14080264 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6045 SHADYGROVE DR CONTRACTOR:ONE DAY COMPLETE PERMIT NO: 14080264
REPIPE
OWNER'S NAME: MAYERS ROGER AND JOANNA 617 N 12TH ST DATE ISSUED:08/28/2014
OWNER'S PHONE: 4087258209 SAN JOSE,CA 95112 PHONE NO:(408)603-0554
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
�i Rcq�.! 9 COPPER REPIPE
License Class i��— Lic.# �o
Contractor Date
I her r'3++" gat I d 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:$4500
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:37540004 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMITE IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 80 DAYS 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 180 DAYS F ST CALLED INSYC ION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, W14
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signatur Dat 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
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 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:31$
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 A9� M E P
COPViMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ��
10300 TORRE AVENUE• CUPERTINO, CA 85014-3255
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By ny sie:natue e]oW,I ce iy to each of tha follo:,4.n; I am u,e prope_`Iy ov ner or authorized went to act on the property o,;ner's behalf. I hate read this
application and the infolmat;on I have provided is correct. I have read the Description of Workand verify it is acu rate. I agree to Comply vrith all applicable local
Ordinances and state laws relating to III="-CDresentatives of CLpw ino t0 enter isle above-Ideritified property for LSpect:On Durposes.
Si_natureOfA . cant,Age.^. Date:
PLE? NTAL LNFORNIATION REQU ED
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h�PA.iscpp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 6045 shadygrove dr DATE: 08/28/2014 REVIEWED BY: MENDEZ
APN: BP#: `VALUATION: 1$4,500
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPR
USE: PERMIT TYPE:
WORK co er re i e
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Re-Pipe Interior 1PRREPIPE 1 # $14
TOTALS: $14.00
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d
If"
., ..
A/,<;� �, f=,r�;c-- Plumb.Plan Check 0.0 hrs $0.00
i't>rr�Jit Fee: Plumb.Permit Fee: IPPERMIT
C)�rr�= :IecI2. trasy� Other Plumb Insp. 0.0 hrs $48.00 oilwi,1; �.: =7sj;.
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These _f
-fees are based on the relinWna information available and are onlyan estimate. Contact the Detor addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711/13) FEE QTY/FEE MISC ITEMS
Plan Uhcck
PME Plan Check: $0.00
_'.
PME Unit Fee: $14.00
PME Permit Fee: $48.00
Administrative Fee: IADMIN $45.00
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: ITRAVDOC $48.00 A
Strom Motion Fee: IBSEISMICR $0.59 0 # Revisions
Bldg Stds Commission.Fee: 1BCBSC $1.00 $0.00 IREVCOMTI Tenant Improvement
` $156.59 $0.00 TOTAL FEE: 1 $156.59
Revised: 08/20/2014