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14110145 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11041 STEVENS CANYON RD CONTRACTOR:PACIFIC PLUMBING PERMIT NO: 14110145 OWNER'S NAME: VIRAY PROPERTIES LLC 2138 O'TOOLE AVE DATE ISSUED: 11/25/2014 OWNER'S PHONE: 4089048614 SAN JOSE,CA 95131 PHONE NO:(408)452-8633 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑ �r �� REPAIR SEWER LINE License Class n Lic.# Contractor94C/AC P OlV dim Date ozFl 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 p@rformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7000 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:34219002.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT F WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WIT 180 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 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 granting of this permit. Additionally,the,poplicant understands and will comply Issued by: Date: with all non-point source regulations per a Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signature ®C DateAll 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) 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 25505,25 an 25534. Section 3700 of the Labor Code,for the performance of the work for which this /lrr �7GZ Date: / permit is issued. Owner or authorized agent: 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION V 1� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildingCW-cupertino.org "\ ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS Jt041 5T"rNS Cft�-1`10N APN# 3+z 2,�v OWNER NAME C*�J5T_Df ,n �1 n PHONE /�� Olry [ C;{_r E-MAIL STREET ADDRESS p t 04, ' � -l CITY, STATE,Z'IP 1`y l/��/� FAX CONTACT NAME j�n'� j PHONE /Ihe�L/\ � E-MAIL STREET ADDRESS Yr b ��j CITY,STATE, ZIP ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME� �y/ LICENSE NUMBER�,r�Q LICENSE T�E BUS.LIC# 2' r l / COMPANY NAME �^ E-MAIL j ! J�JA I • FAX Ir-J STREET ADDRESS ^^ ''�'I { CITY,STATE(ZIP I� Vl PHONE/;��S 8q 1-qIz 1399 0 Cr ARCHITECT//ENGINEERHNAIM\lE W 7� LICENSE NUMBER BUS.LICI# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK _ - EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA FNETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH #DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF - IS THE BLDG AN ❑YES RECEIVED=BI': TOTAL VALUATION: PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER ETCH LER HOME? []No _ YD By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is co ct. I ead the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating uil ing const ctio orize representatives of Cupertino to enter the a/bo/v�-identifie r erty for inspection purposes. Signature of Applicant/Agent Date: SUPPLEMEN AL INFORMATION REQUIRED PLty,cHcx 7 YPE 4 aovTlNc SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for OVER FHE COIJNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is.required prior to issuance of building r . permit for new building. ❑ EXPRESS ❑JiPLANNING PLAN REVIEW' _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. 0 LARGE El FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application: of SEWER DISTRICT El ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 11041 stevens canyon blvd DATE: 11/25/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$7,000 RIPERMITTYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPRP USE: PERMIT TYPE: woRK repair sewer line SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe Interior 1PRREPIPE 1 # $14 TOTALS: ,a, ,. .; $14.00 t :. s O� ,i/�io AIech. Plan.('geek Plumb.Plan Check 0.0 hrs $0.00 Elea Ph?;i C.h<, k Afe>,h.Peropi Fee: Plumb.Permit Fee: 1 PPERMIT Other He,h.7r:m� Other Plumb Insp. 0.0 hrs $48.00 O1 her E€ec�,lrj,,�. Tec r. lrzrv. Fe"', rs , tce:�la�fr NOTE:This estimate does not include fees due to other Departments(Ge.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 (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan. Cbec� Fee: ;errppl, PC lee PME Plan Check: $0.00 Permir Tee: PME Unit Fee: $14.00 PME Permit Fee: $48.00 Construction Administrative Fee: 1ADMIN $45.00 Work Without Permit? ® Yes (E) No $0.00 Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.91 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 a . .E �,# A. $156.91 TOTAL FEE. $156.91 Revised: 10/01/2014