14050025 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22913 LONG DOWN RD CONTRACTOR:CONSOLIDATED PERMIT NO: 14050025
PLUMBING INC
OWNER'S NAME: LODEN WILLIAM A AND CAROL D 3732 CHARTER PARK DR STE D DATE ISSUED:05/02/2014
OWNER'S PHONE: 4085991977 SAN JOSE,CA 95136 PHONE NO:(408)978-3093
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
/ REPAIR&REPLACE AS NEEDED(E)SEWER LINE.
License Class 3 Lic.# 0 Z INSTALL
n�`IL (N)PROPERTY LINE CLEANOUT(HOA LETTER REC'VD)
Contractor V L� � Date �" 2
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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$20000
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:34240006.00 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 WITBIIN 180 D + PERMIT SUANCE 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 DA OM LAST C INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, /2
costs,and expenses which may accrue against said City in consequence of the Date: 3 l
granting of this permit. Additionally,the applicant understands and will comply
with all non-point sour egulations the Cupertino Municipal Code,Sectio
I--,-
918.
RE-ROOFS:
Signature ate 2 y 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)
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 Qu Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cu Mun' ipa Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 505 25 and 5534.
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
GENERAL PERMIT APPLICATION �O
MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �V
(408) 777-3228•FAX(408)777-3333•building(ftuoertino.org 1 S C
CUPFERTNO
PLUMBING ❑MECHANicAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS J�2 q13 I j APN# 2 Z O — 0 O 6
OWNTERNAME PH �J9,� E-MAII.
dAw ALI
STREET ADDRESS CITY, STATE,ZIP. `, r I FAX
CONTACT NAME d PHONE rgry�J E MAIL
STREET ADDRESS CITY,S ATE ZIP FAX r 9 70
❑ OWNER ❑ OVR.IER-BUaDER ❑ OWNER AGENT R-6DNIRACTOR ❑CONTRACTOR AGENT ❑ ARCe cT ❑ENGA'EER ❑ DEVELOPER ❑TENANT
CONTRACTOR N LICENSE NUMBER /� ^ LICENSE TYPE„^� BUS.LIC#
,r.
COMPANY NAME / E-MAIL
STREET ADDRESS CITY,STA IP30-e L t4 �� PH /� ,�,3
r1r
ARCHTTECTXNGWEER NAME LICEA'SE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMII,Y PROJECT IN w'DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN n TERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK �jy,/ r
4�'J�(/ l
rte'
. r
TOTAL VALUATION: EIVED �
By my signature below,I certify to each of the following: I am the property owner or authorized agent the p owner's behalf.1.4WTfad this
application and the information I have co ead a Description of Work and verify it is accurate. I agree to com all applicable local
ordinances and state laws rela' o buildin c' author' r presentatives of Cupertino to enter the above-identified perty for inspection purposes.
0.Signature ofApplican gen Date:
SUPPLEMEI�rTAL OR.MATION REQ LURED
�VFRTHJrCOLTiTE
;rte-- - _ ._._-..,, _•.-�=
a _� R
4
MEPMisc.4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
IQ] ADDRESS: 22913 LONG DOWN RD DATE: 05/02/2014 REVIEWED BY: MELISSA
APN: 342 40 006 BP#: "VALUATION: 1$20,000
xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARYPENTAMATION 1 RPSS
USE: SFD or Duplex PERMIT TYPE: i
WORK REPAIR & REPLACE AS NEEDED E SEWER LINE. INSTALL N PROPERTY LINE CLEANOUT
SCOPE (HOA LETTER REC'VD)
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $24
TOTALS: $24.00
iA,ch. 1'kwra(..'Aw(k Plumb.Plan Check 0.0 hrs $0.00
Plumb.Permit Fee: IPPERMIT
O�?3�.r. ,fr,t-zz, -•;•,,. Other Plumb Insp. 0.0 hrs $47.00
Lj
11171 1h. Inst;. Fee: Is7e(-.Inst PC":
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prelimina information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7f /1/13) FEE QTY/FEE MISC ITEMS
:5'rppl. I'C'Pee
[PME Plan Check: $0.00
PME Unit Fee: $24.00
PME Permit Fee: $47.00
(,on,.vr zwiion 1irx
Administrative Fee: 1ADMIN $44.00
Work Without Permit? ® Yes (j) No $0.00
,Ie;.'vojfced P1,111"lirig Fees:
Travel Documentation Fee: ITRAVDOC $47.00 i
Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldp,Stds Commission Fee: IBCBSC $1.00
TOTAL FEE: $165.00
a $165.00 $0.00 :s
Revised: 04/01/2014
he
q�1\NiTq,py 20 STEVENS CREEK BOULEVARD,SUITE 100
CUPERTINO,CALIFORNIA 95014-2154
PHONE(408)253-7071.FAX(408)253-5173
www:cuoertinosanitarvdistrict.com
RECEIPT OF FEES
Receipt No: 4929 Received from: Consolidated Plumbing
Date: 5/1/2014 Address: 3732-D Charter Park Dr,San Jose 95136
Check No: 4277 ABA No: 907.78/1211 Bank Name: Bank of thw a Westg
Amount of: lone Thousand,Two Hundred Dollars&00/100boa dollars
Property Location: APN: ,Tract No: Other: 408-978-3093
Address: 22913/22903/22893-J22946 Longdown Road,Cupertino(De Anza Oaks) Job No:
RECEIVED FOR THE PURPOSE OF: (Account No) AMOU
1. Connection`Fees Zone No: Reim6ursemenfAgreement:
a. Acreage
Acres at$ �./Ac. (31031)
b. Front Footage
Front Ft."at$ Ft. (31032)
c. Additional Dwelling"Unit
unit at$ /Ea. (31033)
d. Additional Commercial]Industria!
`Gallons at$ (Gal. (31034)
e. Special Benefit Zone.-
2.
one:2. Checking Inspection Processing Deposit (31040) 1$1,200.00
Sewer Inspection Fee(x's 4)(new P/LC/0)
3.
TOTAL $1,200.00
MARK THOMAS AND COMPANY,INC.
District Engineer Manager by: r
Page 1 of 1
COMMUNITY MANAGEMENT SERVICES
March 18,2014
To Whom It May Concern
Re: De Anza Oaks Homeowners Association
Dear Sirs:
Consolidated:Plumb:ing 'Inc. has the association's permission to seek permits for the repairs of any domestic
water lines or sewer lines located within the De Anza Oaks community.
Sin(Ana
Coty'Managainem Services, Inc.
Bilard,'tAssociation Manager
DeOWs 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