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13050067 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10552 CEDAR TREE CT CONTRACTOR:GENMOR PLUMBING PERMIT NO: 13050067 OWNER'S NAME: JOAN WELLER 2552 SEABOARD AVE DATE ISSUED:05/08/2013 OWNER'S PHONE: 4082539705 SAN JOSE,CA 95131 PHONE NO:(408)855-8348 ❑ LICENSED CONTRACTOR'S�DE(CQLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class 1p.�J1Un�,! /Lic.# � ✓ l� COPPER REPIPE FROM METER TO HOUSE Contractor I hereby affirm that I am licensed under 4e 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. Sq.Ft Floor Area: Valuation:$13500 1 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 APN Number:31634025.00 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 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 DAY M LAST CALLED INSP TION. 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 pe . dditionally;the licant unders ds and will comply Issued by: Date: with all non-poi a regulations a Cupe o 1cipal Cod ,Section 9.18. 3 RE-ROOFS: Signature _ 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. ElOWNER-BUILDERDECLARATI N I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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. 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 Area Air Qu Mana ement District I performance of the work for which this permit is issued. will maintain compliance with t ertino Mu ' i al Cod , hapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec o 5505,255 5 4 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: ate: . 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 CP 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•build ing@cupertino.orqC CUPERTINO 'y �LUMBING [:1 MECHANICAL [—]ELECTRICAL MISCELLANEOUS PROJECT ADDRESS –y-{ APN# 31 ^ r-\2 L-- OWNER NAME 1,(� HONE ��I�� E-MAIL`,J G—J STREET ADDRESS ��]]]]]]��–� � CITY,STATE,ZIP 1� FAX VU V-coCONTACT NAME PH Ot'i 1T}( ) �S�?/ ) E-MAIL+kIq r STREET AD R S �� 1 CITY,STAT`ECZIPV V�l �J �`��. �j rI Fp7(_ ��r��q ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT kl TRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER`[�❑ DEVELOPER ❑TENANT CONTRACTOR NAME \)M 1� LICE N NUMBER LICENSE TYPE BUS.LIC# LO COMPANY NAMET `m)dl� -2-DAC, alwwayea), - FAX )� STT ESS v�1„tel ►J^ ITY,STATE,ZIP PHONE ^�� ARCHITECT/ENGINEER NAME LICENSE NUMBER J` BUS LIC k (� COMPANY NAME E-MAIL FAX STREET.ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or 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 TOTAL VALUATION: 13 In B By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the p erty owner's behalf. I have read this application and the information I have provided is correct. I hay read the Description of W%,en,, verify it iS accur I ree to comply with all applicable local ordinances and state laws relating to bui construct.0 I rize re r sen tiv s o to enter the above tifie property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY W ❑ OVER-THE-COUNTER a F ❑ EXPRESS J w ❑ STANDARD 2 J a ❑ LARGE o. ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10552 CEDAR TREE CT DATE: 05/08/2013 REVIEWED BY: MENDEZ APN: BP#: *VALUATION: 1$13,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or DuplexPENTAMATION 1 RPD USE: PERMIT TYPE: A WORK COPPER RE—PIPE FORM METER TO HOUSE SCOPE r , kfech.Plan Check Plumb.Plan Check0.0 hrs $0.00 Elec.Plan(.heck iLfech.Permit Fee: Plumb.Permit Fee: IPPERMIT Elec.Permit Fee: Other lfech.Insp. Other Plumb Insp. 0.0 hrs 1 $45.00 Ocher!'lec.Insp. .11ech.Insp.Fee: Plumb. Insp.Fee: Elec.Insp.Fee: 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 reliWna information available and are onlyan estimate. Contact the De t or addn'l into. FEE ITEMS(Fee Resolution 11-053 E,f' 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Plumbing Suppl.PC Fee: (2) Reg. 0 OT M hrs $0.00 $45.00 1PREPPIPE Piping,Area PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Fee Reg. OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Construction .Tax: Administrative Fee: 1ADMIN $42.00 Work Without Permit? 0 Yes (j) No $0.00 Advanced PlanningFee: $0.00 Select a Non-Residential Travel Documentation Feer ITRA VDOC $45.00 Building or Structure i Strong Motion Fee: IBSEISMICR $1.35 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $134.35 $45.00 `_ �o r $179.35 Revised: 04/29/2013