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14110030 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22380 MCCLELLAN RD CONTRACTOR:PLUMBING TECH PERMIT NO: 14110030 SEWER AND REPIPE INC OWNER'S NAME: SAN JOSE,CA 95112 PHONE NO:(408)437-6207 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL �� DUPLEX;22380&22382 COPPER REPIPE AND REPLACE License Class �v Lic.# MAIN WATER LINE. Contractor4 N 1 Date P I hereby affirm that 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:$9600 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:35604026.22380 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 18 AYS OF�' ORK' 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 FR ST ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: f/// Date: 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: Signature Date 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 1,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 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 918. Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22380 MCCLELLAN RD CONTRACTOR:'f:,'�i/ 9,,,/Ve7 (� PERMIT NO: 14110030 ;��tc'EtZ Ai✓�f2��r NG. OWNER'S NAME: DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL (� COPPER REPIPE AND REPLACE MAIN WATER LINE. License Class `(' Lemic..# Contractor Ny (o 7L1at� J t/ I hereby affirm thatu am ed 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:$9600 to 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:35604026.22380 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 FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: granting of this permit. Additionally,the applicant understands and will comply /—/ Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. #I/ RE-ROOFS: Signature Date (�� 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, Section 3700 of the Labor Code,for the performance of the work for which this / r/ permit is issued. Owner or authorized agent: Date: —///C/// 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 • . �'�ll X030 , I - CcNEP,4L PERMIT A-1PPLICATION EP -u COMMUNI—i Y DEVELOPM(EN i DEPAP,—1 HENT• BUILDING DIVISION' 10300 TORRE AVENUE- CUPER i INO, CA 95014-3255 .19 (408) 28 i=PX;4G5)i i i-3333 buildinaC�cuo=r-ino.ore SMIS (; U E• i INC3 21PL-u7ST0 El I, C J" ❑ ECt'Zi-1C,,T �I1. SCELLki�-OuS r Gra!L.mmrms 2Z o M llrn� «N R 3�6 r��a 3� ST c:ADDRESS -0-& 1�, ala A/ I c e,ST A==,Z.L?,. COiv?ACT NE_y� �� • a� ?30� r�1 h� _;J�.� =lf ST � O'v t ❑ C3;ll-:_t_7rZ ❑ Ovil 15 7 ❑ CO?m crop, COT'ti��CTC?U C.? ❑ x�C�__CT G/❑-NC t. ❑ Dom.-O?? ❑ =��,\T CGh'ti SG0:2i�c LI, I ISCaT'EA Tl,!^F1Z� I i iCn Sc I SL S.1: cobOA NK�I-1MS l ei! I ?:.ti �� 2CailECT C?� ERKAIJ� I TlC�S^)�TIJhr�LR. I BUS.LiciC l COiJMY ldd1MB I 1JiA3 =lX S l?, T ADDP.ESS I CIIY,STATP,=P F--icZ-- U52 0'a _r xDilPs_�. !� b.JLiI-iAl�Y P80��CIW,WiL.�LANM YFs ? ❑ ROrEc—,W Yis S =size/.N 1S 3UP�J C. CCin✓�.CLtL I IMB?'T-MPsAC t�. A ?O I -l-ooD?A-,—,- RNO =,C'� V c°_n7a i 1 -. yr ofthe. •ince L mn a r id c l thal-, L... iuv__ .=fl Ol"+', Cw:..�'�0 B �a 0.i.:a F011y\i_.� 1 E::�u!� TOf7B.'i}�O�iv..-f 07 Lu�,oriu._ ent to act on T-:e;.rope:� Oli•Ti�i•S�., 1:cFC i:2�iP15 r• C�:S CO-✓'.t. T}]g" �� D i?i n of-Work i Ertt' 1 ;0. _ppi!CEnon F-nd i_h0 lni0i'ci,on I have prOU n f v:B esc_tion Oi\�'ork and VCi-: .t?S fiCC+.r€tom. 1�_.-...0 CO'!pl\'iiC utl 21_ , OC2 Or dam-C.s�7d st_ie i=v;'S-1el_ w is of Cipai-no t0 tnter ti. ctJO�'C-.GB^Tlt B3 rm. :, cn�r:;p, v+, _ ) ✓_J7w:� 150-1L__-C :1D_'pOS�S. Sid€� o=:_ppli =_,�".g�:. e: _= TF T T i r i'T � i SU—'i P h_...�� OR��•� ON+Z.•QUZ�D __— i'N =�_t 153- .=- 4 Me. JF ?A1:SL!�'/�_�VI LGOC revised 06/=1/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 22380 McClellan Road DATE: 11/05/2014 REVIEWED BY: Sean APN: BP#: *VALUATION: 1$9,600 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 RPR WORK Copper re i e and replace main water line. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe interior 1PRREPIPE 1 # $14 Water Service 1 BPWSVCS 1 # $25 TOTALS: $39.00 P kc'/I. Non Plumb.Plan Check 0.0 hrs $0.00 i'.>t,iW Fees Plumb.Permit Fee: IPPERMIT j,Akch `nsn Other Plumb Insp. 0.0 hrs $48.00 O;i,er <<- E3 llcc z imp.1 vc 1'lu nh, hup. Feu: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (hee Resolution 11-053 Elf.' 7/1/131 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $39.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes . No $0.00 �rll`cddtC'c'f//'IL17?t177'tfn 1•e'es: Travel Documentation Fee: ITRAVDOC $48.00 Strom Motion Fee: IBSEISMICR $1.25 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $182.25 $0.00a..µ TOTAL FEE: $182.25 Revised: 10/01/2014