B-2017-1276CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1276
7449 TIPTOE IN CUPERTINO, CA 95014-5818 (359 28 004)
THE GREAT
AMERICAN
PLUMBING COMPANY
INCORPORATED
SAN JOSE, CA 95159
OWNER'S NAME: SORICH VIRGRUAATRUSTEE
DATE ISSUED: 08/02/2017
OWNER'S PHONE: 408-564-7164
PHONE NO: (408) 995-6400
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CC=36 Lic. #501065
Contractor THE GREAT AMERICAN PLUMBING COMPANY INCORPORATED
X BLDG —ELECT X PLUMB
—
MECH X RESIDENTIAL _ COMMERCIAL
Date 11/3012018
I hereby affirm that I am licensed under the provisionstof 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.
CLEANOUT
I hereby affirm under penalty of perjury one of the following two declarations:
i
1. 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 forlwhich this permit is issued.
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
Sq: Ft Floor Area:
Valuation: $2700.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is,correct. I agree'to comply with all city and county ordinances
359 28 004
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
PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino'againstliabilities, judgments, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the .pplicant understands and will comply with all non -point
180 DAYS FROM LAST CALLED INSPECTION.
source regulati s perth Cu' rt- 0, Code, Section 9.18.
'I
Si re Date 2 2017
Issued by: Jasmine Archbold
Date: 08!02/2017
IF
R- DER DECLARATION
RE -ROOFS:
I hereby affirm 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. I, as owner of the property' am exclusively contracting with licensed
Date: 8/2/2017
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
1. 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;workforiwhich 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 by
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
Section 3700 of theLabor Code, for the performance of the work for which this
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
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 devices which emit 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 Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain. compliance with the C pertino Municipal Code, Chapter 9.12 and
exemption, I become'subJect to the Worker's Compensation provisions of the
the Health & Safety Cod Sections 05 25533, and 25534.
Labor Code, I must,forthwith comply with such provisions or this permit shall`
-
efiZ:-,1"Cd
be deemed revoked]
Own
eer agen
APPLICANT CER1;
TIFICATIONCONS
I certify that I have read this,appli don and state that the above information is
COM ON LENDING AGMCY
I hereby affirm that there is construction 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 permit is 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 keel,,,, ,, mle"ss 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 understands
ARCHITECT'S DECLARATION
and will comply with all non"point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
I''le`P
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildingCcDcupertino.org
CUPERTINO
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS L14�– --7N#
2 � � O o�
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OWNER NAME
Vt^�1A1.r15,
PIC
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E-MAIL
STREET ADDRESS_
CITY STATE, ZIP FAX
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A CJZ�n
CONTACT NAME
PHONE -7 —
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER-BUB.DER ❑ OWNER AGENT '1CONTRICTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBS i� _
LICENSE TC E
BUS. LIC #
uCL /
L
COMPANY NAME
E-MAIL
FAX
C
Y
STREET ADDRESS q n n ,
CITY TATE, ZIP l (( [M
PHONE
Cr R
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA -
TOTAL DECKNORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY [J YES
BEING ADDED? ❑ NO
ADDITION? [:]NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING.APPL # ❑ NO PLANNING APPROVAL LETTER
Is THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
EIVED BY F � s } �.
TOTAL VALUATION-
By my signature below, I certify toe h of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I ha 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 t wild' g s ction I ` thorize`fepresentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of ApplicantlAgent: Date:
SUPPLEME AL INFORMATION REQUIRED
cHEcx YPE
PLAN 7
_ New SFD or Multifamily dwellings: Apply for demolition permit for
❑ COUNTERQ
existing building(s). Demolition permit is required prior to issuance of building
,O\'ER THE
BUILDING PLAN REVIEW
permit for new building.
❑ EaPRESS
❑ PLAN REVIEW
tl rx
PLANNING
la soe
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑° STANDA"
❑ r ruBLlc woxxs F '
_
fond if any Hazardous Materials are being used as part of this project.
� ❑; "LARGE � a} � ��' � � "
,
❑ FIRE�DEPT � ,,� � ry``
Copy of Planning Approval Letter or Meeting with Planning prior to
tr
_
submittal of Building Permit application.
❑ MAJOR ' a
❑ SANITARXSEWERDISTRICT
` ``, '
❑
.r _ 'fit,: -_ j
„°ENVIROIVIVIENTAti HEALTH, f
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BldgApp_2011.doe revised 06121111
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aim
CUPERTINO SANITARY DISTRICT
20863 Stevens Creek Blvd #100, Cupertino, CA 95014
Tel (408) 253-7071 • Fax (408) 253-5173
���`�� SANIlARYD,f
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FS%4IsBtu ♦CUPERTINO
SANITARY DISTRICT PERMIT LETTER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over -the -Counter)
Single Family Project ❑ Multi -Family Project ❑ Commercial Project
Project Address: -1 LA 40( ---ri jD +Z 2 L—OLK-Q- . CA,c
Permit Number:
Scope of Work: 610 w1 a-(.�
Owner/Applicant Name:'�l5 5nA r 4_ !tDra ( 1& Phone: �ZE
Address:
Date: Prepared By:
City Authorized Representative
1, as property owner or authorized agent, acknowledge that all Cupertino Sanitary District requirements
will be met and all required fees will be paid prior to the approval of final inspection for proposed project.
Date: Signature:
Owner / Authorized Agent
Date:
CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
❑ Pre -inspection Required
Date Scheduled:
YJFinal Inspection Required
Conditional Approval By:
Authorized Representative
Cupertino Sanitary District
District will notify owner of the required fee within 5 days after Pre -Inspection has been completed and cc
City of Cupertino.
Inspection Fee Paid Date Paid: 212-
Inspection
2Inspection Fees:
$250/unit - Single Family Residential already connected, but new cleanout is required
O $150/unit - Single Family Residential already connected with existing cleanout in working order
D $350 Minimum - Commercial and Retail Actual Amount:
E=1 $200/each - Disconnect and/or abandon lateral service
Connection Permit Fees:
$350/unit - Single Family Residential connecting to existing lateral
D $650/unit - Single Family Residential connecting with new lateral
D $100/unit- Multi, Hotel, Living Units; etc. Actual Amount:
D $500/connection - Commercial and Retail Actual Amount:
Connection Use Fees (See Attached Calculation Sheet):
D Area and Frontage Fees Amount:
Residential Excess Fees over 3.5 unit/acre Amount:
O Commercial and Retail Connection Fees Amount:
O Commercial and Retail Change in Use Fees Amount:
Date: / Final Approval
By: _ �� h_���
uthori d R presentative
Cupert o S itary District