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15100182I CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 10326 TONITA WAY I CRESIDENTIALNTOR: AME I OF CA I CAN PERMIT NO: 15100182 I OWNER'S NAME: GERNER DEANNA J AND KARL J ET 1 965 RIDGE LAKE BLVD STE 201 1 DATE ISSUED: 19/22/2015 I OWNER'S PHONE: 4082181883 ! MEMPHIS, TN 38120 1 PHONE NO: (408) 982-0405 1 @&F/ LICENSSEED CONTRACTOR'S DECCLARATION Livens lass /�VTic,./.�# Cca7�Itraetcr 7Y�`l R.�G eye !/1'D ✓ Da 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: 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. ooI have and will maintain Worker's Compensation Insurance, as provided for by ion 3700 of the Labor Code, for the performance of the work for which this i 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 9.188.. Signa e /'/� Date, %�`-� ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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: t . 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. a. 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 IOWDESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ RE-PIPE(E) SEWER UNDI SER BUILDING AND INSTALL NEW FOUNDATION CLEANOUT Sq. Ft Floor. Area: I Valuation: $3000 APN Number: 35915050.00 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: pV Z3 is - 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 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 or authorized a� 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10326 Tonita Way DATE: 10/23/2015 REVIEWED BY: Phuong UNITS APN: 359-15-050 BP#: *'VALUATION: Iso PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: $14 PENTAMATION 1 RPRP I PERMIT TYPE: A WORK INSTALL NEW FOUNDATION CLEANOUT SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Re -Pipe Interior 1PRREPIPE 1 # $14 Permit Fee: Suppl. Insp Fee PME Unit Fee: $14.00 PME Permit Fee: $48.00 Construction Tax: r7l Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 TOTALS: i Travel Documentation Fee: ITRA VDOC $14.00 Strong Motion Fee: 14ech. Pleas Check Plumb. Plan Check 0.0 1 hrs $0.00 E'lec. Plan Check Alech. Permit T'ee: Other Ifech. Rasp, Afech. Insp. Fee: Plumb. Permit Fee: IPPERMIT Elec. 1'eraaait Fee: Other Plumb Insp. 0.0 1 hrs $48.00 Other Elec. hasp. Plumb. Insp. Fee: Elea Insp, Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Di.vtrirt. otC)_ Tho.Qo foov aro hasod nn the nroliminary infnrmatinn availahlo find aro n"f r an octimnio Cnnfarf fhv l) i fnr fidd"ll info FEE ITEMS (Fee Resolution .1.1-053 E(f. 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: SuPPI. PC .Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $14.00 PME Permit Fee: $48.00 Construction Tax: r7l Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 Aclv,aneed .Planning Fees: i Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS. $155.00 $0.001, $155.00 Revised: 10/01/2015 I CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 10326 TONITA WAY I CONTRA IAOSECES AMERICAN CA I PERMIT NO: 15100182 I OWNER'S NAME: GERNER DEANNA J AND KARL J ET 1965 RIDGE LAKE BLVD STE 201 1 DATE ISSUED: 10/22/2015 1 OWNER'S PHONE: 4082181883 1 MEMPHIS, TN 38120 1 PHONE NO: (408) 982-0405 []"' LICENSED CONTRACTOR'S DECLARATION License Class Lic. # S^%•pis Contractor 1/y/ ; ra {ie S i J'19 Ate 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: 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 ami �s 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. Signature6p�:f DateOV I ❑ 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: i. 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. 1 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. 3. 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 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REPLACE (E) BUILDING SECONDARY SEWER DRAIN LINE (UNDER DWELLING ONLY) Sq. Ft Floor Area: I Valuation: $3000 APN Number: 35915050.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS_ -OFTERMIT ISSUANCE OR 180 PA RO ,CALLED INSPECTION. 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. orized agent: Date: J 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 ............................................ GENERAL PERMIT APPLICATION MEP COMMIUNI lY DEVELOPA%iENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildin0(�cupejinc.or�c /� cu, P;~RTIN0-2mls(; l 5rI(/� [ LLTh 3%iG ❑N�CILA?�ZC�L ❑ELECTRiCA1, ❑b/HSCELLJI�T0US j ROIEC-�DFESS C �� I ,L�? . T Q /Y- ` 0n:? /1 fOW t�at.c� ' I PHONE /ter///_//�y//(j(���////4)Q I E MILAi 9 0, Y • `� / f./ C..�� TREET t-DDP,ESc- S CITY, STATE, ZIP l/ CO?vTACT NA_U,E TRFETA.DD ( CITY, STATE, ZIP � I FAX E3 OH.ma, ❑ OwNrR-BUILDER ❑ Oti NTE:R AGE\T ❑ C0 \7KACTOR ly C0 \'TRACTOR AGENT ❑ A-kCi-=lrC- ❑ --NGWB ❑ D��ELOP�t ❑ Tc'v;1.? C TRACTOR LICENSE NU,SI ER IC --NSE TYPE BUS. LIC C0M2AI\Y NAJYM E-MAIL FAX ~-TFps i CITYSTSTE; ZIP PHO: r fiRCETBCTrNGL'\=ERN.Ah4E I LNSEI\TU s- - COI\12A-NTY N.AIv!E E -Mf i7� STREET .ADDRESS C::TY, STATE., ZIP i USE OF ❑ SFD or DUPLEX ❑ MULTI-F.A ,M Y PROTECT LN VVMDLAT L [] � r.S 13=' dG! ❑ COI,2�tCL',T UPRL?. LN7E-RTACE ARRA ❑ I,sO DESCPaTION OF WORK M ria c -AL N BUS. LIC r FAX ��FHOI\t I PROjtC7IN ❑YES I IS TI E BIG AN _ [] Y=S FLOOD ZONE ❑ NO EICI'-LERHOWM? J l"O MEr�'A!iscg p_2011.doc revised 06/21/11 CITY OF CUPERTINO I WL�w FF.F. ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10326 TONITA WAY DATE: 10/22/2015 REVIEWED BY: MELISSA UNITS APN: 359 15 050 BP#: *VALUATION: 1$3,000 PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION 1 RPS PERMIT TYPE: WORK REPLACE E BUILDING SECONDARY SEWER DRAIN LINE UNDER SFD ONLY SCOPE APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check 0.0 1 hrs $0.00 QTY UNITS BP FEES Elec. Permit Fee - Sewer, Building 1 PRSEWER oflier Iles. Inst?. 1 # $25 PME Unit Fee: $25.00 PME Permit Fee: $48.00 C.'on:sti-uction Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? Yes E) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $25.00 Strom Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nictrirt_ ptr- )_ Thovp fpec are ha.ced on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E .. 7,1,13> Afech. Plan Check Plumb. Plan Check 0.0 1 hrs $0.00 Elec..Plan Check Tech. Permit Fee Plumb. Permit Fee: 1PPERMIT Elec. Permit Fee - Other ,'llec Ii. Insp. Other Plumb Insp. 0.0 hrs $48.00 oflier Iles. Inst?. .,.leech. Insp. hee: `'Itim7. Insp. T . 1lec. Insp. Lee. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nictrirt_ ptr- )_ Thovp fpec are ha.ced on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E .. 7,1,13> FEE QTY/FEE MISC ITEMS Plan Check dee: 1tj'1/??. PCF CCF71 PME Plan Check: $0.00 PME Unit Fee: $25.00 PME Permit Fee: $48.00 C.'on:sti-uction Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? Yes E) No $0.00 Advaneed Throning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $167.501$0.00 TOTAL FEE: $167.50 Revised: 10/01/2015