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16010012I CITY OF CUPERTINO BUILDING PERMIT J BUILDING ADDRESS: 20730 GARDEN CREST CT I CONTRACTOR: TRENCHFREE INC PERMIT NO: 16010012 OWNER'S NAME: U_L4 Ct0 fft OWNER'S PHONE: 7755465833 License Class I& Lic. # '7-7/ 01.b Contractor 7&-a �`Z �,, a_ Date 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 Performance of the work for which this permit is issued. 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. , Z . 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'grisource regulations per the Cupertino Municipal Code, Section 9.18. Signature Date l ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. 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 IPOBOX U SAN JOSE, CA 95151 DATE ISSUED: 01/04/2016 PHONE NO: (408) 726-7926 JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL REPLACE WATER SERVICE FROM METER TO PROPERTY Sq. Ft Floor Area: I Valuation: $2350 APN Number: 36230056.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180YS FROM LAST CALLED INSP CT ON. Issued by: i—©v aawd Date: v`ti►'L 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 255( '25533, and 25534. Owner or authorized agent: Dater 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 . . CUP ERTINO GENERAL PERMIT APPLICATION ) MIOOR, COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (4-08) 777-3333 • buildino(d)Cuoertino.org ,rPLUl,rMNiG ❑MECIi?1\7IC.,kL ❑ELECTRICAL 7 Mil- OUS PROJ-r.CTADDRESS�� I pP?�' 2/� ®5 J� [ C� ju OCvTiR1 AME ` L G �t�, J PHOMr I 7S r�6_ 5 3 E•IJi-IL A Guu 591,' E Cd -7, STREET ADDRESS u� I CITY, STATE, ZIP I FAX CO?,,TACT )\.SIDE I PH0N-B E-?vLkLT STREET ADDRESS I CITY, STATE, ZIP FAX ❑ 0,w.=R ❑OV1 ?-3UTi�� ❑ OFrNTEtAcm,7 ❑ CO?TKA.CTOR ❑COMRACTORAGE ZT ❑ ARC::TitCT ❑ ENGIN—=R ❑ DciLLOP R ❑ T_? e]� CONTI ACTOR KAJ,C •. I LICENSE I.ZJA/u3' ER - f / LIC SE 1 'PE / I BUS. LIC -1., ���� • C0111TANY NA1 — FA.X STREET ADDRESS CITY, STAT_, ZIP 1°Ir A, -- q: PHOK ) 7 AaCHITEC T /T GNBER XAT:E LICENCE NFUlDBER BUS. LIC r COh/24-W K l,E E-MAM FAY, STREET ADDRESS CITY, STATE, ZIP I PHOKE u -SE OF ❑ sm. or DUPUr Y. ❑ X✓,ULTI-PAl°=Y PRO cCT N V 1nDLP N7D ❑ YES ?ROiLCT LK ❑ YES I IS THE BLDG .4X3 ❑ Y :s B–u=N1G:❑C0t,G tCLA URBANLD\Tf2tAC:ARF4 ❑ X.'O FLOOD ZOME El NO EICFLER$OME? E3 NO DESCRIPTION OF WORK r `) alb 6 6 S— ` Yl Aa J cJ� moi+ r r an i Ar\ 14u- - 6-W ixa) TOTa.LVALUATIO\: ` _ By my signz«re below, I certify to each of the following: I am the property owner or autborized agent to act on the pr pe Ly owner's behalf. I have read this - a pplication and the L-iformation 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 crd�nances and state IaNvs relatLng to build' a onst�-MIction. I authorize representatives of Cupertino to enter the above -identified ro i P p pe'y for inspectionpurposes. Signature of" ppl-icant/Agent: Date SU-PP_E?\rENTAI. L\rORMATION REQULRED R 15 J �aT��D3� D ism=k s F..q�`.,' 1 -AlFPhaisc.4PP_2011.doc revised 06/21/11 CITY OF CUPERTINO 010010 Ww FEE ESTIMATOR - BUILDING' DIVISION ADDRESS: 20730 Garden Place Ct FEE DATE: 01/04/2016 REVIEWED BY: PAUL APN: 362 BP#: *VALUATION: 1$2,350 `rPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: PNM Plan Check: $0.00 PENTAMATION 1 RPWS PERMIT TYPE: WORK Replace water service from meter to property SCOPE A,/ech. PLrn, Plumb. Plan Check 10.0 1 hrs $0.00 c I Fee: Plumb. Permit Fee: IPPERMIT Other Plumb Insp. L L -O I hrs Lj Phvnb. luso, VOTE. 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 preliminary information available and are only an estimate. (;ontactthe Dept,loraddli'llt!fo, FEE ITEMS (Fee Resolution .1.1-053 FQ7/1113) FEE QTY/FEE I MISC ITEMS Pian ("heckf`ft: .. ,i� PNM Plan Check: $0.00 Perm 'I PIC!(": PME Unit Fee: $25.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 1 / va�, .I t I eCs" A11 ,ce/.," annh?,.�,F Travel Documentation Fee: ITR.4VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item -1, Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $167.50 $0.00 $1 Revised: 10/01/2015