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14100119 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18841 BARNHART AVE CONTRACTOR:MIKE COUNSIL PERMIT NO: 14100119 PLUMBING INC OWNER'S NAME: SAN JOSE,CA 95131 PHONE NO:(408)272-4900 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] p� REPLACEMENT OF WATER MAIN License Class AA �o Lic.# (07 12& I Contractor VV\ttihslt.— Date �O '2-t 114 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:$10000 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:37516054 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information isPERMIT E S IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 18 AYS ERMIT 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 LED INSPEC O 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 a plicant understands and will comply Issued by: Date: with all no poi t s ce re latio er Cupertino Municipal Code,Section 9 18. 1© �' t r ( RE-ROOFS: Signature Date 7 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 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. 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,�icti s 2550 25533,and 25534.Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized 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 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 18841 barnhart ave DATE: 10/21/2014 REVIEWED BY: Mendez APN: BP#: `VALUATION: 1$10,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPDP USE: p PERMIT TYPE: 14 WORK main water re i e SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Drainage 1 PREPPIPE 1 # $48 TOTALS: $48.00 15, l clz. Plass CCe(k Plumb.Plan Check 0.0 hrs $0.00 11:rec.1'iw C,=�ck a7c>ca;- t'E>tv�tid h'ee Plumb.Permit Fee: IPPERMIT 0.0 1>lac- 1'�<oni" {)rlrer t fec'/s. Irrsp Other Plumb Insp. hrs $48.00 00.wr L:/cc.In'sl:. lar;h. fnasp. 1"ec /'harzzb, h7sp. Fee: 1./cf.Ins' 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 in ormation available and are onl an estimate. Contact the Det or addn'/info. FEE ITEMS (Fee Resolution 11-053 Ef. 7111131 FEE QTY/FEE MISC ITEMS Plun 01cc'I PME Plan Check: $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 C onsirYI'c lion /gra: Administrative Fee: ]ADMIN $45.00 Work Without Permit? ®Yes 0 No $0.00 P('ciVII.11 ,`i'f's: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $1.30 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 � $191.301 $0.0011"-- TO`>-AL FEE: $191.30 Revised: 08/20/2014