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14050072 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21107 RED FIR CT CONTRACTOR:CMS PLUMBING PERMIT NO: 14050072 OWNER'S NAME: HO GILBERT D AND JEAN C ET AL 3891 CAMDEN AVE DATE ISSUED:05/12/2014 OWNER'S PHONE: 4085106700 SAN JOSE,CA 95124 PHONE NO:(408)828-6700 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL �9 �© INTERIOR REPIPE License Class`'��G Lic.# TO� /� / Contractor l_/1 (�/` J f Date ` I hereby affirm that I am licensed no er 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:$3000 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:35905040.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPHIES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 18 AYS 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 LAST CALLED 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 Issued by: Date:(5/0-/1-7/ granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. �� G( RE-ROOFS: Signature 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 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 performance of the work for which this permit is issued. will maintain compliance with the Cupertino nicipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25 ,and 25534. G 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 918. Signature Date GENERAL PERMIT APPLICATION ^^a P ' 1 1W COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION � ' 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 MMM I S C (408) 777-322la� 8•FAX(408)777-3333•build!nocupertino.org CUPS i`r[No UMBING ❑MECHANIC-AL ❑ELECTRICAL ❑MISCELLANEOUS PROTECT ADDRESS APN# q0 .` (_y OVTNERNAME \ ` PHONE yp�r�/OrQV E-NLAIIVl� alaAQ STREET ADDRESS CITY, STATE,ZIP. I FAX CONTACT NAME�v PHO E 1J�°II STREET ADDRESS CITY,STATE,ZIP / FAX [3 OWNER ❑ OWNER-BUILDER 13 OWNER AGENT CONTRACTOR 11 CONTRACTOR AGENTT ❑ ARCrIITECT ❑ENGINEER CIDEVELOPER ❑TENANT CONTRACTOR NAME n �_ D LI ENUIJB£R LICENSE B BUS.LIC COMPANY NAME t I(>•b( E tTE STREET ADDRESS Ve S O- CCITY_Y STATB Z /f C ARCHITECT/ENGINEERNAME YLIICENSENUNBER. (/ BUS.LIC# t� COMPANYNAME B-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX MULTIFAMILY I PROJECT IN WIIALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ITS BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK (� 11 6 p d 'Now -3 : TOTAL VALUATION: �a ME"75 K-10- By fi ,z ` sN ; my signature below,I certify to each of the following: I am the property owner or authorized agent to Zt e property owner's behalf. I have read this application and the information I have provided is corre . I haver ad the Description of Work and verify it is accurate. I agree to comply With all applicable local ordinances and state laws relating to Iding construe on I au ize. epresentatives of Cupertino to enter the above-identified property for inspection purposes. S i pature of Applicant/Agent: Date: SUPP NTAL II\TFORMATION REQUIREDI an 11"Off 10500-10h:7141-6 ._ OFFTCE1TSk}ANI ' Qj - EJt'PRESS ': MEPMi3a4PP_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION W-PERMIT DDRESS: 21107 red fir ct DATE: 05/12/2014 REVIEWED BY: Mendez PN: BP#: EVALUATION: $3,000 PE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY __FPENTAMATION 1 RPRP USE: SFD or Duplex PERMIT TYPE: WORK re i e SCOPE SEMR AM t .n Ltcclr l°I t�€ c Plumb.Plan Check 0.0 hrs $0.00 Iiezr.1' zn C:`h�c% bli>-c`1. 1'errtrit Fee; Plumb.Permit Fee: IPPERMIT P, f'cec: �� tr�a• c c°1i. ��,>. Other Plumb Insp. 0.0 hrs $47.00 olher 1,7ec Inst. 1Tr°cr. Ciisl�.f at phallb. hsq). Fee: />'lec.Ino}5 P,v: 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 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F—T-1 # Plumbing Suppl.PC Fee: Q Reg. 0 OT r070 hrs $0.00 $14.00 1PRREPIPE Re-Pipe Interior PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Feer Reg. 0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 (.`rpt, N't Cr.On T�Tv: Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes (F) No $0.00 1 G Advanced Planning.Fee: $0.00 Select a Non-Residential G Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure , Strong Motion Fee: 1BSEIS1vffCR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 B =9QrIS. $139.50 $14.00 TOTAL FEE: $153.50 Revised: 04/01/2014