15120119CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10357 GREENWOOD CT
CONTRACTOR: MASTER PLUMBING & PERMIT NO: 15120119
SEWER INC
OWNER'S NAME: RYDEN PAUL M TRUSTEE & ET AL
650 VAQUEROS AVE UNIT D DATE ISSUED: 12/14/2015
OWNER'S PHONE: 4089977100
SUNNYVALE, CA 94085 PHONE NO: (408) 945-1000
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
?'
REPAIR SEWER AND WATER LINE BETWEEN THE
License Class C Lie. # v
BUILDING
Contractor S ��L Date 2 ` ' ,
AND PROPERTY LINE.
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:
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
Sq. Ft Floor Area:
Valuation: $1200
performance of the work for which this permit is issued.
JI 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: 36914028.00
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 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
granting of this permit. Additionally, the applicant understands and will comply
Issued by: % Date: /
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature 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 (See.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, Sec ions 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
� 11-P .I . I �
Owner or authorized ages t� 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
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA °5014-3255
(408) 777-3228 - FAX (4,08) 777-3333 • buildina(a cuoeriino.org
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By my signature below, I certify to each of the following: I am the properr ly owner or authorized agent to act on the property owner's belkdf. I have read this
application and the information I have provided is correct. I have read the Description of'Work and verity it is accurate. I agree to comply with all applicable local
ordinances and state laNvs relating to build's nstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
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?ABPh�iscflpp_7011.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
19,
ADDRESS: 10357 Greenwood Ct Apt #A
DATE: 12/14/2015
REVIEWED BY: Phuong
UNITS
APN: 36914 028
BP#:
'VALUATION: 1$1,200
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
#
PENTAMATION
PERMIT TYPE: I RPSS 4,
WORK
Repair sewer and water line between the building and property line.
SCOPE
Other Plumb Insp. 0.0 hrs
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Plumb. Plan Check 0.0 hrs
Sewer, Sanitary A
1 PRSEWER
Ph
1
#
$25
Piping, Drainage
1PREPPIPE
Other Plumb Insp. 0.0 hrs
1
#
$48
A ;r?
-va
$73.00
PME Permit Fee:
$48.00
F
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? C) Yes (j) No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$73.00
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
T);vtr;rt-Ptr-)- Thp.vp fpp.v are based on the Dreliminary information available and are onlv an estimate. Contact the Dept for addh 'I info.
FEE ITEMS (Pee Resolution] 1-053 Lfij.711113)
FEE
QTY/FEE
MISC ITEMS
Plumb. Plan Check 0.0 hrs
$0.00
Ph
Plumb. Pen -nit Fee:
IPPERMIT
P -C'-":
h-
Other Plumb Insp. 0.0 hrs
$48.00
A ;r?
-va
$73.00
PME Permit Fee:
$48.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
T);vtr;rt-Ptr-)- Thp.vp fpp.v are based on the Dreliminary information available and are onlv an estimate. Contact the Dept for addh 'I info.
FEE ITEMS (Pee Resolution] 1-053 Lfij.711113)
FEE
QTY/FEE
MISC ITEMS
A
:)za.v"i, .z 3i..
PME Plan Check:
$0.00
PME Unit Fee:
$73.00
PME Permit Fee:
$48.00
F
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? C) Yes (j) No
$0.00
V�, , !X, 1 1 'a , !�� Ct'�S:
/16�71C,11� J, 11 F!
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTO ALS:
$215.5 0
TOTALYEE:
$215,501
Revised: 10/01/2015