13120152 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1142 KENTWOOD AVE CONTRACTOR:TATS INC DBA MR PERMIT NO:13120152
ROOTER PLUMBING
OWNER'S NAME: BERNHARDT IRWIN B AND NORMA TR 1260 YARD CT DATE ISSUED: 12/19/2013
OWNER'S PHONE: 4087255407 SAN JOSE,CA 95133 PHONE NO:(408)271-2822
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL Ej COMMERCIAL ❑
REPLACE KITCHEN AND SHOWER PIPE LINE
License Class,,�L�62S' Lic.#�,^�
Contractor /V 1,, -�(r Date2-r��
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 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:$1700
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:35931052.00 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. of
agree to save 180 DAYS + AST 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 Issued by:
Date: oC
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
RE-ROOFS:
Signature Date�p c r �,z�� 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 Date:
Signature of Applicant:
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
1,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(x)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 25505,2553 nd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:().e 1 g. 0
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 CONST UCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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 MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION `��
10300 TORRE AVENUE CUPERTINO, CA 95014-3255 0\ MISC
CUpEttTlC�iO (408)777-3228•FAX(408)777-3333•buildingCcDcupertino.org n
PLUMBING [—]MECHANICAL ❑ELECTRICAL ' �v❑MISICELLANEOU'Sn
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
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USE OF ❑SFD.,DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES 7ROOIECTIll El YES IS THE BLDG AN El YES
BUILDING. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO OD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK i
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TOTAL VALUATION: / 00
By my signature below,I 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 pr *ded 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 di uthorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: d
SUPP MENTAL INFORMATION REQUIRED ' }
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 1142.Kentwood ave DATE: 12/19/2013 REVIEWED BY: Mendez
APN: BP#: "VALUATION: $1,700
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION 1 RPDP
USE: SFD or Duplex PERMIT TYPE: i
WORK replace kitchen and shower pipe line
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Piping, Area 1PREPPIPE 2 # $94
TOTALS: $94.00
.
�. ,
�Ieclr. flan('heckPlumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check
;Lfech.Permit Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit Fee:
[1J,,h.
klech.Insp. Other Plumb Insp. 0.0 hrs $47.00 Other Elec.Insp.
Insp.lite: Plumb. Insp.Fee. Elec.Cnsp Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based:oh!the relimina information available and are only an estimate. Contact the Dept-for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7f�11113_) FEE QTY/FEE MISC ITEMS
Plan Cheek Fee:
.5uppl. PC.Fee
PME Plan Check: $0.00
Perinit Fee:
Suppl. Insp Fee
PME Unit Fee: $94.00
PME Permit Fee: $47.00
Consir action Tax:
Administrative Fee: IADMIN $44.00
Work Without Permit? ®Yes (E) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldjz Stds Commission Fee: 1BCBSC $1.00
$233.50 $0.00 'a" O5X"11 $233.50
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Revised: 10/01/2013