14070028 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10992 SWEET OAK ST CONTRACTOR:WATER QUALITY PERMIT NO: 14070028
PLUMBING
OWNER'S NAME: BALLOU RICHARD AND REASA 1860 ALMADEN RD DATE ISSUED:07/09/2014
OWNER'S PHONE: 4083913211 SAN JOSE,CA 95123 PHONE NO:(408)267-9330
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
/ /�y� COPPER REPIPE
License Clasp_3`J Lic.# zs>o"JO
Contractor\ �(L1�1 I `$Date 1
z
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:$7400
have and will maintain Worker's Compensation hisurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32651058.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is PERMIT ORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 80 DAYS OF P IT 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 OM 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
granting of this permit. Additionally,the pplicant understands and will comply Issued by: Date:
with all non-point source ulations per a Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signat Date , 7 All roofs shall be inspected prior to any roofing material being installed.If a roof is
14 installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER D CLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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 Cupertit1pJ,%1unicipalJCode,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505, - d 2 34.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age
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
GENERAL PERMIT APPLICATION MEP
13 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION U�
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinge-cupertino.org MISC
LUMBING MECHANICAL ELECTRICAL ❑NHSCCEE{L�LArNC'EOUS
PROTECT ADDRESS <7(?g ol/�� APN# 2
OWNER NAME PHONE _ G E-MAIL;06
STREET ADDRESS W` 1 CITY,STATE,ZIP A/
CONTACT
t_
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 1r ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#n.
COMPANY NAME r EMAIL FAX OG SbL CD
STREET ADDRESS CITY,STATE,ZIr PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF Ai FD or DUPLEX ❑ MULTI FAMI Y PROJECT IN WBALAND ❑ YES PROTECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO IICHLER HOME? ❑NO
DESCRIPTION OF WORK f�
Ci 1
TOTAL VALUATION: (/00'UU RECEIVBDY-
By my signature below,I certify to each of the following: I am the pro erty owner or authorized agent to act on the pro rty owner's be f I have read this
application and the information I have provi ect. I have r e Description of Work and verify it is accurate. I agre comply with all applicable local
ordinances and state laws relating to building frac ori presentatives of Cupertino to enter the abo a-ide ' ied property for inspection purposes.
Signature of Applicant/Agen Date: 1
SUPPLEMENTAL INFORMATIrON REQUIRED ti`�o vSEONLY
,---
OVER-TH&COUNTER
EXPRESS
STANDARD
pt
' LARGE
U%MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10992 sweet oak st DATE: 07/09/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$7,400
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPR
USE: PERMIT TYPE:
WORK copper re i e
SCOPE
Plumb.Plan Check 0.0 hrs $0.00 e,
1117, P trait Fee.- Plumb.Permit Fee: IPPERMIT
I ;>rr_ Other Plumb Insp. 0.0 hrs
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn7 info,
FEE ITEMS (Fee Resolution 11-053 E f 711/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: 1 $0.00 0 # Plumbing
Suppl. PC Fee: (F) Reg. 0 OT0.0 hrs $0.00 $14.00 1PRREPIPE Re-Pipe Interior
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. ® OT 0,0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $48.00
Administrative Fee: ]ADMIN $45.00 0
Work Without Permit? ® Yes (F) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRA VDOC $48.00 Building or Structure
i
Strang Motion Fee: IBSEISMICR $0.96 Select an Administrative Item
Bldp-Stds Commission Fee: 1BCBSC $1.00
q $142.96 $14.00 TOfiAL FEE; $156.96
Revised: 07/08/2014