14040031 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10121 ORANGE AVE CONTRACTOR:ADVANCED PLUMBING PERMIT NO: 14040031
TECHNIQUES
OWNER'S NAME: JUAN GARCIA 1023 BLAZIN WOOD DR DATE ISSUED:04/04/2014
OWNER'S PHONE: 4082536310 SUNNYVALE,CA 94089 PHONE NO:(408)396-8071
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL El COMMERCIALE]
3LtP COPPER REPIPE
License Class/l� Lic.#
Contractor 1 Mfg! 01 VO
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:$3700
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:35716097 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 A 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 F O LAST CALLED INSPE TION.
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 Issued by: Date:
with all non-point source ations per the Cupertino Municipal Co e,Section
918.
RE-ROOFS:
Signatur 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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)
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. 1 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,Chapterl.11 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 05,25533,and 25534.01
��99
Section 3700 of the Labor Code,for the performance of the work for which this Z(i
Owner or authorized agent: l Dat .�
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 hat 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
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a .org MISCV
CUPERTINO
PLUMBING ❑MECHANICAL ❑ELECTRICAL MISCELLANEOUS
PROJECT ADDRESS \ (/ APN# ��
OWNERNANM ` � PHO �l
STREET ADDRESS CITY, STATE,ZIP. I FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWIER-BUIIAER ❑ 0 AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ AR CI ❑ENGINEER ❑ DEVELOPER ❑TENANT
CO CTOR N "'C, "7E TYPE BUS.LICtvt—
ITO
#
Y N4"% E-MAIL FAX
ANh _
STREET ADDRESS CITY,STATE ZIP
( V l
ARCHTTECT/ENGWEER NAME LICENSE NUMBER. BUS.LIC it
COMPANY NAME EMAIL FAX
STREET ADDRESS MY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT INWBALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
3F
TOTAL VALUATION:
By my signature below,I certify to Elfch of the follo . I am the property owner or authorized agent to act on the -AmerIs behalf. I have read this
application and the information I have provideqja5Kect. read the Description of Work and verify it is accurate. I a e to comply vrith all applicable local
ordinances and state laws relating to buil ' c tru I thorize presentatives of Cupertino to enter the above-illentilied property or inspection purposes.
ITSignature of Applicant/Ai- Date: M I
CEMEN -61
T INFO REQUIRED '
ORFJCE USE 011TsS
�DV�ER�THE-COUNT�R ,y,-�,,.
Nor,�XPRESS
9 �Fa ST�A1�'IIARD 5 �'
Mm
T.7RG
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10121 orange ave DATE: 04/04/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$3,700
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTAMATION 1 RPDP
USE: P PERMIT TYPE:
WORK copper re i e
SCOPE
n +
Plan Aja(.k. Plumb.Plan Check 0.0 hrs $0.00 1,ie,,:. Plan
F""<re; Plumb.Permit Fee: IPPERMIT 1 ' -
r
Other Plumb Insp. 0.0 hrs
Plunih. lusp. !''cue; Is'7<zc. Irgr) 1°,e,
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
p� District,etc.). Theseees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 in o.
FEE ITEMS (Tee Resolution 11-053 E(f. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 0 # Plumbing
Suppl.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $47.00 IPREPPIPE Piping,Area
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee:Q Reg. ® OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
CU72stnicTion Tax:
Administrative Fee: IADMIN $44.00 0
Work Without Permit? ® Yes F; No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure A
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
C, 139.50 $47.00 TOTAL FEE: $186.50
_ $
.,, ' ._ _ i
Revised: 04/01/2014