14090040 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10150 SANTA CLARA AVE CONTRACTOR:TRIPLE A PLUMBING PERMIT NO: 14090040
SERVICES
OWNER'S NAME:
SANTA CLARA,CA 95056 PHONE NO-(408)245-4940
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO- BLDG ELECT PLUMB
License Class a Lic.# q3(0381 F I—
MECH RESIDENTIAL COMMERCIAL
Contractor rl r' K -M 1'NSr Date ?A A 1
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION REPLACE 1-10"f&COLD WATER LINES THROUGI LOUT
(commencing with Section 7000)of Division 3 of the Business&Professions I-IOUSE
Code and that my license is in full force and effect. W/COPPER PIPE
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.
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 Sq.Ft Floor Area: Valuation:$5000
permit is issued.
APPLICANT CERTIFICATION APN Number:32624017 00 Occupancy"Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DA S FRO ST CALL D INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18
` LL/ Issued by: Date:
Signature Date ZO
❑ OWNER-BUILDER DECLARATION
RI';ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roofjs
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant. Date
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
1 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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
1 have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
I certify that in the performance of the work for which this permit is issued,1 shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner uthorized agent: /,
forthwith comply with such provisions or this permit shall be deemed revoked. Date: �o C�
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of-work's
correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITEC'T'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18. I understand my plans shall be used as public records.
Signature Date Licensed Professional __
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10150 santa Clara ave. DATE: 09/09/2014 REVIEWED BY: larrys
APN: BP#: *VALUATION: 1$5,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 RPR
WORK �re lace hot and cold water lines throughout house with copper pipe
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Re-Pipe Interior 1PRREPIPE 1 # $14
TOTALS: $14.00
y
i.
Nuti
Plumb.Plan Check 0.0 hrs $0.00 1/eco !','M
P,,;a :1 fee Plumb.Permit Fee: IPPERMIT
Of,bf �i i'i. Other Plumb Insp. 0.0 hrs $48.00 Orher
rz ). , Thewb� hup. Fc e: PIC(. h7sp,
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 relimina information available and are onlyan estimate. Contact the Det or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $14.00
PME Permit Fee: $48.00
l.t%itJf3't.1C'L`2<)iZ C7,2.
Administrative Fee: IADMIN $45.00
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: ITRA VDOC $48.00
Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
°' x 1 $156.65 $0.00 TOTAL FEE: $156.65
Revised: 08/20/2014