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14040121 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10406 S FOOTHILL BLVD CONTRACTOR:7j,f P41(n PERMIT NO: 14040121 OWNER'S NAME: LEE KENNETH M AND DAISY DATE ISSUED:04/18/2014 OWNER'S PHONE: 4088582802 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] License Class ""� 3(> Lic.it 2 REPLACE MAIN WATER LINE WITH V COPPER/PVC -� }� Contractor �cl ��` ��' Date l G 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:$1500 Jhvve 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:35703072.10406 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 DAYS OF PERMIT I DANCE 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 FRO CALLED I CTION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issue Date: f granting of this permit. Additionally,the applicant understands and will comply with all non-point sourc ® er pertino Municipal Code,Section 918. RE-ROOFS: Signature Date 1 t� 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 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. 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 perfonnance of the work for which this permit is issued. will maintain compliance with the Cuperti icipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec' ,25533 n 534.Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ent. Date:48t y 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 GENERAL PERMIT APPLICATION x E p COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION j\V 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 [VI Is C GUp>`E TItJO (408) 777-3228•FAX(408)777-3333•building(a1cupertino.orp \ PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS U PROJECT ADDRESS t �/I("1 S ('_'.�� ' , I APN# /'� 1..)+� /ry�1 � ♦ I /h O OwN`ER NAME \L(�/��V T�Q� PHONE E-MAIL � ,I 1 �j 144- STREET ADDRESS r' C� AP,ZIPr/Y� I FAx CONTACT NAME PHONEJ6 —5C6,2-00Z-Z- L�J eL. IZd77��0�CL1�'I STREET ADDRESSCTTY . ZIP J .� C i4- ^!�� s/ FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT S.}CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAM LICENSER LICENSE TYPE_316 BUS.LIC# COMPANY NAME ` E-MAILFAX 111114 �r 27 32tS� LCIS C-� 701 O 3Z PpONdE �E -28STREET RESS. C,09 42 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF WFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WIIALAND ❑ YES PROJECT IN ❑YES Is THE BLDG AN ❑YES BUII DING: ❑COMMERCIAL URBAN INTERFACE AREA wo FLOOD ZONE P-NO EICHLER HOME? ,;-NO DESCRIPTION OF WORK �1 r �m TOTAL VALUATION: Iix ` A By my signature below,I certify to each of am a roe ie author' agent to a roperty ovmer's read this application and the information I ha ovlded' ave lead the Descriptio Work and verify it is accurate. I agree t mply with all applicable local ordinances and state laws relating to b co es of Cupertino to enter the above-identiried property for inspection purposes. Signature of Applicant/A Date: PLEMENTAL INFORMATION REQUIRED an or zeJSEoiYr ; . .��AVER TH)iCOIINTE��`� = .zr - �� m- E3 PRESSE.'�-:��I Ea : v _ _ 6 21 � STANDA1tD�a�� i IS— �ZAIFG ` s E - MEPMisct4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION 12ADDRESS: 10406 S FOOTHILL BLVD DATE: 04/18/2014 REVIEWED BY: MELISSA APN: 357 03 072.10406 BP#: *VALUATION: $1,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY TVPEN-TAM-ATIONMI.TY1 RPWS USE: SFD or Duplex PERMIT TYPE: i WORK REPLACE MAIN WATER LINE WITH V COPPER/PVC GRANNY UNIT SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Service 1BPWSVCS 1 # $24 TOTALS: $24.00 1007�pffl-1 1,54 jN a .+ ma .N v,_�<ar Play,f.`Ii<rk Plumb.Plan Check 0.0 hrs $0.00 rrldif Fee: Plumb.Permit Fee: IPPERMT 0--t- - Other Plumb Insp. 0.0 Fhrs $47.00 oilwe' 9 fe�ci=. hzst3. I<:e: phimb Insp. Fee: Lice.It sp k cc: 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 relimina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check PME Plan Check: $0.00 Perlt,fii Fee: afjs/:T. 111q)Fee PME Unit Fee: $24.00 PME Permit Fee: $47.00 (.,011s1rucT17on, Tax; Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes (F) No $0.00 �l•r'�;;�r:t'e'c#�l�l<trt�titt€T I'`t'c'S': Travel Documentation Fee: 1TRAVDOC $47.00 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 V 117 I MAN' $163.50 $0.00 TOTAL FEE: $163.50 Revised: 04/01/2014