14010131 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10744 MORENGO DR' CONTRACTOR:BATH FITTER PERMIT NO: 14010131
NORTHERN CALIFORNIA
OWNER'S NAME:
SAN JOSE,CA 95133 PHONE NO:(408)834-1111
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E]
License ClassREPLACE(E)WATER MIXING VALVE IN SHOWER AREA
( 1/�6 l Lic.#
Contractor /7('"/liT�r�](� Date
I hereby affirm that I am licensed under the provisions of apter 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
pe5formance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$900
,Yfiave 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:37535058.00 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 T ED 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 V. Date: Z 3
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regul ions per the Cupertino Municipal Code,Section
918.
RE-ROOFS:
Signature Date 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 affirm that I am exempt from 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. 1 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 Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:
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 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
918.
Signature Date
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTM O MEP
ENT BUILDING DNISION
10300 TORRE AVENUE•CUPERTINO,CA 950143255
CUPERTINO (408)7773228•FAX(408)m' 'buildino(Mcupertino ora !� misc
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BY my signature below,I certify to earls ooff the fol l I am the property owns or anthorimd
application and the i�otmatioa I have providedcorrect have read the or
au Work anagent to on the property owner's have
ordiaanoes and stat laws relating to a Desrnp verify it is accurate. I agree mp1Y wi liable local
Signature ofA hcant/A Mdm of Cupertino to enter the abov inspection
8�t Dat:
PLEMENTAL INFORMATION REQUMM
OFFICE USE ONLY
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MEPMUMPP 1011.doc revised 0621111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10744 MORENGO DR DATE: 01/23/2014 REVIEWED BY: MELISSA
APN: 375 35 058 BP#: `VALUATION: $900
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex . PENTAMATION 1 RPFIX
USE: PERMIT TYPE: A
WORK REPLACE E WATER MIXING VALVE IN SHOWER AREA
SCOPE
F '77
01
7 5 _
Mech.Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check
tech. Permit Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit F ee:
FH,'�",,"h.
AIcrc'h.Insp. Other Plumb Insp. 0.0 hrs $47.00 Ocher Glee.Insp.
Insp.Fc—w: Plumb. Irish.Tee: Elec.Insp.flee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fees are based on the prelimina information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 LL_j # Plumbing
Suppl.PC Fee: E Reg. 0 OT 0.0 hrs $0.00 $10.00 1BPF=RE Fixture or Trap
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.0 Reg. Q OT0,0 hrs. $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Construction Tax: T-17
Administrative Fee: 1ADMIN $44.00
Work Without Permit? O Yes No $0.00
Advanced Planning Fee. $0.00 Select a Non-Residential 0
Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure 0
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
v $139.50 $10.00TO �L FEES $149.50
,
Revised: 01/15/2014