15070088CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10462 SCENIC CIR
CONTRACTOR: PLUMBING TECH
PERMIT NO: 15070088
SEWER AND REPIPE INC
OWNER'S NAME: STROD ARIEH A AND RAMA A
278 E GISH RD
DATE ISSUED: 07/13/2015
OWNER'S PHONE: 4084463894
SAN JOSE, CA 95112
PHONE NO: (408) 437-6207
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL [J COMMERCIAL
COPPER RE -PIPE, ENTIRE SFD
License Class Lic.#
Contractor Date �S
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.
1 hereby affirm under penalty of perjury one of the following two declaration,:
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
Sq. Ft Floor Area:
Valuation: $� X00
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
APN Number: 35707009.00
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
WIT180 DA T 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 D OM L LED 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 applicant understands and will comp
ssued by: Date: 3 �/
with all non -point source regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
9.18.
O
Signature A/�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)
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. 1 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 5V, 25533, and 25534.
25533,,
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: l �1 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
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
F1GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
1
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build inaCa)cupertino.ora / C�
CUPERTINO l 0;
PLUM❑BING ❑ MECHANICAL ELECTRICAL lD h�SCEL��,La.NIEO/USS
PROJECT ADDRESS IV ldq//
APN R 3 -5 _
O
OWNERNAME )�O
PHONE �j fj9 E-MAIL
a
STREET ADDRESS 011�2j
/ , - -
C�E ZIP
q—VI1]_ L
I FAX
CONTACT NAME0�
! /
PHO 0 O '/ � E-MAII
STREET ADDRESS 2
CITY, ST. ZIP O n /
FAX
❑ OWNER ❑ OWNER-BUIIDER
❑ OWNER AGENTCONTRACTOR 13CONTRACTORAGENT 13ARCHITECT ElENaDTEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAt,IE . . ;0
//� LICENSE NUMBER
✓ ('
LICENSE TYPE
I
BUS. LIC #
COMPANY N " `r G e�( E-MAIL v��-/
FAX
STREET ADDRESS
A01 CITY, S TE ZIP O
PHONE ze)g
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC n
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑
BUILDING: ❑ COMMERCIAL
MULTI -FAMILY
PROJECT IN WnDLAND ❑ YES PROJECT IN ❑ YES
URBAN II.'TERFACE AREA ❑ NO FLOOD ZONE ❑ NO
Is THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
7f
TOTAL VALUATION:
By my signature below, e certify to each of the following: I am the property owner or authorized agent to act on the property . I have read ------
application and the information I have provided is correct. I have read the Description of Work and verify it is acc gre y with all applicable local
ordinances and state laws re ding con ction. I authorizy repr tatives of Cupertino to enter the above-ide rope for inspection purposes.
Si°piature of A,pplicant/Aa Date:
SUPPLEMENTAL INFORMATION REQUIRED-
, L.SL o r
.':'�J'.: i)
A,fEPA7iscApp_2011.doc remised 06/21/11
IN
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE
10462 SCENIC CIR
DATE: 07/13/2015
REVIEWED BY: MELISSA
ImADDRESS:
APN: 357 07 009
BP#: 1-50 06 6- S,
"VALUATION: 1$5,500
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION 1 RPRP
PERMIT TYPE:
WORK
COPPER RE -PIPE ENTIRE SFD
SCOPE
Suppl. Insp Fee
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check 0.0 1 hrs $0.00
QTY
UNITS
BP FEES
Elec. Permit Fee,
Re -Pipe Interior
1PRREPIPE
01her Elec. Inst:>.
1
#
$14
Permit .Fee:
Suppl. Insp Fee
PME Unit Fee:
$14.00
PME Permit Fee:
$48.00
onstruction Tax:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? Yes (F) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$14.00
Strona Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the areliminary information available and are onlv an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eft: 7%1%13,)
Mech. Plan Check
Plumb. Plan Check 0.0 1 hrs $0.00
.':1ec. P/an Check
Mech. Permit Fee'.
Plumb. Permit Fee: IPPERMIT
Elec. Permit Fee,
Other Alech. Inst,
Other Plumb Insp. 0.0 hrs $48.00
01her Elec. Inst:>.
PME Plan Check:
1„ I c"
, s
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the areliminary information available and are onlv an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eft: 7%1%13,)
FEE
QTY/FEE
MISC ITEMS
Plan Check F :
Suppl. PC:` 1,ce
PME Plan Check:
$0.00
Permit .Fee:
Suppl. Insp Fee
PME Unit Fee:
$14.00
PME Permit Fee:
$48.00
onstruction Tax:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? Yes (F) No
$0.00
,Advanced Planning l.':
Travel Documentation Fee: ITRA VDOC
$48.00
Strona Motion Fee: IBSEISMICR
$0.72
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$156.72
$0.00 TOTAL FEE:
1 $156.72
Revised: 07/02/2015