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15110198CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: -'7362 RAINBOW DR - �,�n PERMIT NO: 15110198 Cg MTCTORPE OWNER'S NAME:, EBERHARDT NOEL H AND HORTENCIA C TR a) ��� 7 DATE ISSUED: 11/30/2015 OWNER'S PHONE:' 6502791216 1 PHONE NO 01, LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL REPLACE MAIN WATER SERVICE AND REPIPE BUILDING License Class G Cr3 . Lic. # ( D O 8 �-� ( (4 -FLEX) c Contractor Date l I hereby a� that) am licensed d r the provisio s of Chapter 9 (commencing with ;Section 7000) of Division 3 of the Business & Professions Code and ihat my license is: in full force and effect. I hereby affirm under enalty of perjury one of the following two declarations: I have an&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: $18200 I have andwill 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: 36619020.00 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 DYS 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 r Issued by: �—t��� 16�-- Date: granting of this permit. Additionally, the applicant understands and will comply with all non -poi eurce-regula i er_t Cupertino Municipal Code, Section 9.18. _ qq r Si tune 1 _ Date �I 1 �� S 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. ❑ 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 owrerof 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 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(x) 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. I have and will'inaintain Worker's Compensation Insurance, as provided for by will maintain compliance,k'th-thLrCu` erimo Municipal Code, Chapter 9.12 and e, ections 505, 25533, and 25534. the Health & Sr,-i,,d Section 3700 of the Labor Code„for the performance of the work for which this I �� permit is issued.:': Owner or authe"nt: Date: 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.Califomia. If, after making this certificate of exemption, I CONST U TIO LENDING AGENCY become subject to the�Worker's Compensation provisions of the Labor Code, I must I hereby affirm that therei construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this per tis issued (Sec. 3097, Civ C.) Lender's Name j APPLICANT CERTIFICATION Lender's Address I certify, that I have read this application and state that the above information is correct. I agree to compfy 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 axpenses•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 :i� a -V CUPERTINO GENERAL PERMIT APPLICATION j 5110 jq5 COMMiUNI T `( DEVELOPV ENT DEPARTMENT • BUILDING DIVISION 10300 T ORRE AVENUE • CUPERTINO, CA 85014-3255 (408) 777-3228 - FAX (408) 777-3333 • building5cuoerino.org I9PLUh/3-a�G. ❑1,MCHANICAL ❑ELECTRIC, L ❑h,12SCET—LANE0US 1�11FPAffsc-�pp_?011.doc reW. Cl Ott,/' ` OSkTzRl-A7J4. I P'HOKE^. /' 10%6 I -I✓=..Z KJ�i� ODIC S T R'K_i:T S I CITY S T.0.TP, ZIP L�iti - CON'TACT MM -E PrIO �� I E-?✓� tr STR=--T ADDP=- S I CITY, STAT'a, ZIP -A X ❑ OW) -R ❑ OF^.' ;-3LJ1Da ❑ 0, \--E R AL' T 2)2p.RCTOR ❑ CO!71-R-kCTOR ACM T ❑ .4RG ,TCT ❑ = vGZ\= ❑ r'i1rLOP= CO?O I LIC?�j+�� I LSC S-1 I BLS. LIC' COMP N -Y ?\AIJ,F /� 'l = FAX' G GL lL��'QS Y 7 j' , STP ET /DDRSS ( EA W �'qlp) k I � CIc���,',, _ C% J P G . f �.LC C / ✓ iC7 ARCFjTECTlENGtT=ER TAM LICENSE NUM— BUS. LIC CONIUMNY Nt E-? I FA STREET ADDRESS I CITY, STATE, ZIP I PHONE USE OP ❑ SPD or DL-PLEX ❑ 1J,nn.FA1gLY PROMECT INWIT I)LI-ND ❑ Y s PROTECT IN ❑ YES is i = BLDG tN B=11 G: ❑ Cobo,r-1- .CLA_T I L)'FBkN,LNl=- 2FACEAK-7k ❑ NO FLOOD ZO?,ME ❑ -0 I :1C_'L 1tHOlJ. 7 DERIP7 ON OF 17JORK C_ �8ii -� I ko Gr �� 7 fl6 W n TOTAi W.LU.-.T?ON: GD By my signa«rebelow, I ce-�iy to each of the follo,;vL-g: I un, the D� ope owner or authorized agent to act on the , ope. ty owner's behalf. I have rear application and th-, Lzfonnation 1 have Dro;'ided '- tav rea - -iation of Work z,d verify itis accurate. I agree to comply with all appl; .d-znces ands state laws relit ng to buil' construction. I a hor e r epresen� t of Cupe t no to enter ue abqove-idea iced p iYvv inspec ion I Sigmzture /Agent: v of:,pplican Date: 1 J SU _ � T t0. 1 UT DRE K a� '�.. .g.. f 2-0 a NO 1�11FPAffsc-�pp_?011.doc reW. CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION C� ADDRESS: 7362 Rainbow Dr. DATE: 11/30/2015 REVIEWED BY: PAUL 36619 020 BP#: *VALUATION: $18,200 *PERMIT TYPE:. Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY . SFD or Du lex PENTAMATION 1 RPWS USE:, p PERMIT TYPE: WORK Re lace main water service and re i e building 4-Plex SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Water Service 1 BPWSVCs 1 # $25 Re. -Pipe Interior 1PRREPIPE 1 # $14 TOTALS: $39.00 1 : FEE ITEMS (Fee .Resolution .1.1-053 F,ff. 7,-1/.13) FEE QTY/FEET MISC ITEMS 1'itatc ciie,c% Pee: `ar3l..f't:'�Je Plumb. Plan Check 0.0 hrs $0.00 Iae<:, Pf an (----h ck {PME permit h 2e: Plumb. Permit Fee: IPPERMIT PME Unit, Fee: $39.00 01her rWeeh. J isp. $48.00 " .0Y1.1tP'tfL'aon ,. a.q , Other Plumb Insp. 0.0 hrs $48.00 oil."er kllev. Insp.Ll Work Without Permit? ' " 0 Yes (E) No $0.00 AdV', i fcxi% .P,.1, rtrir.`ilr �F,ees: Yfe—k. Travel, Documentation Fee: 1 TIM VDOC $48.00 Feel NUIE. /"his estimate does not ancluaefees aue to otner vepartments (t.e. rtanntng, ruDuc morns, Lsos.ac g, "District, etc.: Thesefees are based on the prelinmdina in orntation available and are only an estimate. Contact the De t or adan't into. rX1CVjbVU. FEE ITEMS (Fee .Resolution .1.1-053 F,ff. 7,-1/.13) FEE QTY/FEET MISC ITEMS 1'itatc ciie,c% Pee: `ar3l..f't:'�Je Plan// Check: $0.00 {PME PME Unit, Fee: $39.00 ,PME''Permit Fee: ;' $48.00 " .0Y1.1tP'tfL'aon ,. a.q , 'Administrative Fee':*: ]ADMIN $45.00 Work Without Permit? ' " 0 Yes (E) No $0.00 AdV', i fcxi% .P,.1, rtrir.`ilr �F,ees: Travel, Documentation Fee: 1 TIM VDOC $48.00 Stfon 'Nlotion Fee`; IBSEISMICR $2.37 Select an Administrative Item i Bld:''Stds'Commission Fee: IBCBSC $1.00 l .TOTAL SUBTOTALS: $183.37 401:'1-'17-FEE:, IUlU L/GU I.