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14040194 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 845 LONNA LN CONTRACTOR:ALLSTAR PLUMBING PERMIT NO: 14040194 OWNER'S NAME: BOUCREE JAMES J AND GLORIA E T 326 PHELAN AVE DATE ISSUED:04/29/2014 OWNER'S PHONE: 4082574149 SAN JOSE,CA 95122 PHONE NO:(408)230-5569 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL INSTALL FOUNDATION LINE CLEANOUT ONLY License Class /Lie.# j2.0&�1 Contractor Date 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:$2000 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:35919026.00 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 WITBIIN 180 DAYS O 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 LAST D INSPEC ION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Z-1granting of this permit. Additionally,the applicant understands and will comply ue by Date: with all non-points ice regulations per the Cupertino Municipal Code, n 918. y �(� RE-ROOFS: Signature Date —1 G."l ( 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. 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,Secti ns 25505,25 ,and 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 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 C� M COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION & EP 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �kl (408) 777-3228-FAX(408)777-3333-building a)cuoertino.org MISC �UP>`Ei`TCE�CO 7(PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 1 ��1 1 p r I APN# .S Q /� 7 OWNER NAME ,_^O y,('W!\/``I ti c^I D-C, P /- G 1-7- I L � EMAIL }/P I i C (fa,(/ STREET ADDRESS _„ / D r A- CI ' STAVE,ZIP.6 �c_� I FAX CONTACT NAME l �v PHONFq_2 J - !`` &MAIL STREET ADDRESS C! CITY,STATE,ZIP �p `� ( F� FAX (� c q pw �' e ❑ OWNER ❑ OWNa-BUILDER ❑ O'%gTRAGENT ❑ CONTRACTOR ❑CONTRACTORAGEA7 ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME �l (_ `r LICENSE NUMBER 2 C00 LIr TE/ BUS.LIC COMPANY NAME l C G( A4 /I(W &MA11 V �/I/ b /7 C( �sr FAX STREET ADDRESS ( f� 1 it ,nln/�^{,/J Q W� CITY,STATE,ZIPC� 2 `/✓ C L PHONE 51_bo4o ARCHTTECT/ENGINEERNAME �. (^ LICENSENUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREETADDRESS CrrY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ man-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUMDING: ❑COMMERCIAL. URBAN ITTTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK Dtt ev I`d`v C C .ems ©C-f - �W CIL Id TOTAL VALUATION: INS By my signature below,I certify to each of the following: I am the property owner or authorized agent to act o pro owner's behalf. I have application and the information I haw provided is co ave read the Description of Work and verify it is acc . I agree t applicable local ordinances and state laws relating to lding construct . I au ize representatives of Cupertino to enter the a en I Jed property for inspection purposes. Signature of ApplicanUAgent: Date: S LE N TION RE UIRED ` 0151 � �'�"-' $� Off �w � '==D�IR➢ 2_ p MEPMisc-4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 845 LONNA LN DATE: 04/29/2014 REVIEWED BY: MELISSA APN: 359 19 026 BP#: *VALUATION: 1$2,000 xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 RPS WORK INSTALL FOUNDATION LINE CLEANOUT ONLY SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Building 1PRSEWER 1 # $24 TOTALS: $24.00 :W'Cc r. Plant t'?,c:cf Plumb.Plan Check 0.0 hrs $0.00 F�er�. zt,Ch= c% 1 c r_ I'>rnait Fee: Plumb.Permit Fee: IPPERA47T 0"/?�,,- Iryj"', Other Plumb Insp. 0.0 hrs $47.00 CJt/ref` :i,rc. sly. Ac( , fn,sP. 1-cc, 7,12m13 h,Sp. Fee: /,"loc.ins/, Pc( 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 relimina information available and are onlyan estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 11-053 Eff. 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Fee PME Ptlaln Check: $0.00 I'r:'t'Jr_ri, .pctpp/, hop-ee PME Unit Fee: $24.00 PME Permit Fee: $47.00 C'0n751PM.IiOn TM-: Administrative Fee: 1ADMIN $44.00 Work Without Permit? O Yes 0 No $0.00 ,1C,lL'�inc'.'<i f'J<t,trr;r'ttr T'<'eS`: Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 ISM il OTALS� $163.50 $0.00 TOTAL FEE: $163.50 «. �� Revised: 04/01/2014