B-2016-1393 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-1393
10762 LA RODA DR CUPERTINO,CA 95014-4444(369 34 039) (THE GREAT
AMERICAN PLUMBING
COMPANY
INCORPORATED)
SAN JOSE,CA 95159
OWNER'S NAME: SlU MATTHEW MAN FAI DATE ISSUED:02/18/2016
OWNER'S PHONE:4088577430 PHONE NO:4082791515
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC6 Lic.#521 QFC X BLDG —ELECT X PLUMB
Contractor(THE GREAT AMERICAN PLUMBING COMPANY —
INCORPORATED)Date 2/18/2016 —MECH X RESIDENTIAL_COMMERCIAL
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 JOB DESCRIPTION:
license is in full force and effect. REPIPE ENTIRE HOUSE-HOT AND COLD;REPLACE SHOWER
VALVES;REPLACE WATER SERVICE;INSTALL(I)WATER HEATER
I hereby affirm under penalty of perjury one of the following two declarations: WITH EXPANSION TANK
s. 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.
z. I have and will maintain Worker's Compensation Insurance,as provided for
w6� by Section 3700 of the Labor Code,for the performance of the work for which Sq.Ft Floor Area: Valuation:$8300.00
this permit is issued..
APPLICANT CERTIFICATION APN Number: Occupancy Type:
I certify that I have read this application and state that the above 369 34 039
information is correct.i agree to comply with all city and county
ordinances and state laws relating to building construction,and hereby
authorize representatives of this city to enter upon the above mentioned
property for inspection purposes. (We)agree to save indemnify and keep PERMIT EXPIRES IF WORK IS NOT STARTED
harmless the City of Cupertino against liabilities,judgments,costs,and WITHIN 180 DAYS OF PERMIT ISSUANCE OR
expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will 180 DAYS FROM LAST CALLED INSPECTION.
comply with all non-point source regulations per the Cupertino Municipal
Code,Sectio 9.18. i
Issued by:PAUL O'$ULLIVAN
Date:2/18/2016
Signatur Date 2/18/2016
RE-ROOFS;
OWNER- UH.DER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without fust obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of the inspection.
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 Signature of Applicant:
for sale(Sec.7044,Business&Professions Code) Date:2/18/2016
z. i,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
performance of the work for which this permit is issued.
z. I have and will maintain Worker's Compensation Insurance,as provided for maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
by Section 3700 of the Labor Code,for the performance of the work for which Health&Safety Code,Section 25532(a)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
this permit is issued. air contaminants as defined by the Bay Area Air Quality Management District I
3. I certify that in the performance of the work for which this permit is issued,I will maintain compliance with the upertino Municipal Code,Chapter 9.12 and
shall not employ any person in any manner so as to become subject to the the Health&Safety Co ,Section 5 ,25533_and 25534.
Worker's Compensation laws of California. If,after making this certificate Of /
exemption,I become subject to the Worker's Compensation provisions of the Owner or authorized ages. r
Labor Code,I must forthwith comply with such provisions or this permit shall Date:2/1812016
be deemed revoked. 11 TION LENMG AGENCY
APPLICANT CERTIFICATION l hereby affirm that there is 0n truction lending agency for the performance
of work's for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, ARCHITECT'S DECLARATION
judgments,costs,and expenses which may accrue against said City in I understand my plans shall be used as public records.
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. Licensed
i
GENERAL PERMIT APPLICATION C CaMEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDINGDIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building misc
(a-cupertino.org
CLJPERTINO
LUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS APN# q 0 cc
OWNER NAME „ 9 PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
Wf: i .
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER.BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
1 f ,- ® O
COMPANY NAME E-MAIL FAX
h / I
STREET ADDRESS�� CITY,STA ZIP PHONE -rZ*7
ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC N
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD m DUPLEX [IMULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN EYES
W IS THE BLDG AN El YES
BUILDING: ❑COMMERCIAL URBAN ATTERFACEAREA ❑.NO FLOOD ZONE ❑NO EICHLERHOME? ❑NO
DESCRIPTION OF WORK '
TOTAL VALUATI6N: RECEIS ED BY ,
By ray signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owners behalf. I have read this
application and the information I ve 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 o build o tmcti n. rr�e representatives of Cupertino to enter the above-identified property for inspection purposes.
..,
Signature of Applicant/Agent Date:
SUPPLEMENTAL INFORMATION REQUIRED ori zc usE oI�I , ,
w OVERT COUL\1ER
EXPRESS
v
, to ❑ `
sT�ARD
.1, a
A4EPMiscApp_2011.doe revised 06121111
- CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10762 LA RODA DRIVE DATE: 0211812016 REVIEWED BY: PAUL
APN: 369 34 039 BP#: VALUATION: $000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY PENTAMATION 1 RPRP
USE: SFD Or DUpleX PERMIT TYPE:
WORK REPIPE ENTIRE HOUSE- HOT AND COLD; REPLACE SHOWER VALVES; REPLACE WATER
SCOPE SERVICE; INSTALL (N) WATER HEATER WITH EXPANSION TANK
APPLIANCE I EQUIP TYPE FEE ID QTY UNITS BP FEES
Re-Pipe Interior 1PRREPIPE 1 # $14
Water Service
1 BPWSVCS 1 # $25
Water Heater 1PRWHEATR 1 # $29
TOTALS: $68.00 '
? tr,Check
Plumb.Plan CheckgPermit
hrs $0.00Plumb. Fee: IPPERMIT 0,1' ?.°:uf�. h"fir. Other PlumbInsp.
hrs $48.00 z 3, ,._x E
/ex`:F tft tF.i. rte;, -,
NOTE. This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS CFee Res-olution.1.1-053 Ef. 7,U13), FEE QTY/FEE MISC ITEMS
'34p,,,.1 .p(714'eie _T71E_
PME Plan Check: $0.00
er t t i�,T
PME Unit Fee: $68.00
PME Permit Fee: $48.00
Administrative Fee: ]ADMIN $45.00
Work Without Permit? 0 Yes (j) No $0.00
ix
Travel Documentation Fee: 1TRA VDOC $48.00
StronMotion feeIBSEISNIICR $1.08 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SCTBTOTrL$:', $211.08 $0.00
joAv:FEE: $211.08
Revised: 01 /201