BLD-2020-0867BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 21052 WHITE FIR CT Cupertino
APN: 359 05 112
PERMIT NO: BLD-2020-0867
CONTRACTOR:
CONSOLIDATED PLUMBING INC, 3732 D CHARTER PARK DRIVE SAN JOSE
CONTRACTOR PHONE:
4089783093
DATE ISSUED 7/15/2020 9:54:02 AM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $80023.60
JOB DESCRIPTION
OF 2" WATER LINE FROM METER TO 14 UNITS WITH (N) 2" HDPE PIPE AND TEE OFF (BUTT FUSED) FROM THE 2" WATER
COPPER RISER BY THE UNIT, MAIN HOUSE SHUT-OFF BALL VALVE, HOSE BIB, AN IRRIGATION SHUT-OFF BALL VALVE IF
CUPERTINO ROUNDTREE - REPLACE (466 FT) OF 1" AND (266 FT)
MAIN TO EACH UNIT WITH 1" LINE; INCLUDES (N) METER UNION,
APPLICABLE
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
CONSOLIDATED
LICENSED
C36
LICENSED
505162
EXP
02/28/2021
I hereby
force
I hereby
CLASS:
PLUMBING
NO:
DATE:
affirm
and effect.
affirm
I have and
for which
I have and
I certify that
with
PLUMBING INC
that I am licensed under the provisions of Chapter
under penatiy of perjury one of the following
will maintain a certificate of consent to self
this permit is issued.
will maintain Worker's Compensation Insurance,
in the performance of the work for which
laws of California. If, after making this certificate
such provisions or this permit shall be deemed
three declarations:
-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
revoked.
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under
the Cupertino Municipal Code, Chapter 9.12 and the
V
with
equipment
Municipal
Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
EPA LEAD -SAFE DISCLOSURE
for this project.
Firm Certification No:
An EPA Lead -Safe Certified Renovator will be responsible
Firm Name:
No EPA Lead -Safe Certified Firm is required for this project.
Certified
V
CONSTRUCTION LENDING AGENCY
lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there is a construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
:
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.
BUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 21052 WHITE FIR CT Cupertino APN: 359 05 112 PERMIT NO: BLD-2020-0867
OWNER'S NAME: LUM DARREL W AND CHERRYL O TRUSTEE OWNER'S PHONE: 4082554899
CONTRACTOR:
CONSOLIDATED PLUMBING INC, 3732 D CHARTER PARK DRIVE SAN JOSE
CONTRACTOR PHONE:
4089783093
DATE ISSUED 7/15/2020 11:53:31 AM ISSUED BY: KDUNBAR VALUATION: $80023.60
JOB DESCRIPTION
CUPERTINO ROUNDTREE - REPLACE (466 FT) OF 1" AND (266 FT) OF 2" WATER LINE FROM METER TO 14 UNITS WITH (N) 2" HDPE PIPE AND TEE OFF (BUTT FUSED) FROM THE 2" WATER
MAIN TO EACH UNIT WITH 1" LINE; INCLUDES (N) METER UNION, COPPER RISER BY THE UNIT, MAIN HOUSE SHUT-OFF BALL VALVE, HOSE BIB, AN IRRIGATION SHUT-OFF BALL VALVE IF
APPLICABLE ALL ADDRESSES FOR WHITE FIR CT: 21052, 21054, 21056, 21058, 21060, 21062, 21064, 21066, 21068, 21070, 21071, 21074, 21076, 21078,
LICENSED CONTRACTOR DECLARATION
CONTRACTOR:
CONSOLIDATED PLUMBING INC
LICENSED CLASS:
Could not retrieve LP info.
LICENSED NO:
505162
EXP DATE:
Could not retrieve LP info.
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 penatly 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, l must forthwith
comply with such provisions or this permit shall be deemed revoked.
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, Sections 25505, 25533, and 25534.
EPA LEAD-SAFE DISCLOSURE
An EPA Lead-Safe Certified Renovator will be responsible for this project.
Certified Firm Name:
No EPA Lead-Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Yes No
Lender's Name:
APPLICATION 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, judgements, 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.
Signature:
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.
Firm Certification No:
Lender's Address: