14050024 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22903 LONG DOWN RD CONTRACTOR:CONSOLIDATED PERMIT NO: 14050024
PLUMBING INC
OWNER'S NAME: JOAN ALLAN TRUSTEE 3732 CHARTER PARK DR STE D DATE ISSUED:05/02/2014
OWNER'S PHONE: 4085325346 SAN JOSE,CA 95136 PHONE NO:(408)978-3093
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
REPAIR&REPLACE AS NEEDED(E)SEWER LINE.
License Class 6 Lic.# INSTALL
C`` ` `PLUVYI Date (N)PROPERTY LINE CLEANOUT(HOA LETTER REC'VD)
Contractor �- Z_ � �
I hereby affirm that I am licensed under the provisionsof 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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$20000
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:34240005 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 DAYS HT 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 LED 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 Issu Date: S 2
granting of this permit. Additionally,the applicant understands and will comply
with all non-point s urce lations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature Date _2 ( l 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. 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,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 , 5533,a 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:,� 2�'
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 l� MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 V
(408) 777-3228•FAX(408)777-3333•buildina( cupertino.org
CUpEAT.
tNO MISC\
PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑NUSCEL/L,ANEOUS
PROJECT ADDRESS
APN# 3 I Z - U
OVTI\TER NAMEe—, PHONE E-MAIL
A 'd Aliody I
STREET ADDRESS �VCITY,STA ,ZIP �� I FAX
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CONTACT NAZ fE PHO } 5 77 E �
STREET ADDRESS �. J CITY, ATE,ZIP / F -
❑ OWNER ❑ OWNER-BUILDER ❑ OWNM AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR N LICENSE NUIMER� LICENSE TYPE BUS.LIC r
COMPANYNAMEC/GEMAIL F
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STREET ADDRESS n CITY,STATE ZIP PHO ��_�3
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ARCHITECT/ENGINEERNAME LICENSE NUMBER. BUS.LIC
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI•FAMII Y PROJECT INWILDLAND ❑ YES PROJECT IN ❑YES IS=BLDG AN ❑YES
BUILDING ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO -
DESCRIPTION OF WORK
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TOTAL VALUATI
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ON. ' �v_ - " �-•�
By my signature below,I t aah of the following: I mer or authorized agent to act on th o vtim f. I have read this
application and the information I have provide rrect. I hav a the es I' of Work and verify itis ac te. I agree comply vdth all applicable local
ordinances and state laws relating to bu' g cons o repre a' s of Cupertino to enter the above-ide tified pro rty for inspection purposes.
Signature of Applicant/Agent: Date:
PLO ON REQUIRED —ice
NTAL '
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-ate-
MEPMisc4pp_M1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
kADDRESS: 22903 LONG DOWN RD DATE: 05/02/2014 REVIEWED BY: MELISSA
PN: 342 40 005 BP#: VALUATION: 1$20,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY PENTAMATION 1 RPSS
USE: SFD or Duplex PERMIT TYPE:
WORK REPAIR& REPLACE AS NEEDED E SEWER LINE. INSTALL N PROPERTY LINE CLEANOUT
SCOPE (HOA LETTER RECVD)
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1 PRSEWER 1 # $24
TOTALS: $24.00
i..ALe-Ci;
Plumb.Plan Check 0.0 hrs $0.00 Eiuc' Pi'm Chcc'lc
",:1'_ t'r:a It Fee: Plumb.Permit Fee: 1PPERMIT
Other Plumb Insp. 0.0 hrs $47.00 1nsp.
NOTE. This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etG). These fees are based on the prelimina information available and are onl an estimate. Contact the Dept for addh7 info.
FEE ITEMS (Tee Resolution 11-053 Eff 7/1/131 FEE QTY/FEE MISC ITEMS
l hin C'hcc k
.S'trppL I'(;Fee
PME Plan Check: $0.00
Sc,ppl. Irisp f ei�
PME Unit Fee: $24.00
PME Permit Fee: $47.00
I"onstruco On p
Administrative Fee: 1ADMIN $44.00
Work Without Permit? 0 Yes (F) No $0.00
l,77L'Utlf.°t'Cl l�rJt7f'i?I Yt£?Fees:
Travel Documentation Fee: ITRAVDOC $47.00 i
Strom:Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg,Stds Commission Fee: IBCBSC $1.00
° ¢ trB° tnS $165.00 $0.00 TOTAL FEE:. $165.00
Revised: 04/01/2014
p s► dpy. 2STEVENS CREEK BOULEVARD,SUITE 100
�4 ��`j• CUPERTINO,CALIFORNIA 95014-2154
w �' PHONE(408)253-7071.FAX(408)253-5173
www.cunertinosanitarydistrict.com
RECEIPT OF FEES
Receipt No: 4929 Received from: lConsolidated Plumbing
Date: 5/1/201 Address: 3732-1)Charter Park Dr,San Jose 95136
Check NO: 14277 ABA NO: 90-78/1211 Bank Name: 113ank of the Westg
Amount of: lone Thousand,Two-Hundred Dollars&00/100)x= dollars
Property location: APN: 177, 7,! Tract No: Other: 408-978-3093
Address: 22913/22903/22893122946 Longdown Road,Cupertino(De Anza Oaks) Job No:
RECEIVED FOR THE PURPOSE OF: (Account No) AMOU
1. Connection Fees .Zone No:. Reimbursement Agreement:
a. Acreage
Acres at$ /Ac. (31031)
b. Front Footage
Front Ft.at.$ Ft. (31032)
c. Additional Dwelling Unit
Unit at$ /Ea. (31033)
d. Additional Commercial/Industrial,
Gallons at$ /Gal: (31.034)
e. Special Benefit Zone: ( )
2. Checking Inspection Processing Deposit (31040) $1,200.00
Sewer Inspection Fee)es 4)(new P/L C/O)
3. ( )
O
TOTAL $1,200.00
MARK THOMAS AND COMPANY,INC.
District Engineer Manager by: Ath
Page 1 of 1
COMMUNITY MANAGEMENT SERVICES
March 18,2014
To Whom It May Concern
Re: De Anza Oaks Homeowners Association
Dear Sirs:
Consolidated Plumbing, Inc.has the association's permission to seek permits for the repairs of any domestic
water lines ar sewer lines located within the De An Oaks community.
Since
Co munity Manag nent Services, Inc.
r
Bill 1` ubbard;)Association Manager
De Ate a Oak's Homeowners Association
BH/st
cc: Board of Directors
1935 Dry Creek Road, Suite 203■`Campbell,CA 95008-3631 •voice (408) 559-1977 fax(408) 559-1970