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B-2016-1307
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1307 10183 COLBYAVE CUPERTINO,CA 95014-2419(316 28 043) CUPERTINO PLUMBING INC OWNER'S NAME: MARTIN LLOYD H AND JULIE B DATE ISSUED:02/04/2016 OWNER'S PHONE:650-534-6062 PHONE NO:408-309-3411 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic.#5242D5 Contractor CUPERTINO PLUMBING INC Date 02/22/2016 X BLDG —ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect, JOB DESCRIPTION: COPPER RE-PIPE BENEATH SFD&REPLACE(E)MAIN WATER LINE I hereby affirm under penalty of perjury one of the following two declarations- V#1-ADD SEWER LINE REPLACE WITH PROPERTY AND t. I have and will maintain a certificate of consent to self-insure for Worker' FOUNDATION CLEANOUTS-ISSUED 2/22/16 Compensation,as provided for by Section 3700 of the Labor Code,for the � mance of the work for which this permit is issued. 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 permit is issued. Sq.Ft Floor Area: Valuation:$4000.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction,and hereby 316 28 043 authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs,and PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS + ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal 180 DAYS h+ T1 ST + SPECrI'TON. Code,Section 9.18. Issued by: ' IS A Signature Date 02/22/2016 Dater 02/22/2 OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for r.. I,as owner of the property;or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date:02/22/2016 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER i. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the this permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code,Chapter 9,12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 2559 and 3 exemption,I become subject to the Worker's Compensation provisions of the i Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent y be deemed revoked. Date:02/22/2016 APPLICANT CERTIFICATION CONSTRUCT ON LENDINGAGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant ARCHITECT'S DECLARATION understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date 02/22/2016 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 1000 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(a�cupertino.org CIJPERTIi` O El NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISI FE ORIGINAL PERMIT PROJECT AD SSi Ae— APN; � E-MAILOWNERMwG6 STREET ADD SS CITY, STATE,ZIP FAX CONTACT NAME PHO 6(^ /; !� E-MAIL STREET ADDRESS �� CITY,STATE, ZIP FAX r_/ ❑OWrTER ❑ OR7vTER-BUILDER ❑ OR'IQERAGENTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENG TER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA E LICENSE NUMBER LICENSE E BUS.LIC# COAIPAI�1 � P E-MAIL FAX llff'�_C11- n STREET ADDRE CITY,S ATE,ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL. FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESC TIO F RK EXISTING USE - PROPOSED USE CONSTR TITS -'STORIES _ USE TYPE OCC. SQ,FT. VALUATION($) E}ISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM - KITCHEN - OTHER _ REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GAR40E AREA: LJ DETACH- ❑ATTACH #DWELLING UNITS;. IS A SECOND UNIT ❑YES -SECOND STORY ❑YES BEING ADDED? [:]NO ADDITION? []NO PRE:APPLICATION* ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN EI '� _ � �'. TOTAL VAL .-. .. N: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER - E ... „ ,? By my signature below,I certify to each of the following: I am the property owner or authorized a on the property owner's behalf. I have read this application and the information I ham{e provided is correct. I have the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state lamas re islb`to'�buldi�ng�c-onstrvc' rize r Iv upertino to enter the above-identified property for inspection purposes. Signature of Applicant/A�ent: IV_— Date: Z-Z2P {(p SUPPLEDRENT ° IFO A'TION REQUIRED .:�. PLAN CHECI�'I'1G'E° s„.. ..°�._...� �.•ROUT'I��SLTP , �,�,,`_�. NTew SFD or Multifamily dwellings: Apply for demolition permit for aQ � - OVER THE C{}U\TER BUILDS\GXLA,e RE3IE� } existing building(s). Demolition permit is required prior to issuance of building ,'X 10 permit for new building. i EXTRE NG PL RES IET3' Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1=7 sTA © �uBLIc oRI # T form if any Hazardous Materials are being used as part of this project. 7 LARGE S L14IRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to R "y MAJOR �; SAAITAR]SEERDISTRV_ submittal of Building Permit application. lx r 'I]•s_E\ViRO_lA4E�NTALHEALTH ._. Bldg.App_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1307 10183 COLBYAVE CUPERTINO,CA 95014-2419(316 28 043) OWNER'S NAME: MARTIN LLOYD HAND JULIE B DATE ISSUED:02/04/2016 OWNER'S PHONE:6505346062 PHONE NO:408-309-3411 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC36 Lic.#624905 Contractor Date 02/04/2016 X BLDG _ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: COPPER RE-PIPE BENEATH SFD&REPLACE(E)MAIN WATER LINE I hereby affirm under penalty of perjury one of the following two declarations: 1. 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. I have and will maintain Worker's Compensation Insurance,as provided for q131/by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4000.00 APPLICANT CERTIFICATION 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 16 Number: Occupancy Type: 3 ordinances and state laws relating to building construction,and hereby 316 28 043 authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs,and PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAS INSPECTION. Code,Section 9.18. Issued by:MELIS A NAMES Signature Date 02/04/2016 Date:02/04/2016 OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: installed without fust obtaining an inspection,I agree to remove all new materials for i. I,as owner of the property,or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: z. I,as owner of the property,am exclusively contracting with licensed Date:02/04/2016 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the z. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the this permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous s. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 2�505,255 d 25534. exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized aaent:/ be deemed revoked. Date:02/04/2016 APPLICANT CERTIFICATION CONST CTIONENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant ARCHITECT'S DECLARATION understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date 02/04/2016 1\ GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• buildingC�cupertino.org misc CU.PERTINO 'S3 Zoi 6- ('30 . PLUMBING ❑MECHANICAL ❑ELECTRICAL [:]MISCELLANEOUS PROJECT ADDRESS I Ale, APN# / / — C' — 0(43 pWNBR f AME PHONE Q r E-MAIL 4 �r�l�- 6 STREET AD RESSCITY, STATE,ZIP FAX CONTACT NAME `T PrO�N�Ep EMAIL STREET ADDRESS�►► CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENTCIS ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONT CT RENAME LICENSE UM ER v LICENSE TNE� BUS.LIC# ` 2 t y L— 1 COMPANY NAME E-MAIL FAX STREET AD KESS CITY,STATE,ZIP PHONE �-7�t4 ��. /J�. - C;()- 47 5- 22LE2 6F-3 4 rI ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# 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 SZ -5i G1 t,,, 4. AN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO DESCRIP NOF WORK d a.-►ti adpk 4lil_t 2_2__4ATF TOTAL VALUATION: Q �_ By my signature below,I certify to each of the following: I am the property owner or authorized agent to_act,onerty owner's behalf. I have re application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildi thorize re sentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPYEERENTAL NFORAIATION REQUIRED QFFICE'USE ONLY, � OV THE COUNTER,_ ❑ EXPRESS,, ;. v ❑ STANDARD 'i' U �z s a � LARGE NIr1:TQR � . MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10183 COLBY AVE DATE: 02/04/2016 REVIEWED BY: MELISSA APN: 316 28 043 BP#: *VALUATION: 1$4,000 xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: . Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPR USE: PERMIT TYPE: WORK COPPER RE-PIPE BENEATH SFD & REPLACE E MAIN WATER LINE SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe Interior 1PRREPIPE 1 # $14 Water Service 1 BFWSVCS 1 # $25 TOTALS: $39.00 Plumb.Plan Check 0.0 hrs $0.00 Fee,. Plumb.Permit Fee: ;' f a;i!,u IPPERMIT l>c£:, s'.;a �.<, ;/t ir. /;r z3. Other Plumb Insp. 0.0 hrs $48.00 i.1#he; Eicv.Inesi., C) Ll Meet,IlZSZ7./'r.''e. Phainb.hiss,I`<.;'c'. NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These,fees are based on the relimina information available and are only an estimate. Contact the Dept./or addn'l info. FEE ITEMS (Fee Resolution.1.1-053 fff. 711/13) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 Perm,'�E sty: fnsp PME Unit Fee: $39.00 PME Permit Fee: $48.00 (.7fi3lir`i'uf'Zion T Cw:i: Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes (D No $0.00 Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: 1BSEISMICR $0.52 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $181.52 $0.00 TOTAL FEE:.' $181.52 Revised: 01/01/2016