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15050094CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10520 S DE ANZA BLVD CONTRACTOR: PLUMBING TECH INC PERMIT NO: 15050094 OWNER'S NAME: HARMAN -MANAGERS INVESTMENT INC 1040 HARANA DR DATE ISSUED: 05/15/2015 OWNER'S PHONE: 4082535057 SAN JOSE, CA 95122 PHONE NO: (408) 836-2492 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ ❑ LICENSED CONTRACTOR'S DECLARATION REPLACEMENT OF 30 FEET OF 4 INCH DRAIN PIPE FROM � BUILDING TO GREASE TRAP. _.;fit - Contractor N~ Fate 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: $5600 ~ave 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: 36939017.00 Occupancy Type: permit is issued. Ate- APPLICANT CERTIFICATION R1 -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 180 DAYS FROM LAST CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save 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 b /��, V �` �/� Date: granting of this permit. Additionally, the applicant understands and will comply y' — with all non -point source regulations per the Cupertino Municipal Code, Section r ia' RE -ROOFS: rJYDate' All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature': f' 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 255 5, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this v 3" `-` •L ={' ` Vis'-'' ?'-''': Owner or authorized ag-ent - �- • ° "=-.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 9 18. Signature Date �j 0-� 0& 11 y GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 MISC q CUPERTINO ❑ NICAL ❑ ELECTRICAL ❑ MISCELLANEOUS (408) 777-3228 •FAX (408) 777-3333 • buildingCa�cupertino.or PLUMBING MECHA PROJECT ADDRESS APN #� rj / 7 OWNER NAME �/ PHONE �/ 00 E-MAIL _ STREET ADDRESS C CITY, STATE, ZIP J� 0 FAX CONTACT NAME (� ry O C Q v l PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OwNER ❑ OWNER -BUILDER ❑ OWNERAGENT 2r -CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 0 � C �V C— " LICENSE TYPE BUS. LIC # v r CG ` J COMPANY NAME E-MAIL AX � �N STREET ADDRESS CITY, STATE, ZIP �S e ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WB.DLAND ❑YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: OMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER HOME? O '^ r DESCRIPTION F WORK D fj acc 1^n (-V-1 C (T %'v / Com- l lJ'`�� (� �( �v( Y✓ � l � U l � d c5� TOTAL VALUATION: N Z RECETJED BY i x , } 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 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 constru tion. I authorize representatives of Cupertino to enter the above -identified roperty or inspection purposes. P V Date: Signature of Applicant/Agent: INFORMATION REQUIRED MOM" USE O,NL�z r SUPPLEMENTAL „_ ,. �„' OFFLCE OVER THE -COUNTER s Fa s �'�F' h❑ EXPRESS � n t ��,'�?� ,.t5' y ra ' � ❑5 � r< STANDARDI a U r C C� ! Dy LARGE } _l ,s 4Yr � `' � 4 ❑ MAJOR �� "',`� �:, � Fa! MEPMiscApp_2011.doc revised 06/21/11 ,��,�:�� ;;�,,��,,��, CITY OF CUPERTINO re—MM-1 VUV VQ-rlrl%4A9rnP — RITII DING DIVISION APPLIANCE / EQUIP TYPE 1'1:JJJJ "1—riaasv — QTY UNITS ADDRESS: 10520 S De Anza DATE: 05/15/2015 REVIEWED BY: Sean Ila Other Elec. Imp. BP#: "VALUATION: $5,600 APN: V— D's trict School St+Ppl. 1ns'P Fee *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building PME Unit Fee: PENTAMATION 1 CPSS PERMIT TYPE: i USE: $48.00 WORK lacement of 30 feet of 4 inch drain pipe from building to grease trap. �Re SCOPE $45.00 APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check 0.0 hrs $0.00 QTY UNITS BP FEES flea Permit Fee: Sewer, Sanitary 1PCSEWER Other Elec. Imp. 1 # $25 Pet mit Fee: V— D's trict School St+Ppl. 1ns'P Fee PME Unit Fee: $25.00 PME Permit Fee: $48.00 Construction TCI./'-: Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 TOTALS: A Travel Documentation Fee: ITRAVDOC $25.00 Strong Motion Fee: IBSEISMICO NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Pubhc Works, Fire, San itary eer i , .._ ____le...:........:..[;........f..,.... nrW6'n —d aro ni/%)aM P..ydmate. Contact the Dent for addn'l info. District, etc. . [nese fees are based on the reuiiaicu. FEE ITEMS (Fee Resolution 11-053 E . 7ff 11113) Mech. Plan Check Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check i6lech. Permit Fee: Plumb. Permit Fee: I.PPERMIT flea Permit Fee: Other ;Uech. Insp. her Plumb Insp. 0.0 hrs $48.00 Other Elec. Imp. .Uech. Insp. Fee: hap. Fee: Elec. Insp. Fee: Pet mit Fee: V— D's trict School NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Pubhc Works, Fire, San itary eer i , .._ ____le...:........:..[;........f..,.... nrW6'n —d aro ni/%)aM P..ydmate. Contact the Dent for addn'l info. District, etc. . [nese fees are based on the reuiiaicu. FEE ITEMS (Fee Resolution 11-053 E . 7ff 11113) s.. v...osas............... FEE »•-- »• QTY/FEE �•-_ ___ ____________ L MISC ITEMS Plan Check Fee: Suppl. PC. Fee PME Plan Check: $0.00 Pet mit Fee: St+Ppl. 1ns'P Fee PME Unit Fee: $25.00 PME Permit Fee: $48.00 Construction TCI./'-: Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning- Fees: A Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICO $1.57 Select an Administrative Item BldjStds Commission Fee: IBCBSC $1.00 `°SUBTOTALS $168.57 $0.00 G" TOTAL,FEE:' $168.57 Revised: 05/07/2015 P"TCEIV8 MAY Basemap Labels 13Y Abc Street (dames Secondary Address Labels Primary Address Labels --- Freeway Basemap Street Centerline County Major Roads County Freeways --- Right -of -Way Community Development City Boundary PC Aerials - Sept 2013 SCALE 1 :410 City of Cupertino Y I - I- - _ --- 17": _. jj 4 ; rT in �_. ''� i�'.( �-I � - ° ...ice' `.•�! ,3. I_: -I r�� S • '� �..�� 7: � ice' � I, , _-Jw- 0i_ •yin r J ' - �.1� Y� WT ,f• a` r .si.,:...s�rf' _ -� �.ilC'��.,,v,�.�te�'`.+• `w.,�'��%��. ),',� �Xp;.c ;•;y� CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10520 S DE ANZA BLVD CONTRACTOR:PLUMBING TECH INC PERMIT NO: 15050094 OWNER'S NAME: HARMAN-MANAGERS INVESTMENT INC 1040 HARANA DR DATE ISSUED:05/15/2015 OWNER'S PHONE: 4082535057 SAN JOSE,CA 95122 PHONE NO:(408)836-2492 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ REPLACEMENT OF 30 FEET OF 4 INCH DRAIN PIPE FROM � BUILDING TO GREASE TRAP. ;fit - Contractor N~ Date 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:$5600 ~ ave 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:36939017.00 Occupancy Type: permit is issued. Ate- APPLICANT CERTIFICATION R1-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 b /��, V �`�/� Date: granting of this permit. Additionally,the applicant understands and will comply y' with all non-point source regulations per the Cupertino Municipal Code,Section ra'K RE-ROOFS: rJYDate ' Signature ': All roofs shall be inspected prior to any roofing material being installed.If a roof is f' 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 255 5,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this v 3" `-`•L ={'` Vis'-'' ? '- Owner or authorized ag- ent - �—• 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 9 18. Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MISC(408)777-3228• FAX(408)777-3333•building Ca)cupertino.org CUPERTINO PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN#� r� / 7 O C/ OWNER NAME _ �/ PHONE �/ E-MAIL 00 STREET ADDRESS C CITY, STATE,ZIP J� Q FAX u CONTACT NAME (�ry O C PHONE E-MAIL Q v l STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUB.DER ❑ OWNER AGENT 2r-CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME v r CG LICENSE NUMBER�j C��l LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL CxL STREET ADDRESS CITY,STATE,ZIP e-- ARCHITECTIENGWEERNAME LICENSENUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WB.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUrLDING: WO1,1MERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER HOME? O DESCRIPTION dF WORK D acc 1^n(-V-1 '^ C �(�v( /'v /Com- l lJ'`�� (�Y✓�l\(J l �d it TOTAL VALUATION: N Z RECETJED BY i x } UN 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 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 constru tion. I authorize representatives of Cupertino to enter the above-identified roperty or inspection purposes. P V Signature of Applicant/Agent: S�C� Date: OFFLCE SUPPLEMENTAL INFORMATION REQUIRED MOM" „_ ,. �„' USE O,NL�z r OVER THE-COUNTER s s pU� �a� .�t,Fa h❑ EXPRESS y ��n NP t � �1�M1 t'''; ra r< ❑5 STANDARDI a U C � `'�4 ❑ MAJOR �� "',`� �:, � Fa! MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO itsFEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10520 S De Anza DATE: 05/15/2015 REVIEWED BY: Sean APN: BP#: "VALUATION: $5,600 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY JFENTAMATION 1 CPSS USE: Commercial Building PERMIT TYPE: i WORK Replacement of 30 feet of 4 inch drain pipe from building to grease trap. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PCSEWER 1 # $25 TOTALS: $25.00 Mech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check i6lech. Permit Fee: Plumb.Permit Fee: I.PPERMIT Flea Permit Fee: Other;Uech. Insp. =-1--V111t.wb. her Plumb Insp. 0.0 hrs $48.00 Other Elec.Imp. =-L- il,jech Insp.Fee: hap. Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(i.a 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 Dept for addn'l info, FEE ITEMS (Fee Resolution 11-053 E . 7ff 11113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC. Fee PME Plan Check: $0.00 Pennit Fee: S11Pp1. 17-7sP Fee PME Unit Fee: $25.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes No $0.00 Advanced Planning-Fees: Travel Documentation Fee: ITRAVDOC $48.00 A Strong Motion Fee: IBSEISMICO $1.57 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 '. a, `°SUBTOTALS $168.57 $0.00 . "G" TOTAL FEE: $168.57 Revised: 05/07/2015 CityCupertino®f 3 MAY Basemap Labels - I 4P Abc Street (dames Secondary Address Labels 1 Primary Address Labels --- Freeway Basemap - 7. - - d fy Street Centerlinerp E + ' County Major Roads - ,.,.....I, - s *,-s ' ,. County Freeways --- t W �. Right-of-Way Community Development Ciy�,y Boundary k 'WWF tp —J Aerials - Sept 2013 gum OF I E S " io -.Wa - - � � � b`�'�}s -' t: �,�� f•".a.,., �y"; sr w;; 74�. C F.6„ •g )r r µ4 J 6 u?§ SCALE 1 : 410