14040007CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10183 ALHAMBRA AVE CONTRACTOR: PLUMBING TECH INC PERMIT NO: 14040007
OWNER'S NAME: WEYHE ROBERT I AND SHEILA A 278 E GISH RD DATE ISSUED: 04/01/2014
OWNER'S PHONE: 4087721928 SAN JOSE, CA 95112 PHONE NO: (408) 437 -6207
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
n DUPLEX 10183 & 10185- COPPER REPIPE FROM METER
License Class Lic. # UNITS.
7 r� % Z TO
Contractor
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. Sq. Ft Floor Area: Valuation: $6000
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: 32623026.10183 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT E IRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN YS 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 INSPE 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 Issued b Date:
granting of this permit. Additionally, the applicant understands and will comply y'
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
RE- ROOFS:
Signatu% 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
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 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 Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25 5, 25533, d 25534. /
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 CONSTRUCTION LENDING AGENCY
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 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
�gY.lsss
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building a�cupertino.org MISC
rya ...�,,T- M1,A- Cf'UAwrrrAr FIRTR(`TRT(AT. nMISCELLANEOUS
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PROJECT ADDRESS
APN # X13 �Z� do
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OWNER NAME �O ¢ � r 1 Q �
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E-MAIL
STREET ADDRESS
CITY, STATE ZIP
FAX
CONTACT NAME
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PHONE LOOP r /p 3 SAO
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E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ ORNER- BUILDER ❑ OWNER AGENT
❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
Pum Tech
LIC E NUMBER
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LICENSE TYPE
BUS. LIC #
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5-7
COMPANY NAME
E -MAIL
FAX
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STREET ADDRESS I S I
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CITY, STATE, ZIP sQ n \ J O S � (J�f J
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ARCHITECT/ENGWEERNA6 E
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTT•FAMti.Y
PROJECT IN WWLAND ❑YES
PROJECT IN ❑ YES
❑ NO
FEICHI.ER THE BLDG AN YES
HOME? ❑ NO
BUILDING: ❑ COMMERCIAL
URBAN INTERFACE AREA ❑ NO
FLOOD ZONE
DESCRIPTION OF WORK
1:1
f
TOTALVALUATTON:1tECEIVED
we
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act t 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 a ate. I agree to comply with all applicable local
ordinances and state laws relating to buildin construction. authorize representatives of Cupertino to enter the above - identified property for inspection purposes.
Signature of Applicant/Agent:
Date:
SUPPLEMENTAL INFORMATION REQUIREDroFcEUSEOlt�
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MEPMiscApp_2011.doc revised 06121111
�� CITY OF CUPERTINO
UV U V C'rTM A 9rnU — RT TTT .D1NV T)TVIRION
NOTE: This estimate does not include fees due to other Departments tie. riammng, ruanc rrurno, x tic, .�uuoouiy ��•.
Contact the Deot for addn °l info.
FEE ITEMS (Fee Resolution 11 -053 Ef . 7/U13)
ADDRESS: 10183 alhambra ave
DATE: 04/01/2014
REVIEWED BY: Mendez
APN:
BP #:
'VALUATION: $6,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
Suppl. PC Fee: Reg. ® OT
PENTAMATION 1RPRP
I PERMIT TYPE:
USE:
$0.00
PME Plan Check:
$0.00
woRK
duplex 10183 & 10185- copper re i e from meter to units...
Permit Fee:
SCOPE
Suppl. Insp. Fee :Q Reg. ® OT
NOTE: This estimate does not include fees due to other Departments tie. riammng, ruanc rrurno, x tic, .�uuoouiy ��•.
Contact the Deot for addn °l info.
FEE ITEMS (Fee Resolution 11 -053 Ef . 7/U13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
I—! 1 #
$14.00
Plumbing
IPRREPIPE Re -Pipe Interior
Suppl. PC Fee: Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee :Q Reg. ® OT
O,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
(101 7'5 �Ft'lum IC7.V:
Administrative Fee: IADMIN
$44.00
L
0
E)
Work Without Permit? ® Yes (F) No
$0.00
Advanced Plannim Fee:
$0.00
Select a Non - Residential
Building or Structure,
E)
Travel Documentation Fee: ITRAVDOC
$47.00
Strom Motion. Fee: IBSEISMICR
$0.60
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
?
$139.60
$14.00
_1; TOTAL FEE:
$153.60
Revised: 01/15/2014