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14080223CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7443 STANFORD PL CONTRACTOR: SAN JOSE PLUMBING PERMIT NO: 14080223 INC OWNER'S NAME: LAW PATRICK Y AND HO DOREEN 19970 MCKEAN RD DATE ISSUED: 08/21/2014 OWNER'S PHONE: 4088020737 SAN JOSE, CA 95120 PHONE NO: (408)296-1820 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ ❑ LICENSED CONTRACTOR'S DECLARATION PROPERTY LINE CLEAN OUT License Class @.- 3%a Lic. # ` 1 r l70 Contractor Date tis -L 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: $1200 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 35932037 00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 1 F 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, City in the 180 DAYS AS CALLED INSPECTION. 9 costs, and expenses which may accrue against said consequence of Issued b Date: Y' 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. RE -ROOFS: �C Date 1-'-` "� Signature C All roofs shall be inspected prior to an roofing material being installed. If a roof is P P Y g g 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. 1 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: 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 PcRME T AI, PPLICATION E P M�4 COMMUNITY DEV=LOPh/tiEN i DEPAR i MEET • BUILDING DIVISION O� 10300 TORRE AVENUE - CUPER T INO, CA 95014-3255 (1� (408) 177-3228 • rP-X ('03) 7777-33'13 buildinoCg.cuoa tmora vm I _ EU�'E�TCktO I� :al MVS NTT 01�mc—Pj-LA:n-OIIS �� or yk� r ss S� , f Qo c d V\ e— _ Gl 32, 037. O'v.�=P.1\A1 I P:iO?ti: I E.i✓kL S �" ADDPESS - - - -Iyy+, 1>k-'.."tcl Qltr cm, Y, � , A-, m I Cv$aikin COly aACT X-1 i1r pliMB I ]✓ k- ^A0 -6 o'Lu car=� A>DPESS OR`.n ❑ ❑ GR7 Ate? ❑COQ 4C0& ❑ COh kCTORA�? ❑ P�, C_ BCT ❑ F -=�_?, ❑ D_l- I 0 Z, ❑ - Q'T COh kC ORT.�'kir� p� LCr- S=l�TrT UCTSB E C- 7b BUS. TUC I I �n1T \T-,, S T RIFT ADDRESS \ Ilk °I'1 qz>1Ht 1(.!w✓� C1 �Y STA: r, ZIP I 5� •• �o s� c.li °\T \1� P Oh �o `C 2 'h b \� ZC3 cljB-cr\1c-N EP,X.AN I LICL JBwul's+BR I BUIS.I.icr COIJ.PF Y T Y I �J✓mak II I FAX S-1TRz=P ADDP.ESS I CITY, STATE, ZIP I P30? VSc 0' ❑ �—,D o: DUPLEX ❑ V,.lLTI•F Q B Y I BT"IID-G ❑ CDr✓ � CLSL PROJECT Lei WII-DLA-14il ❑ 1 rS T nBAI II i=R'rAC= AREA ❑ TO I PROJECT IN, ❑ YFS FLOOD ZON- ❑ NO I IS � BLDG Ql ❑ 1 S Mcg"M- HOME? ❑ ?�O DESMPrOT or W0RR TOTkTVkTUTATIOT:Ml Ts_ By my Signa Tf= below, Ice j to each of mm iollo;; g: I uu the ?rope D-.•,-cr or _g nt to act on the prope. y o„ ,er' ehal I h?v.e read this _�alication and the information I have provided is co—ct I have -tad the Dcscri?tion of � rork and v = y it is ace T- - �_' o co -ply v th all aaplicable local OrQ.iilarlCeS &'ld State I_7"S reLthl4 i0 bLll.^i1nH CDs�- jciion. I Fulub ;=_.' Iepresen caves of Cupe wno iD enter the abov---ide ti5le'd p: 07er�� iDi LS�eCt1DII pnliposes. S1�ahtreDr �a111CL1V: Qer:t. + ate, yA SUPl�T T,A T D,7F OT-aLk T ION REQT-j IRED ' O C✓3.egr� r =_ �� FSO �3 = - -''� "��"�-� -"�-• ,est Its•?Visc1pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 7443 stanford dr to orma t FEE DATE: 08/21/2014 REVIEWED BY: Mendez WADDRIESS: $0.00 BP#: -VALUATION: $1,200 t� 'ton t hwe Plumb. Plan Check 0.0 hrs $0.00 I'l/ct:. 1>,'dn C k'ck c:71 rPERMIT TYPE: Building Permit Permit Fee: PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex Plumb. Permit Fee: PENTAMATION 1 RPSS PERMIT TYPE: USE: Other Plumb Insp. E7rsj $48.00 oily, r I k - l'os" $48.00 %721.%'1717. h, s) Fee: WORK ro ert line clean out Administrative Fee: ]ADMIN S S D'strict School SCOPE Work Without Permit? 0 Yes (E) No $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, anttary ewer r , ['t'on available and are onl an estimate. Contact the Dept or addn'1 info. District, etc.. These fees are based on the re tmina FEE ITEMS (Fee Resolution 11-053 Ef: 7./f 1/13) to orma t FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 �� # Plumbing $25.00 IPRSEWER Sewer, Sanitary Suppl. PC Fee: Q Reg. Q OT0.0 t� 'ton t hwe Plumb. Plan Check 0.0 hrs $0.00 I'l/ct:. 1>,'dn C k'ck c:71 Permit Fee: $0.00 ,;Ir. I' .•,uit 1,eee: Plumb. Permit Fee: 1PPERMIT Fie( Pero�kf 1`�'r Other Plumb Insp. E7rsj $48.00 oily, r I k - l'os" $48.00 %721.%'1717. h, s) Fee: 1ps . F cc. Administrative Fee: ]ADMIN S S D'strict School NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, anttary ewer r , ['t'on available and are onl an estimate. Contact the Dept or addn'1 info. District, etc.. These fees are based on the re tmina FEE ITEMS (Fee Resolution 11-053 Ef: 7./f 1/13) to orma t FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 �� # Plumbing $25.00 IPRSEWER Sewer, Sanitary Suppl. PC Fee: Q Reg. Q OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Supp/. Insp. Fee:Q Reg. Q OTJ 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning? Fee: $0.00 Select a Non -Residential Building or Structure 0 Travel Documentation Fee: ITRAVDOC $48.00 Strom Motion Fee: ]BSEISMICR $0.50 Select an Administrative Item Bldg, Stds Commission Fee: IBCBSC $1.00 Foe Es $142.50 $25.00 TOTAL FEE:' $167.50 Revised: umui20i4