14020008 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10540 GASCOIGNE DR CONTRACTOR:CURRO PLUMBING INC PERMIT NO: 14020008
OWNER'S NAME: MAEDA HIRONOBU 5810 OBATA WAY STE 8 DATE ISSUED:02/04/2014
OWNER'S PHONE: 4082962889 GILROY,CA 95020 PHONE NO:(408)847-7704
❑ LICEN�SvED CONTRACTOR'S DECLARATION TION JOB DESCRIPTION• RESIDENTIAL❑' COMMERCIALD
License Class t — Lic.# —37
RELOCATE LOW PRESSURE GAS LINE TO SIDE OF
GARAGE
Contractor Date
I hereby affirm that I am liccjWd under the provisions f 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:$1875
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the ab Code,for the performance of the work for which this APN Number:37523009 00 Occupancy Type:
permit is issued.
PLICANT CERTIFICATION
I certify that I e 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 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 DAY ROM LAST ALLED 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 omply Issued by: Date:
with all non-point source regulati er the Cupertino Municipal od Section
9 18.
RE-ROOFS:
Signature Dat 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.
❑ ER-BUILDER DECLARATION
Signature of Applicant: Date:
Ile by irm that I am exempt from the Contractor's License Law for one of
the f ing 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. 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 Cupertin c al Code,Chapter 9.12 a d
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec on 25505, 5 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 C NSTR TION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that thea is onstruction 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 uU7�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408) 777-3228•FAX(408)777-3333•building aacupertino.orqMISC
�13p��iTENO
PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS 0 S-Zo APN#
OVJNERNA1,4E CGSjj1r
/1 U 1 ;E-MAIL
STREET ADDRESS CITY, STATE,
ZIP.. I FAX
CONTACT NAME PHONE E-MAII
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER-_-�_; LICENSE TYPE/D BUS.LIC#
COMPANY NAME
E-MAIL GV ° FAx
STREET ADDRESS CITY,STATE,2t�
ARCHTTECT/ENGINEER NAME LICENSE NUMBER (j •/ BUS.LIC#
COMPANY NAME EMAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMII Y PROJECT INWI DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING [:I COMMERCIAL URBAN INTERFACE AREA
,/� �❑l N�O/� FLOOD ZONE El NO EIC�H°LLERHOME? ❑NO
DESCRIPTION OF WORK .,�j�Y jC.'�v G v �/�LJ('�!O�%!/"L�i �✓ � � `�
01
��6 REC$IVEDB,1,� °
TOTAL VALUATION:
By my signature below,I certify to each o e following: I am the property owner or authorized agent to act on the prop e over's behalf. I have read this
application and the information I have pr ed is corre I have r the Descriptim
on of Work and verify it is accurate. I afire to comply with all applicable local
ordinances and state laws relating to bu' cons n. I au or' r pre a tatives of Cupertino to enter the above-id ti ed property for inspection purposes.
Signature of Applicant/Agent: Date:
P Er TAL INFORMATION REQUIRED GacE IIs>bnY
OPEN '� �
�WK, XPI2ESS��-
NE- 02 E
MEPMisc,4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: "VALUATION: 1$1,875
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 RPGA
WORK relocate low pressure gas line to side of garage
SCOPE
Vg
Plumb.Plan Check0.0 hrs $0.00 L/61e:.t w t`heck
�a I es Plumb.Permit Fee: IPPERMIT t":
Other Plumb Insp. 0.0 �rs $47_00 01,4-s'1"74)<_li sp, Li
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E .' 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 0 # Plumbing
Suppl. PC Fee: Q Reg. 0 OT0.0 hrs $0.00 $70.00 IPGASRES Piping, Gas<=4 Outlets
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. ® OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Administrative Fee: IADMIN $44.00 Q
Work Without Permit? ® Yes 0 No $0.00 E)
Advanced Pla.nnin Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure 0
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldy,Stds Commission.Fee: IBCBSC 1 $1.00
' �' 3� ( �L $139.50 $70.00 TOTAL FEE:
$209.50
� ,.
� ;
Revised: 01/15/2014
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NOTIFIED
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GARAGEF �. CM�„ Z
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µ NEW t" PL SERVICE PLAiV1liE DEYL
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FACE OF WM(FOG'
'AS PaMG1AGLj ---- PACPOt7Y rage �.
E'GttE NOTES �
^� � PROPOSED OAS SERMCE
1.PGU to deflgn.'trench,backfM4e acdym Anexh ing3/4 J'„?'Q0 300:) E3 PROPOSM 4')t 4'oa,£.X” [*j
Sit,se,vfce at the main. PA. PROPERIY UNE(PL)
2.Gas meter to be rtmwd fiam Wactlon.
3.Cof Caprmnit tegtii'ed. � fit! ( , .• ' & ti E%ISfb7C i/EtIR
4. PG&E co to install a new gas service.
r L@] .
1UaW]je`EjU bu f-jli F r j NEW MMA IOC,CION
ON1 �jJ