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11060128 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7740 SQUIREHILL CT CONTRACTOR:A&A PLUMBING PERMIT NO: 11060128 OWNER'S NAME: LESLIE MARTIN 1030 E EL CAMINO REAL STE 248 DATE ISSUED:06/15/2011 OWNER'S PHONE: 4084463254 SUNNYVALE,CA 94087 PHONE NO:(408)738-8878 L LICENSED CONTRACTOR'S DECLARATION r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 3L L,Z'-Lic.# 1b( s,_3 / MECH RESIDENTIAL COMMERCIAL Contractor tk �`U✓�+Vl["� Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RELOCATE MAIN WATER LINE FROM METER TO (commencing with Section 7000)of Division 3 of the Business&Professions EXISTING SINGLE FAMILY DWELLING Code and that my license is in full force and effect. 1 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. 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. q.Ft Floor Area: Valuation:$2000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36223029.00 Occupancy Type: correct.1 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date �" ( Issued by: Date: r OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain [have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must TZ l forthwith comply with such provisions or this permit shall be deemed revoked. O7� 6 Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, c- '- and expenses which may accrue against said City in consequence of the Lender's Address ig of this permit.Additionally,the applicant understands and will comply w�all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 6 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36223029. 00 DATE ISSUED. . . . . . . : 06/15/2011 RECEIPT #. . . . . . . . . BS000013777 REFERENCE ID # . . . : 11060128 SITE ADDRESS . . . . . : 7740 SQUIREHILL CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER LESLIE MARTIN ADDRESS 7740 SQUIREHILL CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : A & A PLUMBING CONTRACTOR MIKE FOX LIC # 25401 COMPANY . . . . . . . . . . : A & A PLUMBING ADDRESS 1030 E EL CAMINO REAL STE 248 CITY/STATE/ZIP . . . : SUNNYVALE, CA 94087 TELEPHONE . . . . . . . . : (408) 738-8878 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 0 .50 39. 00 0. 00 39.00 0. 00 1BCBSC VALUATION 2, 000 . 00 1. 00 0 . 00 1. 00 0. 00 1BSEISMICR VALUATION 2, 000 .00 0.50 0 . 00 0.50 0. 00 1PPERMITFE FLAT RATE 1 .00 42. 00 0. 00 42 .00 0. 00 1PREPPIPE FLAT RATE 1. 00 42 . 00 0. 00 42 .00 0. 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 166. 50 0. 00 166 .50 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 506 GAS TEST 507 FINAL PLUMBING CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION MAPN: DDRESS: 7740 squirehill ct. DATE: 06/15/2011 REVIEWED BY: bobs. BP#: "VALUATION: $2,000 PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPDP USE: I PERMIT TYPE: WORK reolace main water line from meter to existing sfd SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Area 1PREPPIPE 1 # $42 -T- TOTALS: $42.00 77 Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $42.00 NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addh 7 info. FEE ITEMS (Fee Resolution 09-051 1�&: 7;110) FEE QTY/FEE MISC ITEMS F77 PME Plan Check: $0.00 PME Unit Fee: $42.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 A Strom Motion Fee: 1BSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg Stds Commission Fee: IBCBSC $1.00 $39.00 IADWN SUBTOTALS: 1 $127.501 $39.00 TOTAL FEE: $166.50 Revised: 04/29/2011 Building Department City Of Cupertino Is 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: 1l_L c 4.� PERMIT# L_ OWNER'S NAME: PHONE # clefS' SV GENERAL CONTRACTOR: ;,,� �,c BUSINESS LICENSE# C2 r ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino b siness 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: L Signature Date Please check applicable subcontractors and complete the following information: 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 GENERAL PERMIT APPLICATION _ WMEP COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333 -building(Qcupertino.org MISC CUPERTINO UNMING ❑N ECHAINICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS C—U 2 Y-k\h o Ce. C1501 c-t AIN LI O SGkUI ALL p( OWNER NAME I \ {fin PHONE E-MAIL L -50- 1` I�'`O��r Dd." - ZSC STREET ADDRESS CITY, STATE ZIP t FAX L G.0 e�-�,>�o Sa I a CONTACT NAME p� PHONE E-MAIL t1G.V t; o a STREET ADDRESS CITY.STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME V•ei LICENSE NUMBER LICENSE TYPE BUS.LIC A l u>~: � a� 2 a sc, A JA COMPANY NAME E-MAIL FAX STREET ADDRESSb �O r-- L L L_ ,V\G �L CITY.STATE ZIP1 HO� - ARCHIIECTIENGINEER NAME M LICENSE NUMBER BUS.BUS.LIC f0 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE E OF SFD or Duplex ❑ Multi-Family PROJECT IN WUDLAND PROJECT IN STRUCTURE. ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK TOTAL VALUATION: r1 v a a M By my signature below,I certify to each of the following: I am the property owner or authorized agent to act an 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 construction. I auth ' e representatives of Cupertino to enter the above-iriensffle&oroperty for inspection pEEioses. Signature of ApplicandAger _ Date: SUPPLENIENTAL INFORMATION REQUIRED ". a� &E'PW1ra4pp_2011.daa revised 03/16/11