14060001B-9
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11233 LA JOLLA CT
CONTRACTOR: AMERICAN
PERMIT NO: 14060001
RESIDENTIAL SERVICES OF CA
OWNER'S NAME: PEDROTTI DONALD G AND MIRIAM P
965 RIDGE LAKE BLVD STE 201
DATE ISSUED: 06/02/2014
OWNER'S PHONE: 4082535804
MEMPHIS, TN 38120
PHONE NO: (408) 982-0405
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
REPLACE DRAINS UNDER SFDWL
License Class 63fo Lic. # —1 low SS
Contractor A"cairao-u gf:5VEN-h*11_sERv.Date u1sh'i
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
Sq. Ft Floor Area:
Valuation: $8000
performance of the work for which this permit is issued.
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: 35621045 00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMITE IRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 8 YS 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
180 DAY M LAST CALLED INSPECTION.
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
918.
Signature Date 4 1L,41
RE -ROOFS:
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 Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Dater_
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
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
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
1
GENERAL PERMIT APPLICATIONb�MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION �6
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �OVy
(aUD
(408) 777-3228 • FAX (408) 777-3333 • buildina.Cerlino.orQ m I S
I J�6 1 .T Ir_ F7 m7rWe'nrirei_ 7-P.T.FCTRTCAL F—NUSCELLANEOUS
J11EP1vfisc.4pp_2011.doc revised 06/21/11
PROJECT ADDRESS
I APN I
1 233 L-A 34 LL74 Gt.-
OWNTERN.d.ME
DD N PEDR.6TT \
I PHONE E-��-
t10 8 253 -580
STRn—Er ADDRESS
CITY, STATE, ZIP ..FAX
I
112 3 1.-� 3'0 LUq C.T
c -e A P Lam' R T I u0 c_ YN C(50 1 "
CONTTACT NAME
PHONE E-I✓hII
I
,06 N P E.D P-0MV
L't 0 71 7-!F,6 -SFO Li
STREET ADDRESS
CITY, STATE, ZIP FAX
112 3 ?-A 3'eLLA C -T .
-
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,ter/
L`7 pq+, O Owim-BuaDER ❑ OtLN�EAGEAT
❑ CONTRACTOR ❑ COATIRACTORAGEN''T ❑ ARCrIITECT ❑ ENON—=R 11 DEVELOPER ❑ Tm\,ANT
CONTRACTOR NAME
LICENSE NUMBER LICENSE TYPE
BUS. LIC 4
R EScm: RDotBR
1 S C3lo
21S,04
COMPANY N.AN,E
E-MAIL
FAX
E �'t'61L
STREET ADDRESS
CITY, STATE, ZIP
I
I PHONE
PAROGOP PAL.
SAN76sc, e—A
uo$ 482-oyoS
ARCHTTECTIENGINEER NAME
LICENSE NUMBER
I BUS. LIC 4
COMPANY NART,
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX 2'—MULTI-FAMILY
PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES
IS THE BLDG AN ❑ YES
BL=ING: ri COMMERCIAL (
URBAN INTERFACE AREA SINGIO I FLOOD ZONE NO
EICHLER HOME? m --NO
DESCRIPTION OF WORK
(RF) i t'S EPL -"C-
NT
TOTAL VALUATION: 8 dC 0
RFCEIVEDS^` .ate —
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pr e o�A is behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building truction.
I authorize rApresentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent:
Date: 10 12 1 L/
SUPPLEMENTAL INFORMATION REQUIRED
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J11EP1vfisc.4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
WNW FFF F4TIMATOR — BUILDING DIVISION
L9c��tr, Ilan Che(j," Plumb. Plan Check 0.0 hrs $0.00 �ae'c. 1'rc3; C'a,>cic
?,,,, aw it Fee: Plumb. Permit Fee: IPPERMIT
CiP rcr iie<h. hl,v Other Plumb Insp.0.0 hrs $47.00 Urher !_h� c trzst,
irlec'ia..?t flha ilb, hasp, Fee l;(ara; Ins > 1 c:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Worms, rare, 3annary newer vastrict acnooi
L,... -.J .. sL,. ..1:.....
FEE ITEMS (Fee Resolution 11-053 Eft.' 711113)
ADDRESS: 11233 la Jolla ave
DATE:
REVIEWED BY: Mendez
APN:
BP#:
EVALUATION: 1$8,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: Reg. ®OT
PENTAMATION 1 RPR
PERMIT TYPE:
WORK
re lace drains underneath sfdwl
SCOPE
L9c��tr, Ilan Che(j," Plumb. Plan Check 0.0 hrs $0.00 �ae'c. 1'rc3; C'a,>cic
?,,,, aw it Fee: Plumb. Permit Fee: IPPERMIT
CiP rcr iie<h. hl,v Other Plumb Insp.0.0 hrs $47.00 Urher !_h� c trzst,
irlec'ia..?t flha ilb, hasp, Fee l;(ara; Ins > 1 c:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Worms, rare, 3annary newer vastrict acnooi
L,... -.J .. sL,. ..1:.....
FEE ITEMS (Fee Resolution 11-053 Eft.' 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$14.00
Plumbing
IPRREPIPE Re -Pipe Interior
Suppl. PC Fee: Reg. ®OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. ® OT
0,0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
C071sfrilcti{IPP t UV:
Administrative Fee:
1ADMIN
$44.00
0
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
A
Travel Documentation Fee: ITRA VDOC
$47.00
Strong Motion Fee:
1BSEISMICR
$0.80
Select an Administrative Item
Bldg Stds Commission .Fee: IBCBSC
$1.00
$139.801$14.00
. 3n TOTAL FEE:
$153.80
Revised: 04/01/2014
CITY OF CUPERTINO BUILDING PERMIT INSPECTION CARD
BUILDING ADDRESS: 11233 LA JOLLA CT
CONTRACTOR: AMERICAN
RESIDENTIAL SERVICES OF CA
PERMIT NO: 14060001
OWNER'S NAME: PEDROTTI DONALD G AND
IRIAM P
965 RIDGE LAKE BLVD STE 201
DATE ISSUE • 06/042014
OWNER'S PHONE: 4082535804
MEMPHIS, TN 38120
PHONE N (408) 982-0405
'INSPECTIONS
DATE INSPECTOR
F
BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH r
r
RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: REPLACE DRAINS UNDER SFDWL
/
�D G� 6 � D Zo q Xn C,I`l
o VVV
`' l
TT �7 I )
«l `� i J l h-1
/+�/�
l/l
FOUNDATION/PIERS/H.D.S.
UFER GROUND
PAD/SET BACK-CERT
I
I
GARAGE. SLABS/PREGUNITE
POUR NO CONCRETg` jXrIL-ABOVF HAS BEEN SIGNED
UNDERGROUND6LAB
UNDERGROUND PLUMBING
UNDERGROUND ELECTRICAL
j DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
UNDERFLOOR PLUMBING
'UNDERFLOOR
MECHANICAL
WILDLAND URBAN INTERFACE FIRE AREA ER#
TO ARRANGE INSPECTION
Call 777-3228 between 7:30 am and 3:30 pm Monday through Friday, at least 24 hours
before required inspection. Job address and Permit Numbers are needed when
requesting an inspection.
CUPERTINO SANITARY DISTRICT
Closed circuit video inspection of property line cleanout, point of connection
and street lateral required prior to passing FINAL CITY PLUMBING
INSPECTION. Call the District (408-253-7071) for an appointment.
NO BUILDING FINALS INSPECTIONS UNTIL ALL REQUIRED
BUSINESS LICENSES ARE OBTAINED
PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT
ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION.
IMPORTANT
When a permit has expired, a charge totaling one-half the fees to obtain a new permit
Inbe paid in order to reactivate the permit. If a permit has been expired for more
than one year, a charge totaling the full fees to obtain a new permit must be paid
t0 reactivate the permit.
NOTES:
SPECIAL INSPECTIONS Inspector: Date:
ROOF INSPECTIONS
PRE-INSPECTION: Inspector: Date:
TEAR-OFF: Inspector: Date:
PLYWOOD: Inspector: Date:
BATTENS: Inspector: Date:
IN PROGRESS: Inspector: Date:
Inspector: Date:
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION.
• OCCUPANCY OF BUILDING NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY
INSPECTOR
UNDERFLOOR ELECTRICAL
UNDERFLOOR FRAMING VENTS
UNDERFLOOR INSULATION
PLACE NO`SUBFLOOR'LJNTIL ABOVE HAS BEEN SIGNED
ROOF SHEATHING
i
ROUGH PLUMBING
'TUBS & SHOWER PAN
ROUGH MECHANICAL
ROUGH ELECFRICAUPOOL BOND
FRAMINGISTAIRS/E. EGRESS
INSULATION/VENTILATION
COVER NO avORK UNTIL ABOVE.HAS BEEN SIGNED
EXTERIOR SHE HOLD DOWN
1 INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR
EXTERIOR LATH/WSCREED
1
INTERIOR LATH
I NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED-
f SCRATCH COAT
�
SEWER/WATER
i
T-BAR/MECH/ELECT ABOVE CEIL-
j FINALS
ELECTRIC METER RELEASE
i
GAS TEST/METER RELEASE
GRADE - PUBLIC WORKS
FIRE — CALL (408) 378-4010
PLANNING (408) 777-3308
SANITARY (408) 253-7071
ELECTTRICAL
MECHANICAL
PLUMBINGFINAL:
HANDICAP
ENERGY
BUILDING
CERTIFICATE OF OCCUPANCY •
I