10060153 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10451 TULA LN CONTRACTOR:EAGLE PLUMBING INC PERMIT NO: 10060153
OWNER'S NAME: BERKELEY SIMONDS 544 HASSINGER RD DATE ISSUED:06/23/2010
WNER'S PHONE: 4082578239 Sf.N JOSE,CA 95111 PHONE NO:(408)281-0583
PrI LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class L' — ? (� Lic.# t L Cg Q�- REPLACE V WATER MAIN FROM METER TO HOUSE
Contractors J, _�J��{V�QL)l�1 Date
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.
Ihereby affirm under penalty of perjury one of the following two declarations: SANI 1ARy
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. Si I.Ft Floor Area: Valuation:$4900
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 A PN Number:35913081.00 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 DAYS FROM 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 theZ3
granting of th ermit. Additionally,the applicant understands and will comply I!sued by: Date:�
with all n -point urce regulations per the Cupertino Municipal Code,Section _
9.18. _
j RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
it stalled without first obtaining an inspection,I agree to remove all new materials for
it spection.
OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
1 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. 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: I[ealth&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 niaterial. 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 b Bay Area Air Quality Management District I
performance of the work for which this permit is issued. v,ill maintain compliance ryith the . .pertmo Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by t to Health&Safety Cod g Sections 505,4 533;and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
(owner or author-i�ed Date: 10
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. N rork'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
Iemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
sts,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
CITY OF CL;PERTINO
4 ITEMS OF 12 PERMIT FECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35911081 . 00
DATE ISSUED. . . . . . . : 06/2= /2010
RECEIPT # . . . . . . . . . BS00( 010702
REFERENCE ID # 10060153
SITE ADDRESS . . . . . : 1045:. TULA LN
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER BERKELEY SIMONDS
ADDRESS 1045:_ TULA LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5025
RECEIVED FROM EAGLA PLUMBING CO
CONTRACTOR RODRCGO ARZATE LIC # 25400
COMPANY EAGLA PLUMBING INC
ADDRESS 544 :IASSINGER RD
CITY/STA'TE/ZIP SAN 7OSE, CA 95111
TELEPHONE (408 ) 281-0583
FEE ID UNIT QUANTITY AMDUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --- ------- ---------- -
1BCBSC VALUATION 4, 900 .00 1 . 00 0 . 00 1 . 00 0 . 00
1BPWSVCS WATER SERVICE 1 . 00 21. 00 0 . 00 21 . 00 0 . 00
1PPERMITFE 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 106 . 00 0 .00 106 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 318 . 00 M C
---------------
TOTAL RECEIPT 318 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------
301 ROUGH PLUMBING 507 FINAL PLUMBING
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: 5 PERMIT#
OWNER'S NAME: PHONE # '
GENERAL CONTRACTOR: BUSINESS LICENSE #
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the c ty 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 NTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subco -Factors: A - c?-3 r X01�
ul ignature 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 P\ Q Kb N G (�
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
J
0 01 O
Owner/ ontractor Signature Date
CITY OF CUPERTINO
REPIPE/SEWERI-"N SERVICE
CUPEkTINO PERMIT APPLII-'ATION FORM
/00 Wo 5�
APN # JDate:
Building Address: Jw
10y �
Owner's Name: Phone#:
43 - 5a
Contractor: Phone Fax # #: �0$ _ 0 5 53
Contact: Phone#: j, 6l 59 3 _ r�
� c J
Fax#:
Contractor License#: 60
Cupertino Business License#: oA 5
Job Description:
Residential Commercial ❑
Valuation:"61 �OD
Project Size: xpress Standard Large—F—] Major
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set& thy.- sheet index.
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial build.ng P 1CPSS
sewer/sanitary sever
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASC6M Commercial Gas Piping System P
1-4 Outlets
1BCBSC Cal Bldg Standarc s Commission B ALL PERMIT
Fee TYPES
1BSEISMICOM Seismic Commercial P
Revised 01/07/09
CITY Of
CITY OF CUPERTINO
lul REPIPE/SEWER/MAIN SERVICE
FEE SCHEDULE
CUPERTINO
Quantity Fee ID Fee Description Fee Permit Type
Group
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICR Seismic Residential P
1PRSEWER Residential building; P 1RPSS
sewer/sanitary sew
1 PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1 PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1 BPFIXTURE Plumbing Fixture P
1 PGASRES Residential Gas Piping System P
1-4 Outlets
1 BPGAS Gas Piping System 5+Outlets P
0 1PPERMITFEE Plumbing Permit F,-,e Issuance P
1 PLMBLNCK Plumbing Plan Check P
1 PLMBINSP Other Plumbing/ga 3 Insp. P
1 TRAVDOC Travel &Documer.tation Fee B
1 BUSLIC Business License B
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10451 tula lane DATE: 06/21/2010 REVIEWED BY: building
APN: BP#: "`VALUATION: $4,900
xPERMIT TYPE: Plumbing Permit PLAN CI[ECK TYPE: Alteration /Addition / Repair
PRIMARY �; APPLICATION
USE: SFD or Duplex t .r �, _ TYPE:
xW rppince J"
xa
00
3 �
APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES
Water Service 1 BPWSVC S 1 $21
7 TOTALS: $21.00
Plumb.Plan Check 0.0 hrs $0.00
Plumb.Permit Fee: IPPERMIT
Other Plumb Insp.T710.077hrs $42.00
NOTE: These fees are based on the preliminary in ormation avail able and are on1v an estimate. Contact the De t or addn'l info.
FEE ITEMS (h'ee Resolution 09-051 Eff.' ?/1/09) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $21.00
PME Permit Fee: $42.00
Travel Documentation Fee: ITRA VDOC $42.01)
f Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.01)
SUBTOTALS: $106.0]_ $0.00 TOTAL FEE: $106.00
Revised: 5/27/2010