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15080222EA CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10120 PHAR LAP DR CONTRACTOR: N6 z-/ 4 PERMIT NO: 15080222 OWNER'S NAME: SCHOY ALBRECHT F AND KASHVAD MARJAN ,ISDATE ,iZo /v27 ISSUED: 08/31/2015 OWNER'S PHONE: 4083092973N �s G PHONE NO: G�-j - ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] REPLACE WATER MAIN FROM METER TO RESIDENCE. License Class � �� G 7��L,ic. # % Contractor C Date I hereby affirm that I am licensed under t 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 Co5Vehsation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: N aluation: $1300 ormance of the work for which this permit is issued. 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: 32618043.00 Occupancy "I'} pe: 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 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: v �rj %G� Date: granting of this permit. Additionally, the applicant understands and will comply v��/ with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Si r Date i 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 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. 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 1 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 5533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agy+ 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 7; CUPERTINO GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 M ' (408) 777-3228 • FAX (408) 777-3333 • building(a1cupertino.org /�j/��a� S C I ' IKL ING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS APN i� OWNERN oe P$Qt , STREET DRESS %O CITY,, STATE, ZIP F CONT 'CT NAM PH NE E-MAIL STREET DRESS CITY, STATE, ZIP ® lam! FAX �� ❑ OWNER ❑ OF'NER-BUILDER 1:1 OWNER AGENT 19 CONTRACTOR ❑ CONTRACTOR AGENT El ARCHITECT El ENGINEER 1-1 DEVELOPER 11 TENANT CONT CTOR NAME i ` < LICENSE ER' �i CENSE TYPE C Z BUS. LIC COMPANY NAME E-MAIL FAX STREET APDRESS 0 C CITY, STATE, Z1P ONi; © 7 �� ARCHITECT/ENGINEER NAME elf LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF TPFD or DUPLEX ❑ MULTI -FAMILY BUILDING: COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA NO PROJECT IN ❑ YES FLOOD ZONE ijLN0 IS THE BLDG AN ❑ YES EICHLER HOME? 0 DESCRIPTION OF WORK TOTAL VALUATION:3 a p RECEIVED BY: 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 construct. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/ Date: SUPPLEMENTAL INIFORMATION REQUIRED OFFICE USE ONLY c. = U U < OVER-THE-COUNTER '❑ EXPRESS c❑ "LARGE MAJOR . MEPMiscApp_2011.doc revised 06/21/11 rj CITY OF CUPERTINO 11/I FEE ESTIMATOR — BUILDING DIVISION 191 ADDRESS: 10120 PHAR LAP DR DATE: 08/31/2015 REVIEWED BY: SEAN UNITS APN: BP#: *VALUATION: $1,300 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex # PENTAMATION PERMIT TYPE: 1 RPWS WORK REPLACE WATER MAIN FROM METER TO RESIDENCE. SCOPE 1.rppl. Insp Fec APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check 0.0 hrs $0.00 QTY UNITS BP FEES Elec. Permit Fee: Water Service 1 BPWSVCS Other hlec. Imp. 1 # $25 "c rmit Fee.: 1.rppl. Insp Fec PME Unit Fee: $25.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: ]ADMIN $45.00 Work Without Permit? Yes (D 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 preliminar in ormation available and are onlV an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Efl: 711/13) Alech. Plug Check Plumb. Plan Check 0.0 hrs $0.00 t-aec. I'lan Check 4•fech. 1'ern:ir ! e . Plumb. Permit Fee: I PPERMIT Elec. Permit Fee: Other A2ech. In.rp, Other Plumb Insp.0.0 hrs $48.00 Other hlec. Imp. :tlech. Imp. Fee PME Plan Check: L:(ec. Insp. Fee 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 preliminar in ormation available and are onlV an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Efl: 711/13) FEE QTY/FEE MISC ITEMS Placa Check Fee: `�gppl. PC Fee PME Plan Check: $0.00 "c rmit Fee.: 1.rppl. Insp Fec PME Unit Fee: $25.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: ]ADMIN $45.00 Work Without Permit? Yes (D No $0.00 Ivonced Planning 1--eec: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $167.501 $0.00 TOTAL FEE: $167.50 Revised: 07/02/2015