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13050152CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22600 ALPINE DR CONTRACTOR: PLUMBING TECH INC PERMIT NO: 13050152 OWNER'S NAME: PATRICK HO 1424 PIEDMONT RD DATE ISSUED: 05/21/2013 OWNER'S PHONE: 6509661074 SAN JOSE, CA 95132 PHONE NO: (408) 493 -5000 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS License Class C Li.. # 7� REPIPE MAIN WATER LINE FROM METER TO /� PROPERTY Contractor ` - ` 6 ate 2 f �20 )5 AN T ARY I hereby affirm that I am lice sed 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. Sq. Ft Floor Area: Valuation: $1350 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 APN Number: 34248037.00 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 180 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 DAYS F AST 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 ed b Date: K12— th-3 granting of this permit. Additionally, the licant understands and will comply with all non -point source re ulatio s p di Cope o Municipal Code, Section 9.18. RE- ROOFS: Signature . Date -f4 f 13 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 a rim that I am exemptirom 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 (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 Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cup lino Munici Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safety Code, Sections 5534. �tion Section 3700 of the Labor Code, for the performance of the work for which this Owner or author' agent: // Date:a 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 CONS UCTION LENDING AGENCY Compensation laws of California. If, a8ermaking this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction fending 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 again aid City in consequence of the I understand my plans shall be used as public records. granting of this pgrmi.LAdditionally, the plic t understands and will comply with all ..nt source r2gulations e_C pertino Municipal Code, Section Licensed Professional 9.18. Signature Date 2 ! T CUPERTINO GENERAL PERMIT APPLICATION V � MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildinp(ftupertino.or4 MPLUMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS MISC PROJECT ADDRESS OWNER NAME k' / PHONE �O © E -MAIL STREET ADDRESS CITY, S ATE, ZIP u © Cv� FAX CONTACT NAME PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LIC SE NUMBER LIC S$ TYPE BUS. LIC # COMPANY NAME / E -MAIL FAX STREET ADDRESS 7 2 CITY, STA ZIP Sae � /�� NE o sy goy ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF FD or DUPLEX ❑ MULTI -FAMMY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK © ^ � 9i � D `? TOTAL VALUATION: V �� By my signature belo , I certify to each of the following: I am th roperty owner or authorized agent to act on the property o ehalf. I have read this application and the information I have provided is co scription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil ' truction. I a th a re entatives of Cupertino to enter the above-id ntified p perty for inspection purposes. Signature of Applicant/Agent: Date: SrEMPAL INFORMATION REQUIRED OFFICE USE ONLY W, OVER- THE - COUNTER x ❑ EXPRESS U x zU a ❑ STANDARD: ❑ LARGE a ❑; MAJOR MEPMiscApp_2011.doc revised 06121111 FIRM CITY OF CUPERTINO FFF. F.RTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 22600 ALPINE DR DATE: 05/21/2013 REVIEWED BY: MELISSA UNITS APN: 342 48 037 BP #: *VALUATION: 1$1,350 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: I PENTAMATION 1 RPWS I PERMIT TYPE: � WORK REPIPE MAIN WATERLINE FROM METER TO PROPERTY SCOPE $0.00 APPLIANCE / EQUIP TYPE FEE ID FEE ITEMS (Fee Resolution 11 -053 E . 71II12,� QTY UNITS BP FEES Water Service 1BPWSVCS 1 # $23 PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $23.00 Ifech. Plan Check I I Plumb. Plan Check 10.0 1 hrs $0.00 Elec_ Plan Check F Ltech. Permit Fee: Plumb. Permit Fee: IPPERMIT Elec. Permit Tee: Cher ;11ech. Insp. Other Plumb Insp. 1 0.0 1 hrs 1 $45.00 (hirer Elec. Insp. L 11ech. Insp. Fee: Plumb. Insp. Fee: Islec. Insp. Fee: NOTE: This estimate does, not include fees due to other Departments (Le. Planning, Public Works, tire, sanitary sewer District, seisoot District, etc). These ees are based on the relinuna in ormation available and are onl an estimate. Contact the De t or addn'1 in o. FEE ITEMS (Fee Resolution 11 -053 E . 71II12,� FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC I'ee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $23.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: 1ADMIN $42.00 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fees: Travel Documentation Fee:. ITRAVDOC $45.00 Strong Motion .Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 o , DOM-` t $156.50 ` Revised: 04/29/2013