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13080130 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10340 LEOLA CT CONTRACTOR:ONE DAY COMPLETE PERMIT NO:13080130 REPIPE OWNER'S NAME: SINGH AVTAR AND SUMEET ET AL 662 N 12TH ST DATE ISSUED:08/19/2013 OWNER'S PHONE: 4087684850 ` ' SAN JOSE,CA 95112 PHONE NO:(408)603-0554 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL EI License CI s—_ Lic.# Iq\( 1�i DUPLEX-COPPER RE-PIPE Qdfo �Oil�I n0 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. 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 ompensation,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:$8250 I have and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number:37504026.00 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 1§0 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 DA 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: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 7-17 9.18. � RE-ROOFS: Signatut 6_ —Dateig 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(Scc.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 agent: Dat 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 MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777- 333•building(c)cupertino.org I/) o misc ❑PLUMBING [—]MECHANICAL ❑ELECTRICAL []MISCELLANEOUS PROJECT ADDRESSAPN# 0 / _ /y (.(J OWNER NAME t^ PHONE E-MAIL J�S�A VQXI q6210 2 &9V&d STREET ADDRESS v �. CITY,STATE,ZIP FAX CONTACT NAM PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP WLF IN ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT C RACTO LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NA E E-MAIL FAX S REST DRE S — CITY,STATE, PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD.,DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK c �-,Lf4i Q TOTAL VALUATIO S RECEIVED BY: By my signature f6elow,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 ovided 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 relatin buil g cons a presentatives of Cupertino to enter the v`ideptified property forinspection purposes. Signature of Applicant/Agent: Date: /JG/j // PLEMENTAL WFORMATION REQUIRED OFFICE USE ONLY w ❑ OVER-THE-COUNTER EXPRESS V x ❑ STANDARD U a ❑ LARGE w MAJOR MEPMiscApp_2011.doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10340 leola ct , , ., I DATE: 08/19/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$8,250 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION SFD or Duplex 1 RPRP USE: TYPE:PERMIT WORK [qQPP.Pr re i e from shut off SCOPE a y R111 VRE 2 ON :Llech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan(,heck L1ech. Permit Fee: Plumb.Permit Fee: IPPERMIT Iaec. Permil Fee: Other.-Wech.Insp. Other Plumb Insp. 0.0 hrs $47.00 Ocher Elec.In . Aleck Insp,Fee: Plumb. Insp.Fee: Elec.Insp.lee: 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 relimina information available and are onlyan estimate Contact the Det or addh7 info. FEE ITEMS(Fee Resolution 11-053 E . 7ff /1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F—T-1 # Plumbing Suppl.PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $14.00 IPRREPIPE Re-Pipe Interior PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee.e Reg. ®OT 0.0 hrs $0.00 PME Unit Feer $0.00 PME Permit Fee: $47.00 Cansimclion ..Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning;Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure 0 i Strong Motion Fee: IBSEISMICR $0.83 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $139.83 $14.00 . 4 , L1 153.83 . Wit. ,,�. Revised: 07/01/2013