14020037CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21870 GRANADA AVE I CONTRACTOR: PLUMBING TECH INC PERMIT NO: 14020037
OWNER'S NAME: SUZETTE KWONG 11424 PIEDMONT RD I DATE ISSUED: 02/05/2014
OWNER'S PHONE: 4086748200 SAN JOSE, CA 95132 PHONE NO: (408) 493 -5000
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
PROPERTY LINE CLEAN OUT
License Class L-3� `C ¢Z Lic. #
Contractor �Civ�l� �-C C-Vl Date 2 15
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.
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
permit is issued.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
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. j
Signature' /' Date Z
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
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.
Date
Sq. Ft Floor Area: I Valuation: $4500
APN Number: 35716024 00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 1 F PERMIT ISSUANCE OR
180 DA FROM LA�T CALLED INSPECTION.
Issued by: Date.
RE- ROOFS:
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.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534. 1 f
'Owner or authorized agent: Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C )
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
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CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
1A
ADDRESS: 21870 granada ave
Plumb. Plan Check 0.0 hrs $0.00
DATE: 02/05/2014
REVIEWED BY: Mendez
Plumb. Permit Fee: IPPERMIT
APN:
BP #:
VALUATION:
1$4,500
*PERMIT TYPE: Building Permit
111wuh. Insp. Fee:
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PME Plan Check:
PENTAMATION 1 RPS
PERMIT TYPE:
WORK
ro erty line clean out
SCOPE
$0.00
Suppl. Insp. Fee: Reg. ® OT
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Dreliminarv, information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS 6(W Resolution 11 -053 Ef. 711113)
-1,; 1", lo;,i "Alu 4
Plumb. Plan Check 0.0 hrs $0.00
- :_
FIT, < � pit Fnr> -:
Plumb. Permit Fee: IPPERMIT
t:,z r C'��r' r- F"(,
#
$24.00
Other Plumb Insp. 0.0 hrs $47.00
El
Suppl. PC Fee: Q) Reg. ® OT
111wuh. Insp. Fee:
1"Ce:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Dreliminarv, information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS 6(W Resolution 11 -053 Ef. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
#
$24.00
Plumbing
IPRSEWER Sewer, Sanitary
Suppl. PC Fee: Q) Reg. ® OT
1 0,0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. ® OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
Coi S'P wcrion T'L?,:
T-T
Administrative Fee: 1ADAffN
$44.00
Q
E)
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
0
i
Travel Documentation Fee: ITRAVDOC
$47.00
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
1 $1.00
_QTALS,
1 $139.50
$24.00
TOTAL FEE:
$163.50
Revised: 01/15/2014
San Jose
Water
Company
110 W. Taylor Street
San Jose, CA 95110 -2131
Suzette Kwong
21870 Granada Avenue
Cupertino, CA 95014
December 9, 2013
Reference: Service Adjustment
21870 Granada Avenue, Cupertino
Dear Ms. Kwong:
San Jose Water Company
Water Services Administration
1265 S. Bascom Ave., San Jose, CA 95128
Facsimile: 1 408 279 -7889
Writer's Direct Dial: 1 408 279 -7879
10 UM'01 IAN 0001
DEC 1. 1 2013
Name;
Thank you for your submittal regarding this project. The purpose of this letter is to inform
you of the procedures you need to follow to extend the existing water service at this address.
Basically, you will need to hire a contractor to install the connection to our standards and under
our inspection. It is suggested, but not required, that you contact one of our general contractors to
have this work performed. They are West Valley Construction at 408 - 371 -5510, and Lewis &
Tibbitts at 408 - 925 -0220. In any case, your contractor must possess a valid license for this type
of installation, and must obtain a permit from the City of Cupertino to do the job.
If you would like to proceed with the work, please sign, date, and return this letter along
with a construction deposit in the amount of $250 to cover the cost of our review and inspection.
Please make your check payable to San Jose Water Company.
Once you have selected your contractor, have him contact Daryl Lambert at 279 -7830 for
a preliminary field meet. A San Jose Water Company inspector must be present when the work
on the service lateral in the street is being done. Once the work is scheduled, please notify Mr.
Lambert at least 48 hours prior to beginning work in the street so that he can meet the contractor
and inspect the work to verify that it has been done to San Jose Water Company standards.
7879.
If you have any questions or require further information, please contact me at (408) 279-
Sincerely,
ORIGINAL SIGNED BY
U
Wanda E. Folk
Water Services Representative
Suzette Kwong
December 9, 2013
Page Two
WEF:BCT
granada21870.doc
Enclosures
cc: Building Department, City of Cupertino
Daryl Lambert, SJWC Construction
ACKNOWLEDGED AND AGREED
Signature
Print Name
Date
Phone Number