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14070079 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10141 PHAR LAP DR CONTRACTOR:ADVANCED PLUMBING PERMIT NO: 14070079 TECHNIQUES OWNER'S NAME: MC FARLIN SHARON A 1023 BLAZIN WOOD DR DATE ISSUED:07/18/2014 OWNER'S PHONE: 4087612687 SUNNYVALE,CA 94089 PHONE NO:(408)396-8071 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ C y 3 b RE-PIPE HORIZONTAL LINES BENEATH SFD(1500 S.F.) License Class_` b Li,.# L�3 f � 1 c� Contractor , ,)tp Kj P:p .S0• Date dZ Lv 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 n performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3800 �t 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:32639058.00 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 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 F LLED INSPECTIONilly indemnify and keep harmless the City Cupertin against liabilities,judgments, costs,and expenses which may accrU�e ains ity in consequence of the granting of this permit. Additional ,{ t understands and will comply e: with all non-point source regulati p upertino Municipal Code,Section 9 18. RE-ROOFS: Signature Date O� 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. r_1OWNER- ILDER DECLARATION 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) 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 it Qua' Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino u �p ode,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505, 25534. Section 3700 of the Labor Code,for the performance of the work for which this r� Owner or authorized agent: Date: 0 p 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 CONSTRUCON 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 PERNFHT APPLICATION � E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 oI\ (408) 777-3228• FAX(40B)777-3333•buildinala gme tino.ora m I S eUP'E�TItiCO % PLUbSD\TG ❑Iv�Ctir11�IC.AL ❑ELECTRICAL /❑MISCELLAh-IOUS PELO.BU ADDRESSftor, I F3N" N Z f7 4 — b SOc O1%JNERNA.hC I PfiOA'E J \ V S=17ET E DDRBSS c I my, STATE,ZIP• I FAX CONTACT N.r•�r I PiiOTB�� l UU L` I 1✓k� a zGK 6 ST?tciADD?E S n ` CITY,STA71B, ZIP I FAXwn�a r. Sj,�h fie• Q 13OWT R 'C7 OWlvZ 3LMMER 13o-wimmAam\r ❑ COMP 4CTOR 13COTTR1,CTOR AGNS ❑ ARC' -CT ❑L^7GD�r—R El DENS OP=TZ ❑T'c l STI CON PJCTORNAIJE ��` 1 ' I LICrTSEI�TU1sLR -�C t, LjcmTSETYPE C-I/ I BUS.LIC4 COIJDAI YNANE d�G.N` Q I E 1vLaII t Gl `� I FAX STREET ADDPFSS CI-i Y.STfiTE ZTP I P30. �!1��3y/�S�O`7 1 w I Svh vale. n U V I ARChTTBCT/ENGI2��'EERN.r1JE LICENSENLlJ?ER I BUS.LIC, COIJiPfNY I�T.AI E IJ.A II I FAX STREET ADDRESS CSSy,STATE,ZIP PHONE USE OF ❑SM.,DtJPLEX ❑ MULTI-FAIAMY I PROSECT N WILDLAIM ❑ YES I PROI'r.CT A ❑YF-S I IS HE BLDG AN ❑ 1iS BLII DING ❑Cowa RcuL URBAN ItTERFACE AREA 02"0 FLOOD ZOIC- ❑NO EIC=- xollmT ❑ NO DF-SCR IPTIONOrrWORK `, vu C e� C(, Soh � U� C i WH r• eA P TOTAL VALUATION: Rig A By ny signature belov4,I certify to each of the folio., e property m ner or authorized as <<o act en top ehalf. I have read this application and t_he information I have provided is c ie —read the Description of Work and verify it is acct ate. I agree to comply vrith all applicable local ordinances and state lads relating to building cons' authorize representatives of Cupertino to enter the above-iddentifed rope :y for inspection purposes. S i--ma ure of Applicant/Agent: Date: O 76 J j SUPPLE?! AL LNFORN,.ATION REQTJ=D ?✓EPA sisc1pp_2011.doc revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10141 PHAR LAP DR DATE: 07/18/2014 REVIEWED BY: MELISSA APN: 326 39 058 BP#: *VALUATION: 1$3,800 xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 RPR WORK RE-PIPE HORIZONTAL LINES BENEATH SFD 1500 S.F. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe Interior 1PRREPIPE 1 # $14 TOTALS: $14.00 M 100E fli, UN"4 Plumb.Plan Check 0.0 hrs $0.00 Fee: Plumb.Permit Fee: IPPERMIT t Other Plumb lnsp. Ehrs $48.00 Olhur 1 r E 1-sp, tern If%si. l :e: I'lu h. hisj�. Fee 1>Cec.It it,, "'co: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the prefinddha information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Elf. 711/13) FEE QTY/FEE MISC ITEMS Plar, (,n11!Ck, Su tr 1. I'( PME Plan Check: $0.00 PME Unit Fee: $14.00 PME Permit Fee: T-7 $48.00 Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 Travel Documentation Fee: ITRAVDOC $48.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $156.501 $0.00 TOTAL FEE: $156.50 Revised: 07/10/2014