12010027 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10349 LEOLA CT CONTRACTOR:CWPM,INC PERMIT NO: 12010027
OWNER'S NAME: YIU TZE-YEE AND ANNE H TRUSTEE 1270 S WINCHESTER BLVD DATE ISSUED:01/04/2012
O1"IER'S PHONE: 4087739128 SAN JOSE,CA 95128 PHONE NO:(408)554-1818
LICENSED CONTRACTOR'S DECLARATION fl
_ 2BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# 7_� 8�0 °"
MECH RESIDENTIAL COMMERCIAL
Contractor �_ �►'( � Date ( ,_ Y-
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APT 1-REPLACE WATER HEATER
(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:$985
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
permit is issued. APN Number:37504022.00 Occupancy Type:
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 ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Issued Date
9.18. :
Signature
RE-ROOFS:
I OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any rooting material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
[certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's Ow r o u hor' d agent:
Compensation laws of California. If,after making this certificate of exemption,I Date: q-/2-
become
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of"wrk's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
C and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
L ng of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18• Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
MDDRESS: 10349 leola ct. DATE: 01/04/2012 REVIEWED BY: bobs.
PN: BP#: "VALUATION: $985
'PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION PRWHEATR
USE: p PERMIT TYPE:
WORK replace water heater.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $26
TOTALS: $26.00
-T-T
Plumb.Plan Check 0.0 hrs $0.00
Plumb.Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 hrs $44.00FA I
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 relinina information available and are o an estimate. Contact the Det or addn'1 info.
FEE ITEMS (Fee Resolution 11-05 Lf "1.'11) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $26.00
PME Permit Fee: $44.00
Administrative Fee: ]ADMIN $41.00
Work Without Permit? Yes (F) No $0.00
Travel Documentation Fee: ITRA VDOC $44.00 A
Strong,Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $156.50 $0.00 TOTAL FEE $156.50
Revised: 1/01/2012
/dol- oa 1
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CIJPERTINO (408)777-3228• FAX(408)777-3333• building(aDcupertino.org misc
PLUMBING MECHANICALELECTRICAL ❑MISCELLANEOUS
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PROJECT ADDRESS `a /� -7
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OWNER NAME 44- ` C PHONE -�7�) _ E-MAIL
STREET ADDRESS � CITY, STAT�ZIP � / � FAX
CONTACT NAME f ` PHONE E-MAIL
CL.Y�
STREET ADDRESS f, / ,yt r CITY,STATE, ZIP " FAX
611 `
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT 0 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMELICENSE NUMBER L. SE TYPE BUS.LIC#
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COMPANY NAMEE-MAIL FAX
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STREET ADDRESS / r� �, J`J� C 5 CITY,STATE,ZIP C QK S� ` Cj,J�f� PHO S SSS- I
ARCHITECT/ENG INEER NAME LICENSE NUMBER BUAIC#
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
JSE OF ZkfDor DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
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TOTAL VALUATION: / G
`5, RECEIVED BY:
By my signature below,I certify to 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 pro ed is correct.j 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 build g tructi 'I au a representatives of Cupertino to enter the abo a--iidentified property for inspection putposes.
Signature of Applicant/Agent: Date: .`?
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SUP NTAL ORMATION REQ=D OFFICE USE ONLY
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MEPMiscApp_2011.doc revised 06/21111