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15080183CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 819 HOOSHANG CT CONTRACTOR: PLUMBING TECH PERMIT NO: 15080183 SEWER AND REPIPE INC OWNER'S NAME: KEVIN PHAM 278 E GISH RD DATE ISSUED: 08/25/2015 O ER'S PHONE: 4083355945 SAN JOSE, CA 95112 PHONE NO: (408) 437-6207 of LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] 01 © COOPER RE -PIPE ENTIRE SFD License Class_ Lic. # Contractor yi fl a0 ZS �S 1 hereby a trm 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: $5000 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: 35902002.00 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 D RMIT 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 LLED 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 V, Date: with all non -point source regulations per the Cupertino Municipal Code, Section RE-ROOFS: 9.18. 0�,? Signature % DateJ 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: 1 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) 1, 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 1 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections ;550,V, 25533, and 25534. Owner or authorized agent: 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 CUPERTINO GENERAL PERMIT APPLICATION Rnm E P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buiIdInc(d,)CUDelilno.orq ! -57D 8O( Y -4vi 15 (; PLUh:BINCT ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS ( n i .4PN = D Z UO Z OWNERNAI�S 1 PHONEqor l g E-IJL4IL � J/ STREET?.DDRESS 2 1,171 CITY, STATE, ZIP I FAX / CONTACT NAMEj &�Iz PHOTS /,� E-NLAIL h2 Ifa 2L(%We STREET ADDRESS CITY, STATE, ZIP/ FAX / ❑ OWA'rUt ❑ 01IR. -BUILDER ❑ Oti^N'ER AG;ZT CO171LICTOR ❑ CONTRACTOR AGENT ❑ ARCY.ITECT ❑ ENGL\ctR ❑ DF% ELOPER ❑ TE\AI.°T CO. T ACT R % LICENSE TUhSER G� �� / LICEti"E TIME ��� BUS. LIC r (/) �/ v (A COMPANY NA✓M AIL lJ'i11 GGA Galori FAX STRF S r2W CITY, ST IP 4 �117, PHONE 4RCHITECT/ENGA�ER NAT E LICENSE NUMBER BUS. LIC n i COMPANY NAME E-MAZ FAY. STREET ADDRESS CITY, STATE, ZIP PHONE �� z / USE OF ❑ SFD or DUPLEX ❑ MULTI-FAbELY PROJECT LN WILDLAND ❑ Yts PROJECT IN ❑ YD -s IS THE BLDG .4N ❑ YES B=E,10: ❑ COM1,ERCL4L URBAN 12t, FACE AREA ❑ NO FLOOD ZONL ❑ No EICI-LER HONE? ❑ NO DESCRIPTION OF WORK TOTAL VALUATION: 5 ' By my signature below, I cerAy to each of the following: I am the property owner or authorized as nt to a on the application and the information I have provided is correct. I have read the Description of Work and veri it a ordinances and state laws relating to bu ino, o con. Iautho ' e representatives of Cupertino to enteab Si�atureofApplicanUAgent:D i Date: SUPPLEMENTAL D\TFOR-MATION REQUIRED 'her's behalf.ave read this to co all applicable local pynty for inspection purposes. MEPMiscApp_201120c revised 06121/11 CITY OF CUPERTINO 1'91 FEE ESTIMATOR — BUILDING DIVISION im,ADDRESS: 819 HOOSHANG CT DATE: 08/25/2015 REVIEWED BY: MELISSA UNITS APN: 359 02 002 BP#: 'VALUATION: 1$5,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: $14 PENTAMATION 1 RPR PERMIT TYPE: WORK COOPER RE -PIPE ENTIRE SFD SCOPE APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check 0.0 1 hrs $0.00 QTY UNITS BP FEES llec. 1'errrrir Re -Pipe Interior 1PRREPIPE Other L-lec. Inap.ED 1 # $14 Permit Fee: S't/ppl. Insp Fee PME Unit Fee: $14.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? O Yes O No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $14.00 Strong Motion Fee: 1BSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, /sire, Sanitary Sewer Vistrict, acnool nicirint oto 1 T h—a %oc nro hncod nn tho nroliminary inlarmatinn avoilahlo and aro anly an estimate. Contact the Dent for addn'1 info. FEE ITEMS fFee Resolution 11-053 E . 711/13) Mech. Plan Check Plumb. Plan Check 0.0 1 hrs $0.00 'cc.Plan Check �tlech. Pere Plumb. Permit Fee: IPPERMIT llec. 1'errrrir clrrla ate �. Insp. Other Plumb Insp. 0.0 hrs $48.00 Other L-lec. Inap.ED �Vfech. Insp. F', •. PME Plan Check: Elec. Insp, Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, /sire, Sanitary Sewer Vistrict, acnool nicirint oto 1 T h—a %oc nro hncod nn tho nroliminary inlarmatinn avoilahlo and aro anly an estimate. Contact the Dent for addn'1 info. FEE ITEMS fFee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Sufwl. PC Fee PME Plan Check: $0.00 Permit Fee: S't/ppl. Insp Fee PME Unit Fee: $14.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? O Yes O No $0.00 ldvanced Planning Fees: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: 1BSEISMICR $0.65 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $156.65 $0.00 TOTAL FEE: $156.65 Revised: 07/02/2015