14040055CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10146 ALPINE DR CONT RACTOR:
.r "e-
PERMIT NO: 14040055
OWNER'S NAME: AVRAM MEYERS AND GALE MEYERS
DATE ISSUED: 04/09/2014
OWNER'S PHONE: 4155156644
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
RE -PIPE ALL GAS LINES FOR UNIT 1 ONLY, 5 FIXTURES
LicenseClassL3& Lic.``# -l�3 `23
TOTAL
Contractor Date 4-9 —11
I hereby affirm that I am licensed under Me 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.
arm under penalty of perjury one of the following two declarations:
tffireby
ve and will maintain a certificate of consent to self - insure for Worker's
pensation, 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: $2000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32615105 00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
ertify 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 DAYS 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 FROM LA LLED 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
Date:
granting of this permit. Additionally, the applicant understands and will compl
Y
with all non -point source r s per the Cupertino Municipal Code,
All roofs shall be inspected prior to y roofing material being installed. If a roof is
any roofing
9 18.
Signat ... ��- Date qq r�
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)
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 the Ct unicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Co c ion 5, 25533, a 25534.
Section 3700 of the Labor Code, for the erformance of the work for which this
p
Owner or authorized wi._ Date: i
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
918.
Signature Date
GENERAL PERMIT APPLICATION b� MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building
GUpEEt`T" INO (foupertino.org a MISC
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PROJECT ADDRESS O, � � ^
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APN # 2—a — )S ,jam 0-5
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OWNER NAME (�.
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CONTACT NAME
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STREET ADDRESS
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❑ OWNER ❑ OWNER -B=ER ❑ OWNER AGENT a CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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COMPANY NAME �
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ARCHITECTMNGINEER NAME
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BUS. LIC #
COMPANY NAME
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STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX MULTI - FAMILY
BUILDING- ❑ COMMERCIAL - -
PROJECT IN WIIALAND ❑ YES
URBAN INTERFACE AREA NO
PROJECT IN
FLOOD ZONE ❑ NO
IS THE BLDG AN El YES
EICHLER HOME? E NO -
DESCRIPTION OF WORK
`fur
TOTAL VALUATION: (mac✓ V
J PBXz� '.
By my signature below, I certify oll
application and the info n I have provid I .correct.
ordinances and state la relating to building co tructio
Signature of Applicant/Agen
I am the property owner or authorized agent to act pe wner's behalf �a�lica
have read the Description of Work and verify it is acc agree to c y with a�1�c
authorize representatives of Cupertino to enter the ab 6 property for inspection _.!I rposes.
�� Date:
SUPPLEMENTAL INFORMATION REQUIRED
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
TTF 11T CT11%4ATnJ2 — RITII.nING DIVISION
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Piping, Gas >4 Outlets 1BPGAS 5 # $350
TOTALS: „ . $350.00
Nan sic Plumb. Plan Check 0.0 hrs $0.00
1 iPJI Pc,-1 t I'e>r>; Plumb. Permit Fee: 1PPERMIT
CJrJW , Af(,ch. fn,v, - Other Plumb Insp. 0.0 hrs $47.00 ET
z( : Phold), Trish), Tee: 1 `iec. z »Ft
NOTE: This estimate does not include fees due to other Departments (i.e. rtanning, runic rvorKs, rtre, aunttury newer tf 9, inn we
r___ - L. __.J __ sL_ ..I-- ...fn.. nAn ...7..h /o Dad aro nnhi an octimate Cnntact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Eff. 711113)
ADDRESS: 10146 ALPINE DR UNIT 1
DATE: 04109/2014
REVIEWED BY: MELISSA
APN: 32615105
BP #:
`EVALUATION:
1$2,000
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Multi - Family Dwelling
Building is
>3 Stories 0 Yes (D No
PENTAMATION 1 RPGAS
PERMIT TYPE: A
WORK
RE -PIPE ALL GAS LINES FOR UNIT 1 ONLY 5 FIXTURES TOTAL
SCOPE
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Piping, Gas >4 Outlets 1BPGAS 5 # $350
TOTALS: „ . $350.00
Nan sic Plumb. Plan Check 0.0 hrs $0.00
1 iPJI Pc,-1 t I'e>r>; Plumb. Permit Fee: 1PPERMIT
CJrJW , Af(,ch. fn,v, - Other Plumb Insp. 0.0 hrs $47.00 ET
z( : Phold), Trish), Tee: 1 `iec. z »Ft
NOTE: This estimate does not include fees due to other Departments (i.e. rtanning, runic rvorKs, rtre, aunttury newer tf 9, inn we
r___ - L. __.J __ sL_ ..I-- ...fn.. nAn ...7..h /o Dad aro nnhi an octimate Cnntact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
Slippr. roc,1,ec
FA
PME Plan Check:
$0.00
Ilennii TY,e.'.p
PME Unit Fee:
$350.00
PME Permit Fee:
$47.00
I L
�..tJd'.7t'7?C'ZiOit i cli:
I
I
Administrative Fee: 1ADMIN
$44.00
Work Without Permit? ® Yes No
$0.00
dtiurrce�c 1Plarrning, Ifees:
A
Travel Documentation Fee: 1TRAVDOC
$47.00
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission .Fee: IBCBSC
$1.00
$489.50
$0.00 TOTAL FEE:
$489.50
Revised: 04/01/2014
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08 DdoR 5
2011. ` A C
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RA
CUPERTINO
Building Department
2014
�., APR 0 8
REVIE VED FOR CODE COMPLIANCE
Reviewed By.
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APR 9 201, Depar'77ent
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` COMMUNITY DEVELOPM NT DEPARTMENT
h BUILDING DIVISION CUPERTINO
-APPRO E®
is set of plans and specifica ns MUST be kept at the
v Job site during ccpstruction. is unlawful to make any
t + changes or 'alterations or ame, or to deviate
v therefrom, without approval om the Building Official.
he �t �moi s :s ls.n a "J-4 ficatir ns S I�LI NOT
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` COMMUNITY DEVELOPM NT DEPARTMENT
h BUILDING DIVISION CUPERTINO
-APPRO E®
is set of plans and specifica ns MUST be kept at the
v Job site during ccpstruction. is unlawful to make any
t + changes or 'alterations or ame, or to deviate
v therefrom, without approval om the Building Official.
he �t �moi s :s ls.n a "J-4 ficatir ns S I�LI NOT
.o ai 'N? L am. k l
l ...�i
r �
�.. c.m €ir.i.h4'i P• J^ .s a��VV Qi '.CIL:% Law.
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