15040169 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10760 S STELLING RD CONTRACTOR:ALLSTAR PLUMBING PERMIT NO: 15040169
OWNER'S NAME:
SAN JOSE,CA 95122 PHONE NO:(408)230-5569
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
REPLACE EXISTING WATER LINE FROM WATER METER
License Class \t�� Lic.#_1 � TO
HOUSE
Contractor Date
I hereby affirm that I am licensed under t e 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:$8568
VWand 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:35922078.00 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 AYS FROM LAST CALLED INSP CT ON.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 1 ,VN
costs,and expenses which may accrue against said City in consequence of the /� C l(./�I
granting of this permit. Additionally,the applicant understands and will comply Issued by: fit/ Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
918. /
/� t' RE-ROOFS:
Signature ; ,, Q,4 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 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 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(See.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
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10760 S STELLING RD CONTRACTOR:ALLSTAR PLUMBING PERMIT NO: 15040169
OWNER'S NAME:
SAN JOSE,CA 95122 PHONE NO:(408)230-5569
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
�� REPLACE EXISTING WATER LINE.FROM WATER METER
License Class CIO AlYidj� Lic.# 7��69 j� TO HOUSE
Contractor JW SA d �/.m19+��I//-�vyDate�� w
I hereby affirm that I am licensed under the provisions of Chapter 9 REV#1 -REPLACE(E)BUILDING&SANITARY SEWER
(commencing with Section 7000)of Division 3 of the Business&Professions LINES(NO NEW CLEANOUTS),REPLACE(E)WATER
Code and that my license is in full force and effect. HEATER,RE-PIPE ENTIRE SFD&REPLACE GAS LINE TO
I hereby affirm under penalty of perjury one of the following two declarations: ,WATER HEATER.-ISSUED 5/20/15
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:$8568
8, 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:35922078.00 Occupancy Type:
permit is issued../w"
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 WIT YS OF 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 DAYS + CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgmen costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply ;;0
ate:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature A Date �iJ�@ All roofs shall be inspected Prior to any 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
1 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 agent: � �Y��' Date:.
permit is issued.
1 certify that in the performance of the work for which this permit is issued,l 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(See.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
1 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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10760 S Stelling Rd DATE: 04/23/2015 REVIEWED BY: Paul
APN: 359 22 078 BP#: *VALUATION: 1$8,568
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPWS
USE: p PERMIT TYPE: A
WORK �Re lace existing water line from water meter to house
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Service 1 BPWSVCS 1 # $25
TOTALS: $25.00
Afech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 L'Iec..Plan Check
Flech. fermi[Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit Fee:
F
0.0 Alech. Insp. Other Plumb Insp. hrs $48.00 Other Elec.Insp.
Insp. hie: Phmtb. Insp. lie; I Elec.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 fims are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl—ff'Pee
PME Plan Check: $0.00
Permit Fee:
Supp/. Insp Fee
PME Unit Fee: $25.00
PME Permit Fee: $48.00
COIZSt]'2MOP7 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
Strong Motion Fee: 1BSEISMICR $1.11 Select.an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
SUBTOTALS $168.11 $0.00 TOTAL FEE. $168.11
Revised: 04101/2015
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10760 S STELLING RD DATE: 05/20/2015 REVIEWED BY: MELISSA
191 APN: BP#: I-SoY 016 *VALUATION: 1$20,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPSS
USE: p PERMIT TYPE: A
WORK REV# 1 - REPLACE E BUILDING & SANITARY SEWER LINES NO NEW CLEANOUTS
SCOPE I REPLACE (E)WATER HEATER, RE-PIPE ENTIRE SFD & REPLACE GAS LINE TO WATER p
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Building 1 PRSEWER a 1 # $25
Sewer, Sanitary 1PRSEWER 1 # $25
Re-Pipe Interior 1PRREPIPE 1 # $14
Piping, Gas <=4 Outlets 1 PGASRES 1 # $72
TOTALS: $136.00
Mech.Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec..Plan Check
Ate& Permit tree: Plumb.Permit Fee: IPPERMIT Elec. Permittee:
Othez Rteeda. lnsp. Other Plumb Insp. EEhrs $48.00 Other 1s'lec.Insp.
Llech. Insp. Fee: Plzmrb. Insp. Fee: Elec.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 prelimina information available and are only an estimate. Contact the Dept-for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check hcue:
Suppl. .PC r'ee
PME Plan Check: $0.00
Permit Fee:
Supp/. h7sp Fee
PME Unit Fee: $136.00
PME Permit Fee: $48.00
Construction Tax:
Administrative Fee: 1ADMIN $45.00
Work Without Permit? 0 Yes No $0.00
Advanced Phinnim"Fees:
Travel Documentation Fee: ITRAVDOC $48.00 A
Strong Motion Fee: IBSEISMICR $2.60 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS• $280.60 $0.00 TOTAL FEE: $280.60
Revised: 05/07/2015