/01/2013