15050114 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10181 PHAR LAP DR CONTRACTOR:MARTI'S PLUMBING PERMIT NO: 15050114
OWNER'S NAME: TOM GUNTLY&ANGELES DUFFY 10260 IMPERIAL AVE DATE ISSUED:05/19/2015
OWNER'S PHONE: 6504403317 CUPERTINO,CA 95014 PHONE NO:(408)375-3190
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
INSTALL 70 FT OF 3/4" GAS PIPE TO OUT DOOR
FIREPLACE.
Contractor
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
t performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1500
�4 aI 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:32639054 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
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: ��� �G�/ Date:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupert Municipal Code,Section
RE-ROOFS:
Signa 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 Date:
Signature of Applicant:
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)
HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to
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 derrned by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cu5505,2 pertino Mun' ' al Code,Cha ter 9.12 and
the Health&Safety Code,Sections 2 ,and 25
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 _'= z` T'= P=' - pa{e;
Owner or aulFiorrzed ' n
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
. .................................
l
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333^building Qcupertino.org
GUPERTINO RGv/7?0ff<7
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT 4
PROJECT ADDRESS /O J �I ��1nJ/! GC�n ��y , APN#�
OWNERNAME ( I T P I f yNE E-MAIL/
33/7
STREET ADDRESS D/ / eG p A CITY,STATE,ZIP 9 4 U FAX
CONTACT NAME PHONE E-MAIL
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STREET ADDRESS CITY,STATE,ZIP FAr;C)Z(0d v(PE1Z11K � Cmc�P�i`i.�v G.g ,9 S—d r� �) S�1-3 755 z
❑ OWNER ❑ OWNER-BUIIDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME LICENSENUMBE LICENSETYPE BUS.LIC#
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COMPANY NAME -MAIL FAX
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STREET ADDRESSIP
LLP Q �L��(_�j cI c��n Z�n'7 li✓� G/�-
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
rl�� _ �(;) r U� ���ll �?%rte t�//�•� /
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXLSTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH ARE I GARAGE AREA: DDETACH
❑ATTACH
#DWELLAGUNITS: IS A SECOND UNIT ❑YES SECONDSTORY E]YES
BEING ADDED? ❑NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEI D BY TOTAL VALUATION:
PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER EiCHLER HOME? ❑NO - r � a q' `* I �+y'
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 beha _ihave 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-onstru authorize repres s of Cupertino to enter the above-identified property f r'nspection purposes.
Signature of'App"1 cant/� en " - ': Date: 5 �
SUPPLEMENTAL INFORMATION REQUIRrPLanrcicxTYPE :W ks _ ovru�csLiP3 t
New SFD or Multifamily dwellings: Apply for demolition permit for
OVERTHF�COiJIrTER t43w)y BUIIDINGPLAjREV�ER r f,
existing building(s). Demolition permit is required prior to issuance of building W r r r 3 r 'FxNr
permit for new building. �'ExPxEss k�� t 0`PLniINIlrn7GPLArxEEylEw
r a y
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure L7'sTANnAxD� s t< gQ OWN!
form if any Hazardous Materials are being used as part of this project.
fk ; iY
Copy of Planning Approval Letter or Meeting with Planningb prior to
submittal of Building Permit application. `
B1dgApp_2011.d6c revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10181 PHAR LAP DR DATE: 05/19/2015 REVIEWED BY: SEAN
APN: BP#: `VALUATION: 1$1,500
F*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION 1 RPGAS
USE: SFD or Duplex PERMIT TYPE: i
WORK INSTALL 70 FT OF 3/4" GAS PIPE TO OUT DOOR FIREPLACE.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Piping, Gas <=4 Outlets 1PGASRES 1 # $72
TOTALS: $72.00
llech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check
:llech. Permit Fee- Plumb.Permit Fee: IPPERMIT Elec. Permu Fee:
Other A4ech. Iris/t =7 Other Plumb Insp. 0.0 hrs $48.00 Otter Elco.Insp.
,jech. Insp.Fee: Phinib. hsp. Tee: Elec.Insp. Fee:
EiLd
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-Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/132 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Sulrpl. .P("Fee
PME Plan Check: $0.00
Permit.Fee:
Srrl)pl. Insp Fee
PME Unit Fee: $72.00
PME Permit Fee: $48.00
Construction Tax:
Administrative Fee: IADMIN $45.00
Work Without Permit? 0 Yes (j) No $0.00
,Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $48.00 A
Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALSi $214.50 $0.00 TOTAL FEE: $214.50
Revised: 05/07/2015
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
job site during cor-s ruction. It is unlawful to make any
changes or alterations on same, or to deviate w5mh AF
therefrom, without approval from the Building Official. Raiff
The Stamping of;tus plan and speafica':ons SHALL NOT
F F
be held to permit or to be an approval of the violation
of any provisi ns of any CityOrdinanceor State Law. ro
BY
DATE S •/ -/ $
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