11090147CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7403 STANFORD PLI PCO MRA CONTRACTOR: WATER QUALITY I PERMIT NO: 11090147BINI
OWNER'S NAME: GREENLY KENNETH J AND PATTI J 11860 ALMADEN RD I DATE ISSUED: 09/20/2011 I
"VNER'S PHONE: 4087779505
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor( X A\, - ate
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
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.
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 theupertino Municipal Code, Section
9.18.
Sign Date
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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)
1, 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.
1 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,
and expenses which may accrue against said City in consequence of the
L ag 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 Date
SAN JOSE, CA 95123
PHONE NO: (408)267-9330
BUILDING PERMIT INFO: BLDG J_ ELECT f— PLUMB f—
MECH T_ RESIDENTIAL r COMMERCIAL
JOB DESCRIPTION: COPPER RE -PIPE & NON-METALIC MAIN WATER LINE
REPLACEMENT
Sq. Ft Floor Area: I Valuation: $6500
APN Number: 35932029.00 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 Date: 2 v' L
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, Sections Pf505, 25533, and 25534.
n raranthopize t:.�
i Date:
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
7 ITEMS OF 7
CITY OF CUPERTINO
OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35932029.00
DATE ISSUED.......: 09/20/2011
RECEIPT #.........: BS000014811
REFERENCE ID # ...: 11090147
SITE ADDRESS .....: 7403 STANFORD PL
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......:
OWNER ............: GREENLY KENNETH J AND PATTI J
ADDRESS ..........: 7403 STANFORD PL
CITY/STATE/ZIP ...: CUPERTINO, CA 95014-5814
RECEIVED FROM ....: MARTY SATALINO JR
CONTRACTOR .......: SATALINO, MARTY LIC # 21526
COMPANY ..........: WATER QUALITY PLUMBING
ADDRESS ..........: 1860 ALMADEN RD
CITY/STATE/ZIP ...: SAN JOSE, CA 95123
TELEPHONE ........: (408)267-9330
FEE ID
UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
-ADMIN
-------------
HOURS
----------
1.00
----------
41.00
----------
0.00
----------
41.00
----------
0.00
1BCBSC
VALUATION
6,500.00
1.00
0.00
1.00
0.00
1BPWSVCS
WATER SERVICE
1.00
22.00
0.00
22.00
0.00
1BSEISMICR
VALUATION
6,500.00
0.65
0.00
0.65
0.00
1PPERMITFE
FLAT RATE
1.00
44.00
0.00
44.00
0.00
1PRREPIPE
NO OF FIXTURE
1.00
12.00
0.00
12.00
0.00
1TRAVDOC
FLAT RATE
1.00
44.00
0.00
44.00
0.00
TOTAL PERMIT
----------
164.65
----------
0.00
----------
164.65
----------
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
164.65
---------------
164.65
REFERENCE NUMBER
--------------------
AMEX
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 507 FINAL PLUMBING
CUPERTINO
GENERAL PERMIT APPLICATION
EP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(aDcupertino.org
`'PLUMBING ❑MECHANICAL [:]ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS
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CONTACT NAME
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STREET ADDRESS
CITY, $TATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT
CTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LIC
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BUS. LIC #
COMPANY NAME
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FAX
STREET S
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PH
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME '
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YESPROJECT
URBAN INTERFACE AREA ❑ NO
IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN El YES
EICHLER HOME? El
DESCRIPTION OF WORK l
V
C
t
TOTAL VALUATION:
RECEIVED BY:
By my signature below, I certi 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 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 relatin to building con I authori epresentatives of Cupertino to enter the above-identifie4 property for inspection pu{poses.
Signature of Applicant/Agent: Date: 2 2-�l
SUPPLEMENTAL INFORMATI UIRED
OFFICE USE ONLY
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❑ OVER-THE-COUNTER
❑ EXPRESS
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❑ STANDARD
❑ LARGE
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❑ MAJOR
1EPMIscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
12 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 7403 stanford road DATE: 09/20/2011 REVIEWED BY: larrys
APN: BP#: 'VALUATION: $0
PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY PENTAMATION 1 RPRP
USE: SFD or Duplex PERMIT TYPE:
WORK
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
... • . ••-•-
QTY/FEE
QTY
UNITS
BP FEES
Re -Pipe Interior
1PRREPIPE
1
#
$12
Water Service
1 BPWSVCS
1
#
$22
PME Unit Fee:
$34.00
PME Permit Fee:
$44.00
Administrative Fee: ]ADMIN
$41.00
Work Without Permit? Q Yes (D No
$0.00
TOTALS:
i
Travel Documentation Fee: 1TRAVDOC
$44.00
$34.00
$0.00
NOTE. This estimate does not inctuae fees aue ro orner uepes fir- i-uuu#- ►� nom, ��••«�• r--�.-�• - - -. ___, _____ _ _ _ __ _ _ ,
i.. .:... s . r ,..i... /bo nano Fnr addn'1 inin_
These ees are basea on me pretwunury in urrruiuvis
FEE ITEMS Lee Recohition 11-053 Etf. 7`1/11J
uvasesuuse alas
FEE
... • . ••-•-
QTY/FEE
— ----- ___ _ _ _____
MISC ITEMS
PME Plan Check:
$0.00
PME Unit Fee:
$34.00
PME Permit Fee:
$44.00
Administrative Fee: ]ADMIN
$41.00
Work Without Permit? Q Yes (D No
$0.00
i
Travel Documentation Fee: 1TRAVDOC
$44.00
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg, Stds Commission Fee:
$0.00
SUBTOTALS:
$163.001
$0.00 TOTAL'FEE:
.-. -__J.
$163.00
-1^^
1\GVIJGV. vvv�••-v �
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: "� ' �;(�
PERMIT #
OWNER'S NAME: C `
PHONE # — S�
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE: �, Sl
*Our municipal code requires all businesses working in the city 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 SUBCONTRACTORS WE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: A
Signature Date
Please check applicable subcontractors and complete the following information:
V
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
912q lI
Date
Z�