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16010025CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1018 CRANBERRY DR CONTRACTOR: BLOSSOM VALLEY PERMIT NO: 16010025 PLUMBING OWNER'S NAME: CA A& _ e— I U I kL OWNER'S PHONE: LICENSED CONTRACTOR'S DECLARATION License Class Ac_ Lic. # O Contracto 19 Las -5D& - NL ate 016 I hereby affirm that I am licensed m der 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 rformance of the work for which this permit is issued. ve 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 permit is issued. APPLICANT CERTIFICATION 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 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 with all non -pa' rt ource regulat' ns per the Cupertino Municipal Code, Section 9.18. � JJ r Signature�� Dame t ❑ I / OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 1206 OLIVE BRANCH LN i DATE ISSUED: 01/05/2016 SAN JOSE, CA 95120 1 PHONE NO: (408) 997-1970 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] RE -PIPE UNDER -FLOOR WATER LINE TO COPPER AND TIE IN TO (E) BATHROOMS AND KITCHEN VERTICAL PIPES. Sq. Ft Floor Area: I Valuation: $4400 APN Number: 36204056.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: &0 v Date: 11,5116 RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 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 compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Secti ns 2 505, 533, and 25534. Owner or authorized agent Dat CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's'for which'this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional GENERAL PERlvll i APPLICATION COMMUNITY DEVELOPI\rEN T DEPARTMENT - BUILDING DIVISION 10300 T ORPE- AVENUE • CUPERTINO, CA 55014-3255 (1 8) 777-3228 - FAX (408) 777-3333 • buildino5cuoerino.org I] PLU DING —1 MECN 20. v c� M' 7 E ECTRIC?T 71,/,ISCELLa-"�E0US PROJECTi% DRESS � I .s�>, - 3 6 6 ` N �-r r- f a OWKERT)I - I PHOKE E -I✓- LEMMAW e- 6AldiL- CITY, STAT=; ZIPCr A-0 CONTACT KA_mE PiIO \� E.I✓k t�J STREET MP.ESS CITY, STATE, ZIP I = A,x i �OM'h'k ❑OR'1 nR=nL�Ti ��t ❑ Ow:, ---,m AG TT ❑ CO>'I? 4CTC)R ❑ CO?.'PACTOR AGM -:T ❑ ARCH171 ECT ❑ Gi�c_R ❑ Tj�r_LO? ❑ T= Ch1 CONTRACTOR KAJ,y LICENSE 1,FU3%SER LICEI;SE T } PE I BUS. LiC I -,0 COIJ,PA�'Y 1 Al r -t-N 1^ FAX Cs v STREET ADDRESSCITY, IZT.4 TE ZIP i PHONE A� t �� S C U - <RCHITECT,-NGINEER1 A MM LICENSENUI\ BER BUS. LIC COMPAWKAJy — I E -M - T. I Pa STREni ADDRESS I CITY, STATE, Zi? I PFONE USE OF ❑ SD. or DLPL I❑ mmim-FA1,mY ?ROiEECT N WZD- L«T ❑ Y_S PROT= -N ❑ Y: -:s IS i � SLD0 AN ❑ - _s BUMEDLNIG: ❑ C01,O,�- tCLar LJTPS ?N LN'TERPACE zJ 4 ❑ NO FLOOD ZC\M J] ?:0 I EICM-. R HOl✓.E7 ❑ NO I DESCRIPTIOAT OF 1vORK _ ^ �� '�'Y'--1 f �?-<-- � 1 �'�C� _ i � I`� it :✓ vAA� A IrOIM� i. l�a�-i � �i�- Lig 0-5o C� � � ° � � d s;� TOTAL VA1 liATION: 0, ^ F F 3 1 4 3 R C� DAY {y yy By ;ny signztLre below, I cLir^y to each of the following: I am the Grope. Ly owner or authorized agent to act on the property o;; ner's behal" have read this lc_ application and he in o, -:nation I have pro; ded is correct. I uz; e read he Desc,�ptien of \Trork zn veri, ;� is accnrzte. I zg-ee to com 1_ d �' • � _ p Y;;'2 all appl:czble local , , ordinances zad state laws relating to build 'g cc Ction. I authorize representtives of Cnpe.Lino to enter thezb ve-id= tined propel �} for izspec ion purposes.an Si�znre OfApplict/Agent: �— �� Date: �1�� T E i^ � i j T F SU�P�_?;iEl� 1 AI. L\t O�� iATIOI� tZQU prD ,_a:KAP; ( C a �$E S T -s ..�..-- �,., ._?.iFY N'Sri:i. 102. ...L�.4R 0.- Y ^S M1 T:.y.., 1 1 �F�1/isc.4pp_?011.a'oc revised 06121111 CITY OF CUPERTINO MW FEE ESTIMATOR — BUILDING DIVISION igADDRESS: 1018 Cranberry Dr FEE DATE: 01/05/2016 REVIEWED BY: Phuong -NI APN: 362 04 056 1 BP#: VALUATION: 1$4,400 *PERMIT TYPE: Plumbing Permit FPLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: PNM Plan Check: PENTAMATION I RPD PERMIT TYPE: WORK Re -pipe under -floor water line to copper and tie in toe bathrooms and kitchen vertical pipes. SCOPE N, J� Plumb. Plan Check 10.0 1 hrs - $0. on ChecA: 00 Plumb. Permit Fee: IPPEPMIT C1 is Ch'-/, -). 1' " - - Other Plumb Insp. hrs -'Iunib. VOTE. 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 thepreliminary information available and are only an estimate. Contact the Deptjor addn't FEE ITEMS (Fee Resolution 11-053.&ff 711113) FEE QTY/FEE MISC ITEMS A PNM Plan Check: $0.00 POC"; PME Unit Fee: $48.00 Permit Fee:7 $48.00 CPME Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 e0s,, Travel Documentation Fee: ITR,4VDOC $48,00 Strong Motion Fee: IBSEISMICR $0.57 Select an Administrative ftem Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTAL i :: $190.57 $ 0.00 "TOT ALFFE., 57 $190E Revised: 10/01/2015