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14040007CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10183 ALHAMBRA AVE CONTRACTOR: PLUMBING TECH INC PERMIT NO: 14040007 OWNER'S NAME: WEYHE ROBERT I AND SHEILA A 278 E GISH RD DATE ISSUED: 04/01/2014 OWNER'S PHONE: 4087721928 SAN JOSE, CA 95112 PHONE NO: (408) 437 -6207 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL n DUPLEX 10183 & 10185- COPPER REPIPE FROM METER License Class Lic. # UNITS. 7 r� % Z TO Contractor 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: $6000 1 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: 32623026.10183 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT E IRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN YS 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 DAY M 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 Issued b Date: granting of this permit. Additionally, the applicant understands and will comply y' with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. RE- ROOFS: Signatu% 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 25 5, 25533, d 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 CONSTRUCTION LENDING AGENCY 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 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 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 �gY.lsss 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�cupertino.org MISC rya ...�,,T- M1,A- Cf'UAwrrrAr FIRTR(`TRT(AT. nMISCELLANEOUS U YLUIV1LSllVlT - I,J tvat..�.i uzi. aa..r,•. u------ - - -"-- - PROJECT ADDRESS APN # X13 �Z� do 3 OWNER NAME �O ¢ � r 1 Q � w PHO 071V0 % -T Z'" , Q 2 � /, E-MAIL STREET ADDRESS CITY, STATE ZIP FAX CONTACT NAME 4c:, PHONE LOOP r /p 3 SAO Z / E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ ORNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Pum Tech LIC E NUMBER �3 Z LICENSE TYPE BUS. LIC # O 5-7 COMPANY NAME E -MAIL FAX r STREET ADDRESS I S I Y G+ CITY, STATE, ZIP sQ n \ J O S � (J�f J PHO" o G yq 3 J O M ARCHITECT/ENGWEERNA6 E LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTT•FAMti.Y PROJECT IN WWLAND ❑YES PROJECT IN ❑ YES ❑ NO FEICHI.ER THE BLDG AN YES HOME? ❑ NO BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE DESCRIPTION OF WORK 1:1 f TOTALVALUATTON:1tECEIVED we By my signature below, I certify to each of the following: I am the property owner or authorized agent to act t property owner's behalf. I have read this application and the information I have provided is.correct. I have read the Description of Work and verify it is a ate. I agree to comply with all applicable local ordinances and state laws relating to buildin construction. authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIREDroFcEUSEOlt� N r+- 5 -;-- -� �' .mac• :'xF� y� _pa 3�gg xmm STANDARDr IBM }ARGE MEPMiscApp_2011.doc revised 06121111 �� CITY OF CUPERTINO UV U V C'rTM A 9rnU — RT TTT .D1NV T)TVIRION NOTE: This estimate does not include fees due to other Departments tie. riammng, ruanc rrurno, x tic, .�uuoouiy ��•. Contact the Deot for addn °l info. FEE ITEMS (Fee Resolution 11 -053 Ef . 7/U13) ADDRESS: 10183 alhambra ave DATE: 04/01/2014 REVIEWED BY: Mendez APN: BP #: 'VALUATION: $6,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex Suppl. PC Fee: Reg. ® OT PENTAMATION 1RPRP I PERMIT TYPE: USE: $0.00 PME Plan Check: $0.00 woRK duplex 10183 & 10185- copper re i e from meter to units... Permit Fee: SCOPE Suppl. Insp. Fee :Q Reg. ® OT NOTE: This estimate does not include fees due to other Departments tie. riammng, ruanc rrurno, x tic, .�uuoouiy ��•. Contact the Deot for addn °l info. FEE ITEMS (Fee Resolution 11 -053 Ef . 7/U13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 I—! 1 # $14.00 Plumbing IPRREPIPE Re -Pipe Interior Suppl. PC Fee: Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee :Q Reg. ® OT O,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 (101 7'5 �Ft'lum IC7.V: Administrative Fee: IADMIN $44.00 L 0 E) Work Without Permit? ® Yes (F) No $0.00 Advanced Plannim Fee: $0.00 Select a Non - Residential Building or Structure, E) Travel Documentation Fee: ITRAVDOC $47.00 Strom Motion. Fee: IBSEISMICR $0.60 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 ? $139.60 $14.00 _1­; TOTAL FEE: $153.60 Revised: 01/15/2014