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13070022 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22826 SAN JUAN RD CONTRACTOR:FORSYTHE GENERAL PERMIT NO: 13070022 CONTRACTORS INC OWNER'S NAME: COSTA PAUL AND PAMELA TRUSTEE&ET 3108B FILLMORE ST DATE ISSUED:07/03/2013 OWNER'S PHONE: 4084253680 SAN FRANCISCO,CA 94123 PHONE NO:(415)440-9191 8- LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL❑ License Class Lic.# "� �}�}� NEW UTILITY TRENCH FOR SEWER,WATER MAIN & ELECTRICAL TO SERVE SFD AT 22826 SAN JUAN RD Contractor -�tJ�Z C �' Date_0-7-0 l� I hereby affirm that I am licensed under the proviAons 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: 1 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. Sq.Ft Floor Area: Valuation:$10000 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 APN Number:34221028.00 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 DAY5 FROMI-49;PCALLED INSPECT ON. 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 sue Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date "'� "1 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 1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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(Sec.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. 1 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 ' 2550<2 533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date:(�-d3 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 MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MISC (408)777-3228• FAX(408)777-3333•buildingCakupertino.org CUPERTINO EI PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS / iltKl�1 APN k 2,/ 2- 2-1 ®2 OWNERNAME n- PHONE f` /-, E-MAIl /7([t4� `T25 A6µ1 C-Ovh STREET ADDRESS ./ / G / CITY, STATE,ZIP ��1FAX CONTACT NAME tl� � /"I S/ � PHONE r/� � E-MAIl. STREET ADDRESS. CITY,STATE, ZIP ,1 1• FAX ROWNER ❑ OWNER-BUB-DER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHTrECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME r`Z5 � �, �' LICENSE NUMBERQcS�� �' LICENSE TYPE BUS.LIC N .� 'As Iq COMPANY NAME �.�� 1 n �4J ! N IG FAXq/5 /14 qjq� STREET ADDRESS CITY,STAT I_PIL i _ C fG / 'T/ PHONE �� �`T7C / i ARCHTTECT/ENGQJEER'NAME J LICENSE NUMBER BUS.LIC k . COMP A'ri i .. /IYZL( E-MAI�VYtG.. G J'Gl! �i l E Q.l v1n FAX�L"S�41,76:13. STREET, CITY,STATE, PHO USE OF ❑SPD a DUPLEX ❑ MULTI-FAMILY PROTECT INWB,DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING:. COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑/NO EICHLER HOME? ❑NO DESCRIPTION OF WOR$ 7 re TOTAL VALUATION ii RE C D B By my signature below,I certify to.each of the following: I am the property owner or authorized agent to act on the p erty o . I have read this application and the information 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 ordinances and state laws relating to building conStzyction. I rite representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicant/Agent' J Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ' W R-TH)iCOUNTER ' F" ❑ EXPRESS i YY KC '. i ❑ STANDARD ' Z Q ❑ LARGE a . ❑ MAJOR . MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION ADDRESS: 22826 SAN JUAN RD DATE: 07/03/2013 REVIEWED BY: MELISSA APN: 342 21 028 BP#: 'VALUATION: j$10,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION USE: I PERMIT TYPE: wORKNEW UTILITY TRENCH TO SERVE SFD AT 22826 SAN JUAN RD SCOPE llfech.Plan Check hfech.Permit Fee Phimb. Pemit Fee. Elec. Permit Fee:: Other Meeh.Insp- E17- Other Plumb Insp. !)then Elec.Insp. Mech.Insp. Fee. Plumb. Insp. Fee: !"Ice.Insp.Fee: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l in o. FEE ITEMS /Fee Resolution 11-053 a. 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl. PC Fee: Q Reg. Q OT F0,0Thrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes Q No $0.00 Supp/. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tczx: Administrative Fee: Work Without Permit? © Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Q ?)-nivel Docrtinentution Fees: Building or Structure A Strong Motion Fee: 1BSEISMICR $1.00 2.0 hrs Inspections Bldg Stds Commission Fee: IBCBSC $1.00 $272.00 ISTINSP 7Inspection,Hourly SUBTOTALS: $2.00 $272.00 TOTAL FEE: 1 $274.00 �� Revised: 07/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: �- h.'Yl rl Vw4-- / PERMIT# OWNER'S NAME: AWQ -k + Piij PHONE# 4t5- gell GENERAL CONTRA CTO -15,44-Lie -jL BUSINESS LICENSE# ADDRESS: 5109 -. qS4o CITY/ZIPCODE: 2,-3 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner%Contractor Signature Date EXIST. 4" SCREW NEW 1-112" WATERLINE CAP ON RISER W/ 3/4" PVC OR DIRECT / o \ BURIAL ELECTRIC RESTORE SURFACE OF CONTROL WIRE TRENCH TO ORIGINAL AID, CONDITION 00, b ,�' 0 ,,,— NATIVE MATERIAL TO 90% Li 000 cn RELATIVE COMPACTION- TESTED BY SOILS ENGINEER _t LLJ 0- 0 DURING BACKFILL. ` ti ,, \ \ �` 0- Of < < o > LANDS OF EXIST. 2" WATER HUTTON SAVE & PROTECT INSPIRATION HEIGHTS LOT 296 0 NEW 4 PVCEXIST. 4" PVC (DOC #17320915) SANITARY SEWER 12 Q SANITARY SEWER rx0 LATERAL LATERAL- SAVE & PROTECT l o � C� -91 , Z TRENCH SECTION SCALE: N.T.S. (LOOKING DOWNHILL ) —S85'49*50'PE NEW PRIVATE 273.,38, PRESSURE PUMP PUBLIC (ENCROACHMENT wPERMIT REQUIRED) Ed 20' 20 U_ Q NEW WATER LANDS OF SERVICE & 0 F-UTTON METER o LANDS OF INSPIRATION HEIGHTS o QUEEN4 LOT 297 w / _Q 2C' ' C) (DOC #17320915) p 6 EXISTING INSPIRATION HEIGHTS FIRE HYDRANT LU Q� (DOC #13192233) Q_ 22820 SAN JUAN ROAD '0 22830 SAN JUAN ROAD —4 cc) ® / / /7z_ N32'319'/00"W 5*1 S88'08"E f I 21-76/ ,/ ETAI �iNG -'/ � 266-21' (3 0 W T ING EXIS I 8" WATER MAIN L LANDS OF HUTTON 0 INSPIRATION HEIGHTS JT (CONNECT 0 LOT 298 EXIST. TRANSFORMER) (DOC #17320915) CONNECTION GAS, ELECTRIC, & CABLE Q Q STA: 6+56 (.0 N32*39 '00"W x j 1- 10.00, NN 1/2 WATER "(5 AA FEED LINE NT N84*55'00toW (W/ ELECTRIC ;O..j- GATE 274-29' CONTROL WIRE) 0 ow VALVE STA: 7+25 STA 10' WIDE PRIVATE 4" WHARF HYDRANT @ STREET WATER, ELECTRIC, TELEPHONE 11", 8+ 1 STA: 4+33 & SANITARY SEWER lye 0 EASEMENT COMMIR"INITY SIC 7`7 U1LDiN'GD1'V1, hE Uj 0 0 4" PVC CA 0, CIA- C, (51 LANDS OF Ej (GRAVITY LINE) Thtls s,�,,,t of p!s.ns and spec'fic'aflor;s MUST be-kep,p�,L LANDS OF ­ BIANCHI job,S;t-I'duilnIj COnStrUction. il':-1-fl-iialw"VfUi torj�o,­-_1 LANDS OF ANDERSON INSPIRATION HEIGHTS thersf'i'om,wit; Out approval frorn the Builid:ng 0­'��;C;'al' / / COSTAO ill (DOC #12421779) 22760 SAN JUAN ROAD INSPIRATION Tho<�" ;nPfng of this plan and sineomcations b­,h�ldl to pe.-,mit NOT HEIGHTS 0 an�,Pf-­'Oval of the v:c;i,-,',:cn of anv 5-ons-r- ',�; Lavv. 0 STA: 8+18 ityOrdinanceor&a' 14'X2-4' MIN. LOT 306 Iry :L Z CONC. PAD W/ (DOC #8939066) 2-5,000 GAL. TANKS 0 DA (5 & DOMESTIC PERtviff NO. C)--�-o Z, - cc FIRE PUMP FIRE SPRINKLER& Uj INSPIRATION DOMESTIC PUMP ' `a' �� / HEIGHTS TANK wLOT 307 ' ( , <1 (3 ,t4_7i 37' =�z LLI oil I PRE -RED UNDER THE SUPERVISION r*ry 6 TS CIVIL ENGINEERING, INC. 5 1776 TECHNOLOGY DRIVE UTILITY SYSTEM SCHEMATIC DATE: 03-29-11 SHEET No. 4 SAN JOSE, CA 95110 SCALE: 1"=30' N . 327 EXPO. 9-3550-11 3 LANDS OF COSTA DRAWN BY: LC/QL 5 2 OF rAI_N� TE�E_NCE SZE C DAI. PLANS FOR IMPROVEMENT OF SAN JACINTO ROAD SURVEYEDBY: HB/BT OF5SHEETS RCE 7 ! 9- PROJ ENGR: TJS 355 EXP. BY REVISIONS DATE PH: 408.452.9300 TOLL FREE; 888.327.7070 FAX: 408.452.9301 CUPERTINO, CALIFORNIA JOB NO. CHECK BY: TJS 10-21 , --------- ---- ------------