The URL can be used to link to this page

13100063 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22781 MEDINA LN CONTRACTOR:PLUMBING TECH INC PERMIT NO:13100063 OWNER'S NAME: GARY LEIGHTON 1424 PIEDMONT RD DATE ISSUED: 10/09/2013 OWNER'S PHONE: 4088580940 SAN JOSE,CA 95132 PHONE NO:(408)493-5000 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class (;3 4 _ Lie.# 93317 Z... UNIT A-COPPER REPIPE AND REMOVE AND REPLACE WATER Contractor _Date_/D • 9'/ HEATER I hereby affirm that Lam li sed under the provisions of Chapter 9 UNIT B-COPPER REPIPE (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:$12000 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:34230008.00 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 WITHIN80 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 TROM LAST CALLED IN SP CTION* indemnify and keep harmless the City of Cupertino against liabilities,judgments, Q costs,and expenses which may accrue against-said City in consequence of the Issued by Date'/ granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ♦ RE-ROOFS: Sign to 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 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,Sec'ons 25505 25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age ate: 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I 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 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildinga-cupertino.org MISIC ®PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLA(N�EOUS PROJECT ADDRESS2-7 T I �) �/ �� / _ APN# OWNER NAME 1' �(, /� _ PHON( STREET ADDRESS 2 Vr CITY,STATE✓IP Soy FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR 49 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME 4 j_/4,,;,, y •� LICENSE NUMBER Z LICENSE TYPE BUS.LIC# COMPANY NAME /rJm�� JTG J EMAIL FAX STREET ADDRESS Q V I\ Ci n TE,ZI J 3 2 PHON y,21 104 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 PROJECT IN WII.DLAND ❑ YES 7PO7TIN YES IS THE BLDG AN ❑YES BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO LOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORKCiln Dealt— J;11 � L �� a g' TOTAL VALUATION: Z, QOM ��RECE D$�Y� By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pr pej#owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I Tgree to comply with all applicable local ordinances and state laws relating to building co traction. I aut ize repre ntatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: ",00 SUPPLEMENTAL INFORMATION REQUIRED ^ °t �� OFFT,CE VSE OlYL'Y . . �� t� . 4 - - yER THE,EUVNI�R S ANDARD � .:119; 4"- MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 22781 medina In apt a&B DATE: 10/09/2013 REVIEWED BY: Mendez APN: BP#: "VALUATION: 1$12,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPRP USE: p PERMIT TYPE: WORK unit A-Copper re i e and remove and replace water heater Unit B-copper re i e SCOPE ,Wch. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check V1ech. Permit Fee: Plumb.Permit Fee: 1PPERMIT I k:c. Permit Fee: [1'1c,'h :Much.Insp. Other Plumb Insp. 0.0 hrs $47.00 o/lrer ElecInsp. Insp.Fee: Plurnb.Insp.Fey:: Elec.Imp.Free: 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 prelimin information available and are only an estimate. Contact the Dept for addn'1 info, FEE ITEMS(Fee Resolution 11-053 E�' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 2 # Plumbing Suppl.PC Fee: (2) Reg. ® OT0.0 hrs $0.00 $28.00 IPRREPIPE Re-Pipe Interior PME Plan Check: $0.00 F-1-71 # Plumbing Permit Fee: $0.00 $28.00 IPRWHEATR Water Heater Suppl. Insp.Fee-.0 Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Consiruction lax: Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure i Strong Motion Fee: IBSEISMICR $1.20 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $1 0.201 $56.001 $196.20 Revised: 10/01/2013