11120084 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22330 HOMESTEAD RD CONTRACTOR:ARROYO PLUMBING AND PERMIT NO: 11120084
DRAIN,INC
OWNER'S NAME: WOODSPRING CONDOS 650 LINCOLN AVE STE D DATE ISSUED: 12/14/2011
ER'S PHONE: 488664573 SAN JOSE,CA 95126 PHONE NO:(409)278-0170
LICENSED CONTRACTOR'S DECLARATION r [ r
// ry BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class '3 V Li,.# ( 3 q •3 '-c'
I MECH r RESIDENTIAL rCOMMERCIAL r
Contractor Date ( Z/ 14 a j
then' JOB DESCRIPTION:MAIN BUILDING-REPLACE WATER HEATER AT
1 hereby affirm that 1 am licensed under provisions of Chapter 9 EXISTING
(commencing with Section 7000)of Division 3 of the Business&Professions LOCATION
Code and that my license is in full force and effect.
1 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.
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 Sq.Ft Floor Area: Valuation:54750
permit is issued.
APPLICANT CERTIFICATION APN Number:32659999.MAIN Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and 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 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point s trcc regulations per the C Municipal Code,Section
98. n
9,18. I Signatrll C Date (V tx Issued by:
OWNER-BUILDER DECLARATION '
RE-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Scc.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
1 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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Myrucipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Section 25505,25 ,and 25534.
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 Owner uthorizeVgen
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING 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 of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
iftnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
rg rig of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
• CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32659999.MAIN
DATE ISSUED. . . . . . . : 12/14/2011
RECEIPT #. . . . . . . . . : BS000015566
REFERENCE ID # . . . : 11120084
SITE ADDRESS . . . . . : 22330 HOMESTEAD RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WOODSPRING CONDOS
ADDRESS . . . . . . . . . . : 22330 HOMESTEAD RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ARROYO PLUMBING & D
CONTRACTOR . . . . . . . : MATTHEW PATRICK LIC # 32322
COMPANY . . . . . . . . . . : ARROYO PLUMBING AND DRAIN, INC
ADDRESS . . . . . . . . . . : 650 LINCOLN AVE STE D
CITY/STATE/ZIP . . . : SAN JOSE, CA 95126
TELEPHONE . . . . . . . . : (408) 278-0170
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------ ---------- ---------- ---------- ---------- ----------
-ADMIN HOURS 1. 00 41.00 0.00 41.00 0. 00
1BCBSC VALUATION 4,750 .00 1.00 0. 00 1. 00 0. 00
1BSEISMICR VALUATION 4, 750. 00 0.50 0. 00 0.50 0. 00
1PPERMITFE FLAT RATE 1.00 44.00 0. 00 44 .00 0. 00
1PRWHEATR UNITS 1. 00 26.00 0. 00 26 .00 0. 00
1TRAVDOC FLAT RATE 1. 00 44.00 0. 00 44 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 156.50 0. 00 156 .50 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 156 .50 #11852
---------------
TOTAL RECEIPT 156.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518
--------------------------
518 WATER HEATER
•
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
• ADDRESS: 22330 homestead rd. DATE: 12/14/2011 REVIEWED BY: bobs.ag
APN: BP#: "VALUATION: $4,750
fbPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION PRWHEATR
USE: PERMIT TYPE:
WORK re lace water heater at existing location.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $26
TOTALS: $26.00
t1n:h, PGm r h"k Plumb.Plan Check 0.0 hrs $0.00 1,1ee.Phm Chcck
V ch, Permit P,e" Plumb. Permit Fee: IPPERM/T t_hr. Pern:ir Ive:
• 0ho .11,41,11,hap, Other Plumb Insp. 0.0 hrs $44.00 Urher E/nc. ttrsp. ED
di/•ch./mir. Nee: Ptu"!b tr,p.Fvr; Eley.!nv>. Pee:
NOTE: This estimate does not Include fees due to other Departments(le. Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the preffindina in ormation available and are only an esilmate. Contact the Dept for addn7Info.
FEE ITEMS (Fee Resolution 11-053 E/T 7/1/11/ FEE QTY/FEE MISC ITEMS
F'l,m ("k,rck Fec:
.Suppl. 11C'Fee
PME Plan Check: $0.00
Permit Fee:
Snphr. lisp lee
PME Unit Fee: $26.00
PME Permit Fee: $44.00
.'orlstruction Tar .
Administrative Fee: ]ADMIN $41.00
Work Without Permit? 0 Yes Q No $0.00
:Idvnnced planning Fees:
Travel Documentation Fee: ITRAVDOC $44.00
Stron;Motion Fee: iBSEiSM/CR $0.50 Select an Administrative Item
• Bldg Stds Commission Fee: 1BCBSC $1.00
!' 'SUBTOTALS: $156.50 $0.00 TOTAL FEE: $156.50
Revised: 12/04/2011
it/"o0off(
GENERAL PERMIT APPLICATION M E P
oil COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255• M ' /�CUPERTINO (408)777-3228•FAX(408)777-3333- building gncupertino.org ■�/_
LUMBING MECHANICAL ELECTRICAL MISCELLANEOUS
PROJECT ADDRESS Z L 3 3 0 o kA e s f eA d R a. 'FN"
c
OWNER NAME tA,oy .( Ov"NPHONE E-MAIL, NuA
STREETADDRESS 2.23 3017 \, CITY, STATE,ZIP FAX
h1 w•cl ea IJ Fr C� e., a GA `(sclH
CONTACT NAME PHONE E-MAR.
STREETADDRESS CITY,STATE, ZIP l J GA ( C.A FAX
❑ OWNER ❑ OWNER-BUIDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR AME LICENSE NUMBER LICENSE TYPE BUS.LICA
„ e . �, w ✓A. g3g35- 3G 32312
COMPANY NAME E-MAIL ) FAX
�4el%jI � c 1�n� •vo e — )mow/• .wF.. 4a?- 2,�_al$3
STREET ADDRESS .�q CITU,STATE,IIP PH NE
bP�' t • , , w� P S 7'eC C.� giIZ6 Po8• Ll$ o \� o
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREETADDRESS CIN,STATE,ZIP PHONE
AM
SE OF ❑SFDar DUPLEX MULTI.FAMRV PROJECTIN WILDLAND -5T NO
PROTECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA 5 NO FLOOD ZONE 13 NO EICHLER HOME? I$NO
DESCRIPTION OF WORK
ll Z.0 \v (,2t ALC ( ZS 0 'fin I\Ah Lv4 Zv 2t,Ira, w
f,4 W Vol j„\ .1., v., A-11 CA
TOTAL VALUATION: S—b RECEIVED BY;
By my signature below,I certify m each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have providRd is correct..have read the Descripo=of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to builds construed V I eutho'ze r ta[iv of Cupertino to enter the above•identifi d prop for inspection pu( oses.
Signature of App 20%, 1. Date: 12j I L
SUPPLEMENTAL INF TION REQUIRED OFFICE USE ONLY
N ❑ OVER-THE-COUNTER
d
❑ EXPRESS
Y
U
S ❑ STANDARD
u
3 ❑ LARGE
6
❑ MAJOR
MPPMucApp 2011.doc revised 06121111
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
U P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: Zt33o Nokatt en R PERMIT#
OWNER'SNAME: PHONE# No � Z9,0116
GENERAL CONTRACTOR: BUSINESS LICENSE# 3-1-3LL
ADDRESS: 6S,� L . D f de c� arit CITY/ZIPCODE: 1 -N ?Lb S.-� a �je
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALASU ONTRACT R5 � OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors: ,
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum / Wood
Glass /Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/ Wallpaper
Paving
Plastering
Plumbing Avv� o NIV ,2 D tia otic 3 Z3Lt
Roofing
Septic Tank
Sheet Metal
Adh Sheet Rock
Tile
Owner/Contractor Signature Date