14010168 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7689 SQUIREWOOD WAY CONTRACTOR:GENMOR PLUMBING PERMIT NO: 14010168
OWNER'S NAME: HABEEB ROBERT A 2552 SEABOARD AVE DATE ISSUED:01/31/2014
OWNER'S PHONE: 4082572298 SAN JOSE,CA 95131 PHONE NO:(408)855-8348
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E]
�3�_ ��,�G' ^ � COPPER RE-PIPE THROUGHOUT HOUSE
License Class(T*
Liic..n# l V/2
Contractor( � ml( IU1'�V/�nYIi" i7ate ' J1l
T�
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:$4800
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:36227015 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 FRS CAL 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 3�
granting of this permit. Additionally,the applicant understands and will comply Iss Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
E-ROOFS:
Signat 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
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,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this 131 t
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 1 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 �� E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION `O
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408) 777-3228•FAX(408)777-3333•building(d)cupertino.oraMISC
cu1PYr=A'tN0 \
❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS V wDD(A, WaA4 APN#
OWNERN ,^n„- 'W& I PHONE
Q!b)
STREET ADDRESS v,l'// U Y v► CITY, STA .ZIP7/.n ( /1' q50141 I FAX
CONTACT ; -,-V PHONE��b) �5F KUL /1 i/1 MW
STREET ADDRESS ,(y CITY,STATE,ZIP `�,y Q.-A • '�` FAX Z19r
❑ OWNER ❑ OWNER-B=ER ❑ OR"TTER1/,AAGENT ` CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR N � LICENSE NUMBER LICENSE TY�E BUS.LIC#
COMPANTY NAME E-MAIL M p'�/ /y, FAX
STREET ADDRESS� ' n e� CITY,ST ZIP V< A , 11L 1-5 PHONE p\
ARCHITE &NGINEERNAME LICENSE NUMBER Y-t ,7 BUS.LIC# `�J
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ElSFD or DUPLEX ❑ MULTI-FAMII.Y PROJECT IN WI DLAND ❑ YES PROJECT IN YES IS THE BLDG AN ❑YES
BUIIDINC: ❑COMbIERCIAL URBAN IN IERFACE AREA ❑ NO FLOOD 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 pro er's behalf. I have read this
application and the information I have provided is correct. I have read the Descrip ion of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil ' g ons ction. Ilaqutthhogriize repres t Cu rtino to ter the above-identified property for inspection purposes.
Signature of Applicant/Agent: vV Vv Date:
SUPPL lfNTAL INFORMATION REQUIRED
_aNW-
COITts'TERr
� J�xEss' F �
MEPMiscApp_2011.doc Tevised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
MIADDRESS: 7689 SQUIREWOOD WAY DATE: 01/31/2014 REVIEWED BY: MELISSA
PN: 362 27 015 BP#: *VALUATION: 1$4,800
PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION 1 RPRP
USE: SFD or Duplex PERMIT TYPE:
WORK COPPER RE-PIPE THROUGHOUT HOUSE
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Re-Pipe Interior 1PRREPIPE 1 # $14
TOTALS: $14.00
vl74
z
Plumb.Plan Check 0.0 hrs $0.00 P a?Ck x:/t
Plumb.Permit Fee: IPPERMIT
fir,_ zEl
Other Plumb Insp. 0.0 hrs $47.00 €7/3<rt�t c�_?�sr.
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $14.00
PME Permit Fee: $47.00
Administrative Fee: IADMIN $44.00
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: ITRAVDOC $47.00 A
Strom Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bids Stds Commission Fee: 1BCBSC $1.00
* � 5'' $153.50 $0.00 TOTAL FEE; $153.50
ago
JIf
Revised: 01/15/2014