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B-2016-1475 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1475 22551 MCCLELLAN RD CUPERTINO,CA 95014-2769(357 05 007) (CURRO PLUMBING INC) GILROY,CA 95020 OWNER'S NAME:. OUYANG-SHWE KAREN K DATE ISSUED:03/07/2016 OWNER'S PHONE:408-777-8089 PHONE NO:408-847-7704 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic.#53_7264 Contractor(CURRO PLUMBING INC)Date 03/07/2016 X BLDG —ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: EXTEND HOUSE GAS LINES OVER ROOF FROM BACK OF HOUSE I hereby affirm under penalty of perjury one of the following two declarations: TO FRONT IN 1"GAV.PIPE. r. I have and will maintain a certificate of consent to self-insure for Worker's PCompensation,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. Sq.Ft Floor Area: Valuation:$3650.00 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is correct.I agree to comply with all city and county APN Number: Occupancy Type: ordinances and state laws relating to building construction,and hereby 357 05 007 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against sai City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,th plicant understands and will comply with all non- 'int sourc egu fi s per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code,Section 9. Issued by:ABBY AYENDE Signature Date 03/07/2016 Date:03/07/2016 �'�`� OWNER- DER D CLARATION RE-ROOFS: I herebytirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is, following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1. I,as owner of the property,or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: 2. 1,as owner of the property,am exclusively contracting with licensed Date:03/07/2016 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the this permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devi es whic mit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Qu 'y Ma age ent District I will maintain compliance with the C rfino Muni i al Ce, apter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Cod S tions 255 5 553 ,ayff25534. 'l 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 Owner or authorized agent. be deemed revoked. Date:_03/07/2016 APPLICANT CERTIFICATION NS T Z-- N Y 1 certify that I have read this application and state that the above information is I hereby affirm that there i a co truction lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which this p mit i issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant ARCHITECT'S DECLARATION understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date 03/07/2016 GENERAL PERMIT APPLICATION M E pmm' COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 m m Is 10% CUPERTINO (408)777-3228• FAX(408)777-3333• buildinaacupertino org )PLUMBING — n ❑ �IECIiANIC.AL ELECTRICAL ❑MISCELLANTEOUS 0;-��`� �T PROJECT ADDRESS ® °rte �#y ao 1 I APN tt W ONl>n?ER NAME V � ,- ^��y �C� � PHONE� y s� l E-MAIL STREET ADDRESS -� CITY,STATE,ZIP FAQ CONTACT DAME E-MAIL STREET.ADDRESS CITY,STATE,ZIP FAX OVR.°E}t ❑ 0V''1\ER-BTJII-DER ❑ OE3?T`ER.gGFT*f CONTRACTOR ❑CONTRACTORIGEN ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACT �/ .57 LICENSE f Vjtxomm' LICENSE TYPE BUS.LIC T COMPANY NAME E-MAIL FAX STREET ADDRES CITY,STATE,ZIp I PHON - YV ARCHITECTJENGLNEER NAME LICE?\SE NTJA4BER BUS.LIC COMPANY NAME F_-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 2LSFD.DUPLEX Q 3,4ULTI-FAMILY PROSECT IN,WILDLA'D ❑ YES YES 1$THE BLDG AN ❑YE$ BUIISiL>\G: ElCOTZASERCIAL PROJECT A'I URBANI TERFACE AREA El NO FLOOD ZONE ❑NO --.I ECHLERHOME? "❑ NO DESCRIPTION of WORK e® �/ €a { P4 pi/arj TOTAL VALUATION: RECEIVED BI' By Jny signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property own r s bchal. ... ve read this application and the infonnation I have provided is correct have a the Description of'Work and verify'it is accurate. I aoT to comply with all applicable local ordinances and state laws relating to bu' construct' I a o e representatives of Cupertino to enter the above-"en" ed property for inspection purposes. Signature of Applicant/Agent: Date: . PP EM AL INTO CE RMATION REQUIRED r � OFFIiISE OnL.I =fl fl�ER THE=COU?�TER t: } Z t .x _ < << MEPA4iscApp_2011.doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 22551 MCCLELLAN RD DATE: 03/07/2016 REVIEWED BY: ALEX APN: 357 05 007 BP#: *VALUATION: $3,650 -� '-PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair USE: SFD or Duplex PENTAMATION PERMIT TYPE: 1 RPGAS WORK EXTEND HOUSE GAS LINES OVER ROOF FROM BACK OF HOUSE TO FRONT IN 1" GAV. PIPE. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Gas*4 Outlets 1 BPGAS 1 # $72 TOTALS: $72.00 Plumb.Plan Check10-01hrs $0.00 ,e<,,.. Plumb.Permit Fee: IPPERMIT ;; z,;,• Other Plumb Insp. 0.0 hrs $48.00 NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information,available and are onLyan estimate. Contact the Dept-for addn'l info. FEE ITEMS(I ee Resolution 11-053 Elf' TI/13FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $72.00 PME Permit Fee: $48.00 } 7" Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes Q No $0.00 Travel Documentation Fee: 1TRAVDOC $48.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $214.50 $0.00 TAL FEE: —$214.50 Revise : 01/01/2016 r r IL I FFI - - r i y. P . IST- LANE CKED l3y� r } t ` PLANNIN r It it it it It , I x a e r ..-. h i , I s , r� t ry�j Jx -e i _ r jarm - ' C3,MAR 2016 � ct nv iti 414 ` . , REVI�_.'�vD OR C(? ISE G©MPLIANCE' J c� Reviewed by: , O411X A4&ArA .er 4