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15100094I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 20966 ALVES DR OWNER'S NAME: VIDIS ANN M TRUSTEE OWNER'S PHONE: 4082535072 ❑ LICENSED CONTRACTOR'S DECLARATION License Class c-? 6 Lic. # 9 N(%,� 7 CONTRACTOR: GOGO ROOTER I PERMIT NO: 15100094 2530 BERRYESSA RD STE 509 1 DATE ISSUED: 10/13/2015 SAN JOSE, CA 95132 1 PHONE NO: (408) 282-7026 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE AND REPLACE THE VERTICAL WATER PIPES. Contractor 46�2d�_ (;, tf=V Date J C> v I hereby affirm that I am licensed under the provision 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. Sq. Ft Floor Area: Valuation: $5000 I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self -insure for Worker's ompensation, as provided for by Section 3700 of the Labor Code, for the I p rformance of the work for which this permit is issued. a. Jhave 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 permit is issued. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature ate ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 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. 2. 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 permit is issued. s. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date APN Number: 32631005.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: %D RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner horized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO n iz-mw (YIN QTR T TrTTnl T CONSTRUCTION PERMIT APPLICATION *?/ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building (c-b-cupertino.org /�;le!�?�� G� F7AT)T)TTT(1N AT T -PR ATTnN / TT F-1 RRVTCTnN / T)T=FF.RRF/.T) nRTGTNAT. P'PRMTTT PROJECT ADDRESS 41uesY APN # OWNER NAME T PHONE STREET ADDRESS Zv7 CITY, STATE, ZIP y I FAX CONTACT NAME �k PHONE j ;C_ E-MAIL r - STREET ADDRESS CITY, STATE, ZIP/"/FAX ❑ OW1,1ER ❑. OWNER -BUILDER ElOWI,TER AGENT 9-50MI-RACTOR 13CONTRACTOR AGENT ElARCHITECT 1:1ENGINEER El DEVELOPER El Ti- t:AIv f CONTRACTOR NAM r�LICENSE NUMBER I LICENSE YPE � BUS. LIC # C?6 cp \rx 9 -Flo COMPANY N � E-MAIL FAX STREET ADDRESS- I CITY, TATE, ZIP � PHONE l P � �7 ARCHITECTIENGINTEER NAME LICENSE D'U`MBER BUS. LIC -9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NTEW FLOOR DEMO TAL AREA AREA AREA TNICI T AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL .AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: EIDFTACH []ATTACH I DWELLING UNITS: IS A SEC OND UNIT ❑ YES SECOND STORY []YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNrN1G APPL » ❑ NO PLANNIENTG APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HONE? NO RECERTED BY i -or TOTAL VALUATION: _ 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 const on. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: a ON REQUIRED SUPPLEMENTAL INTFOR-MA Q = = i O� ER TE COUNTER BUII DI's G �L 4N REVIEGi' New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition is required to issuance of building permit prior permit for new building. ExPxss PLAATI�LTtGPLA�V`REYIEW Hazardous ❑ PuslJeoRxs;: Commercial Bldgs: Provide a completed Materials DisclosuresTal��AizD form if any Hazardous Materials are being used as part of this project. 5 i ❑ L 4T2GE. s� �* }T�T��z`���� Copy Planning Approval Letter Meeting ith Planning to - ti S ' 3 ��' ] _b4: SiL<--y�_s,• t' c� .'"5� 1} i of D or with prior -� �� ;� � �� y-- ❑ MA70R C � .,,- �� � ��xaU �,,.. SA1\'TTARi; submittal of Building Permit application.�,•07. �s t� 4 SER`ET'RICT�°x„ � I< RDIS EI+rVIR071'MEI\T4I'IiEAL3Iir-.._ :, B1dgApp_2011.doc revised 06/21/11 0 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20966 Alves Dr TDATE: 10/13/2015 REVIEWED BY: Sean APN: BP#: *VALUATION: 1$5,000 'PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Du lex PENTAMATION 1 RPRP USE: p PERMIT TYPE: 10 WORK Remove and replace the vertical water pipes. SCOPE APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check 0.0 1 hrs $0.00 QTY UNITS BP FEES I Ie c, Permit f ee. Re -Pipe Interior 1PRREPIPE 1 # $14 ,`'e,�•ntit h��t: Suppl. In:sp Fee PME Unit Fee: $14.00 PME Permit Fee: $48.00 ('onstruetion Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $14.00 Stroniz Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to otter Departments (i.e. Flammng, ruaac worKs, Tire, aamiary ,3ewer "isirict, Ccnuuf T:_.�..: _.� ..�.. 1 T/ .... .. L;. ,... ,...,. 1. .......1 ., .,. ♦Ln ..... /:.s.�ui. •s. �n rrs>rnliit al ntrni�n tttn nai ii nr0 /tNttf nN VC1l sslnf0 fin Ntn/'f filo nUnf inr nddN'/ %nin_ FEE ITEMS (Fee Resolution 11-053 E : 7111113) llech. Plan Check17 Plumb. Plan Check 0.0 1 hrs $0.00 f Tec. Plan Check 1leclr. 1'errri<r Plumb. Permit Fee: 1PPER111IT I Ie c, Permit f ee. Cher .,Lf vh. AZT, Other Plumb Insp. 0.0 hrs $48.00 A,h?(:,h. Insp. Fee: Plumb. rasp. Ave. lusp. Fee, NOTE: This estimate does not include fees due to otter Departments (i.e. Flammng, ruaac worKs, Tire, aamiary ,3ewer "isirict, Ccnuuf T:_.�..: _.� ..�.. 1 T/ .... .. L;. ,... ,...,. 1. .......1 ., .,. ♦Ln ..... /:.s.�ui. •s. �n rrs>rnliit al ntrni�n tttn nai ii nr0 /tNttf nN VC1l sslnf0 fin Ntn/'f filo nUnf inr nddN'/ %nin_ FEE ITEMS (Fee Resolution 11-053 E : 7111113) FEE QTY/FEE MISC ITEMS /-Tern Check 14'ee: Stipp/. PC Fee PME Plan Check: $0.00 ,`'e,�•ntit h��t: Suppl. In:sp Fee PME Unit Fee: $14.00 PME Permit Fee: $48.00 ('onstruetion Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 .c/vc/neei/ Planning .1, Eyes: Travel Documentation Fee: ITRA VDOC $48.00 Stroniz Motion Fee: IBSEISMICR $0.65 Select an Administrative Item 7 Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $156.65 $0.00 TOTAL FEE: $156.65 Revised: 10/01/2015