14030135 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21528 ROSARIO AVE CONTRACTOR:6,t If et— f//���H PERMIT NO: 14030135
OWNER'S NAME: RIDLEY DAVID W AND LORRAINE M DATE ISSUED:03/24/2014
OWNER'S PHONE: 4084463599 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
INSTALL(N)PROPERTY LINE CLEANOUT
License Class �'7n Lic.# 43a-q!6
Contractor
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GENERAL PERMIT APPLICATION O MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building a.cupertino.org "\ MISC
CU015—W`INN
LUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESSZ 5 2 S I `1� A cO� APN# 2 S`,6 — i 1 Q Z
OWI�ERNAME J, �`Q �}J
�4✓( A I PHONE-
STREET ADDRESS CITY, STATE,ZIP. (•g ( FAX
CONTACT NAME PHONE E-MAIL
41
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER-BURAER ❑ OWNERAGEW CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHmcr ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACfORNAME LICENSENUMBE LICENSETYPE BUS.LIC#
COMPANY N MEAX
c��t.lfe - E-MAILE M"c leek ;4 ge e.K4hoo-cam
STREET ADDRESS CITY,STATE,ZIP PHOI�
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ARCHITECTJENGINEER NAME LICENSE NUMBER. BUS.LIC it
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF QAFD or DUPLEX [IMULTI-FAMMY PROJECT IN WILDLAND El YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EIC 11IR HOME? ❑NO
DESCRIPTION OF WORKx o0i
TOTAL VALUATION: (/ RM��.I
By my signature below,I certify to each of the foil wing: I am the property owner or a gent to act o rty owner's be 1. e rea
application and the information I have provided i correct. I have read the Description of Work and verify it is accurate. I agree to c 1 all applicable local
ordinances and state laws relating to building co truction. I authorize representatives of Cupertino to enter the above-identifi. for inspection purposes.
Signature of Applicant/Agent: Date:
UP TAL INFORMATION REQUIRED 23106NoF icE zrsE oily
190 1. o ';
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STANDARD
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21528 ROSARIO AVE DATE: 03/24/2014 REVIEWED BY: MELISSA
APN: 356 19 024 BP#: *VALUATION: 1$1,500
rPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1RPSS
USE: PERMIT TYPE: A
WORK INSTALL N PROPERTY LINE CLEANOUT
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1 PRSEWER 1 # $24
TOTALS: $24.00
a�bKGI1Na '4k
� S
a
Plumb.Plan Check 0.0 hrs $0.00 E/Cc. Pion('hcoc
Llnct1_ 11e;nrrt Fee: Plumb.Permit Fee: 1PPERMIT Ve'
01dacr Af,t,c'1?. f sp. Other Plumb Insp. El hrs $47.00 C)rds��t Elea.!ns .
El--t-
11 t�as�. 1^.:r- 11"witb. Insp.Fee: Ilea.lntp. 14'e
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the mina information available and are onlyan estimate Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 Ef. 711113) FEE QTY/FEE MISC ITEMS
I
PME Plan Check: $0.00
>lq)pl. h1sp T'ee
PME Unit Fee: $24.00
PME Permit Fee: -T-F $47.00
("'On.wriection "1 trv.
Administrative Fee: IADMIN $44.00
Work Without Permit? ® Yes 0 No $0.00
1(,lvoncecl Planning 1`ces:
Travel Documentation Fee: 1TRAVDOC $47.00 A
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg:Stds Commission Fee: 1BCBSC $1.00
i75: $163.50 $0.00 TOTAL FEE: $163.50
Revised: 01/15/2014