150701665
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10706 LINDA VISTA DR
CONTRACTOR: CUPERTINO PLUMBING
PERMIT NO: 15070166
OWNER'S NAME: WOO & DE LA GIROND'ARC
2784 S BASCOM AVE
DATE ISSUED: 07/23/2015
OWNER'S PHONE: 4082505069
CAMPBELL, CA 95124
PHONE NO: (408)253-0618
®' LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
(E) MAIN WATER LINE FROM METER TO
/REPLACE
License Class Lic. # G.'Z L/
HOUSE
Contractor - 4nK ? r, P l—'1� i Date 7-23-151:1
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
Sq. Ft Floor Area:
Valuation: $1400
performance of the work for which this permit is issued.
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: 35608021.00
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
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 F 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
23
granting of this permit. Additionally, the applicant understands and will comply
Ong ed b -
with all non -point source re u s per Cupertino Municipal Code, Section
9.18.
r
Signa re Date 1-z %l
-ROOFS:
All roofs shall be inspected pnor to any roofing inbeing 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, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized 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
GENERAL PERMIT APPLICATION
I -JA
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION M E
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(a
CUPERTINp (408) 777-3228 •FAX (408) 777-3333 • buildinoE)cupertino.org/ per,
PLUMBING ❑ MECHANICAL [:]ELECTRICAL ❑ MISCELLANEOUS
PROJECT ADDRESS Or
APN
J
ER NAME PHONE
Q- Lam, r k r e, Izift-150-
E-MAIL
STREETADDRESS
•— s �-r3 v v�
CITY, STATE, ZIP FAX
CONTACT N E
-J 1
ST ADDRESS
CITY, STATE, ZIP
FAX
❑ OtiTTR ❑ OWNTER.BUILDER ❑ OWNERAGE.NT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CQNIRACTOR NAME � LI IZt _
LICF�SE E
BUS. LIC #
C ANY N.
E-MAIL
FAX
STREET ADDRESS
S. C3�scom Ave-,
CITY, STATE, ZIP
PHONE
t.4S-1-" *3
ARCHITECTIENGINEER NAME
LICENNSE NUMBER
BUS. LIC,".
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMMY PROJECT IN WIIALAND ❑ YES PROJECT IN ❑ YESTECHLERHOME?
BUILDING: El COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO
THE BLDG AN ❑ YES
❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: l 4 Co -0-0�EIVED
� � S
t g
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on pe i 6half. I have read this
application and the information I have provided is correct, I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building c ion. of Cupertino to enter the above -identified property for inspection purposes. e
Signature of Applicant/Agent: Date: /
SUPPLEMENTAL INFORMATION REQUIRED
z
011cE USE oil i'
� TZAJ01;
MEPAIiscApp_2011.doc remised 06121/11
CITY OF CUPERTINO
@W,O FEE ESTIMATOR - BUILDING DIVISION
191
ADDRESS: 10706 LINDA VISTA CR
DATE: 07/23/2015
REVIEWED BY: MELISSA
UNITS
APN: 356 08 021
BP#:
`VALUATION: 1$1,400
xPERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
I
PENTAMATION 1 RPWS
I PERMIT TYPE:
WORK
REPLACE E MAIN WATER LINE FROM METER TO HOUSE
SCOPE
Suppl. Inst}
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check 0.0 hrs $0.00
QTY
UNITS
BP FEES
Elec. Permit >`ee
Water Service
1 BPWSVCS
, fherhlec.))Insp. Li
1
#
$25
Permit .Fee.°
Suppl. Inst}
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$25.00
Strong 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 prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053Eff 7%I1/13)
Nfech. flan Check
Plumb. Plan Check 0.0 hrs $0.00
rJee. Plan Check
Nfech. Permit Fee:
Plumb. Permit Fee: 1PPERMIT
Elec. Permit >`ee
_
Other Plumb Insp. 0.0 hrs $48.00
, fherhlec.))Insp. Li
PME Plan Check:
rr
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 prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053Eff 7%I1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check:
$0.00
Permit .Fee.°
Suppl. Inst}
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
r 7
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
1
Bldg Stds Commission Fee: 1BCBSC
$1.001
SUBTOTALS:
$167.50
$0.00 TOTAL FEE:
1 $167.50
Revised: 07/02/2015
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10706 LINDA VISTA DR
CONTRACTOR: CUPERTINO PLUMBING
PERMIT NO: 15070166
OWNER'S NAME: WOO & DE LA GIROND'ARC
2784 S BASCOM AVE
DATE ISSUED: 07/23/2015
OWNER'S PHONE: 4082505069
CAMPBELL, CA 95124
PHONE NO: (408)253-0618
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
REPLACE (E) MAIN WATER LINE FROM METER TO
License Class 3 C— Lic. # 4 <i O'S
HOUSE
ContractorDate j�_ *7. tj
REV # 1 - ADD SEWER LINE & PROPERTY LINE
CLEANOUT & FOUNDATION - ISSUED 8/7/15
�f
1 hereby affirm that I am licensed unde 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
Sq. Ft Floor Area:
Valuation: $1400
,performance of the work for which this permit is issued.
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: 35608021.00
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
WITHIN 180 —NIIT 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 RO 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
granting of this permit. Additionally, the applicant understands and will comply
ssu te:
with all non -point source re OMns r the upertino 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
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 Cupe unicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectio M0 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
A
Owner or authorized agent: Date:7i
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
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
-9-i "
CUPERTINO
GENERAL PEPWI T APPLICATION
COMMUNI TY DEVELOPMENT DEPARTMENT • BUILDING DIV I
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - build ino(a cuoeitino.orcl
PLUMBING ❑ MECHANICAI
amm
V�
❑ELECTRICAL ❑T,USC.ELLMNTEOUS
PROJECTAURESS I APN n
OVJNERITAl�E
PHONYq �v E-MAIL
STREET ADDRESS
CITY, STATE, ZIPI
FAX
CONTACT NAME r
Kp®_
E -MP IL
PHONE42 / I
ST� ADDRESS
CITY, STATE ZIP
FAX
❑ OWNER ❑ OWNER-BUJIDER ❑ OWIN'FRAGENT
CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCi rma ❑ ENGAmR ❑ DEVELOPER ❑ TEN
CONDL4CTOR N .ME
w
LIC 'S£ N ��Ro LIMISE TY -P
��ff CC
BUS. LIC #
CO NAME
i E-MAIL
FAX
STREET AD RPS ` 6
Z cS'ca,�.
I CITY, TACE, ZIP CQ • 9 5 J Z
f/
ARCETECT/ENGWEER NAME
LICENTSE NUMBER
BUS. LIC n
COMPANY NAME
E-MAIL
FAX ` --
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD.,DUPLEX ❑ MULTI-FANULY I .
BUIIDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES
URBAN' INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
C1 cs. yx
AID1
J.
TOTAL VALUATION:
By my signature below, I certify to each of the following:
application and the information I have provided is come
ordinances and state laws relat' to building ct�
Signature ofApplicant/Agent:
I am the property owner or au orized age act perty owner's beha have read this
e read the Desct' tion of Work and verify i is ac rate. I agree y with all applicable local
au ntatives of Cupertino to enter the abov -t enh ed property for inspection purposes.
Date: 40
S EME AL INFORMATION REQUIRED
'�Ti
�1 ,F. 5.. -
MEPAl SC-4Pp_2011.doc revised 06121111
CITY OF CUPERTINO
IM -7, FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10706 LINDA VISTA DR
DATE: 08/07/2015
REVIEWED BY: MELISSA
UNITS
APN: 356 08 021
BP#: 15070166
"VALUATION: Iso
xPERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
#
PENTAMATION
PERMIT TYPE: 1RPS
WORK
REV # 1 - ADD SEWER LINE & PROPERTY LINE CLEANOUT & FOUNDATION
SCOPE
Suppl. Insp Fee
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check 0.0 1 hrs $0.00
QTY
UNITS
BP FEES
'Iec. Perniii V,
Sewer, Sanitary
1 PRSEWER
01hef lllec. In. o. Ll
1
#
$25
Permit Fee:
Suppl. Insp Fee
1
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Construction 7izr:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? Yes (F) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$25.00
Strong; Motion Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sa 'tary Sewer District, School
District. etc). These fees are based on the nreliminary information available and are onlv an estimate. Con ct the Dept for addh7 info.
FEE ITEMS (Fee Resolution 11-053 Eff TU13,)
Afech. flan Check
Plumb. Plan Check 0.0 1 hrs $0.00
Oec. Plan Ch ck
:blech_ Perm;11%
Plumb. Permit Fee: IPPERMIT
'Iec. Perniii V,
Other iikwh. Insp.
Other Plumb Insp. 0.0 hrs 1 $48.00
01hef lllec. In. o. Ll
PME Plan Check:
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sa 'tary Sewer District, School
District. etc). These fees are based on the nreliminary information available and are onlv an estimate. Con ct the Dept for addh7 info.
FEE ITEMS (Fee Resolution 11-053 Eff TU13,)
FEE
QTY/FEE
MI C ITEMS
111un Check 1'ec
;Sufr/rl. PC Fee
PME Plan Check:
$0.00
Permit Fee:
Suppl. Insp Fee
1
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Construction 7izr:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? Yes (F) No
$0.00
Advanced Planning Hees:
Travel Documentation Fee: ITRA VDOC
$48.00
Strong; Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$166.00
$0.00 TOTAL FEE:
$166.00
Revised: 07/02/2015