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13080101 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21242 GARDENA DR CONTRACTOR:ONE DAY COMPLETE PERMIT NO: 13080101 REPIPE OWNER'S NAME: Z F P COMPANY 662 N 12TH ST DATE ISSUED:08/14/2013 OWNER'S PHONE: 4082452795 SAN JOSE,CA 95112 PHONE NO:(408)603-0554 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ElCOMMERCIAL[] License Clas Lic.# COPPER REPIPE FORM WATER METER THRU UNIT er cow ( e ontr c to I hereby affirm that I am licensed under the provisions of Chapter (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. Sq.Ft Floor Area: Valuation:$6392 ave 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:32640006.21242 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 WIT 80 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 D OM LAST CALLED INSPECTION. 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 Issued by DateY with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Sign re Date 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 Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of 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. I 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,Sections 25505,25533,and 25534. Section 3700 of the Labor"Code,for the performance of the work for which this Owner or authorized age Date (` 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, 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 I MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDIJVG DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 Rt MISC (408)777-3228 (ft FAX(408)777-3333•buildingupertino.org CUPERTINO I �✓✓✓ C*31G ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS �JJ APN# O R N PHONE Sf� � � STREET ADDRESS _ CITY,STATE,ZIP FAX - CONTACT N�� PHONE ST ET D S STATE, J (i FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT o4ff: YnxRACToR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT NTRACTOR NAME LICENSE NUMBERLICENSE TYPE BUS.LIC# COMPANY S RE T DD 11'Y,STATE IP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑sFD or DUPLEX ❑ MULTI-FAMH.Y PROJECT IN WIIALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑-NO DESCRIPTION OF ZZA;:�LC �� TOTAL VALUATRN ION: © �...... `.... � . .. ..__.. By my signature elow, certify to each 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 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 b ' ing construction. riz entatives of Cupertino to enter the ove-identified property for ins ection purposes. r Signature of Applicant/Agent: Date: UPPLEMENTAL INFORMATION REQUIRED , o ; N a. f � NFM-lam ; MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: Gardena Dr DATE: 08/14/20137 REVIEWED BY: Mendez APN: BP#: "VALUATION: $6,392 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION SFD or Duplex 1 RPRP USE: TYPE:PERMIT WORK �co er re i e form water meter thru unit SCOPE � ff"11 "A�,1 � hiA` y a Xlech.Plan Check Plumb.Plan Check "00 $0.00 Elec.Plan Check A1ech. Permit Fee: Plumb.Permit Fee: IPPERMIT Elec.Permit Fee.- Other Alech. Insp Other Plumb Insp. 0.0 hrs $47.00 01her Elec.Insp. 11cxh.Insp. lee: Plumb. bish.Fee: Elec.Insp.Fee NOTE: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 prelimina information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 7111121 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Plumbing Suppl.PC Fee: Reg. OT 0.0 hrs $0.00 $14.00 IPRREPIPE Re-Pipe Interior PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee:Q Reg. Q OT Fo,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Construction Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure i Strong;Motion Fee: IBSEISMICR $0.64 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $139.64 $14.00 - r VE . 153.64 Revised: 07/01/2013