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12090142 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22424&22426 MC CLELLAN RD CONTRACTOR:CLEAN ROOTER AND PERMITNO: 12090142 PLUMBING OWNER'S NAME: JEFFERY R VIVIAN WIGMAN 2305 CHERRYSTONE DR DATE ISSUED:09/17/2012 OWNER'S PHONE,: 4082886785 SAN JOSE,CA 95128 PHONE NO:(408)802-9623 LICE`N'SED CONTRACTOR'S DECLARATION •1011 DESCRIPTION: RF,SIDEN"FI L 11 COMMERCIAL, License Class U Lic.4 UNIT 22426 ONLY- REPLACE WATER HEATER LIKE FOR ,,,( � /[p �,..,G„ LIKE Contractor T��I �i✓t /`W�� Date —�- —�� 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 nry license is in full force and effect. hereby affirm under penalty of perjury one of the following neo declarations: 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 performance of the work for which this permit is issued Sq.Ft Floor Area: Valuation:$1200 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for die performance of the work for which this APN Number:95604023.00 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 WITffiN 180 DAYS 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 LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,And expenses which may accrue against said City in consequence of the -7 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cup inn Municipal Code,Section 9.18. RF.Roops: Signature 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 1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF CO\'F,RINGS TO BE CL\SS"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,m owner of the property,am exclusively contracting with licensed contractors to HAZARDOUSMATERIALS 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. 1 will I.hereby affirm under penalty of perjury one of the fnllowing three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code.Section 25532(a)should 1 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 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Code.Sections 25505.25533,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 m to become subject to the Worker's Compensation laws of Califamia. If,after making this certificate of exemption,I CONSTRIICHON LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must 1 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(See.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION' Lender's Address I certify that I have read this application and slate drat 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 ,\RCIII'1'ECT'S DECLARATION 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 till non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date Paving Plastering GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255IM ' CUPERTINO (408)777-3228 • FAX(408)777-3333 • building0guoerino.ora v\ ❑PLUNGING ❑NECHA`RCAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS C/PP((qA I APN 4 OWNER NAhff .r/r, PHONE '?Q IAC4I T E MAB. STREET ADDRESS Pv �✓ 'j / CITY. SLATE,IIP` _ - �j/� �i FAX CONTACT NAME PHONE [yC/5 T `E-MAIL STREET ADDRESS CITY,STATE ZIP FAX ❑OWNER ❑ OWNER-BUI DETt /❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER Cl DEVELOPER ❑TENANT CONTRACTOR NAMF/// O LICENSE TYPE BUS p COMPANY NAME /,s US„ �T E-MAIL FAX STREET ADDRESS CRY,STATE,ZIP PHONE ARCHITECTIENOBNEEY NAME LICENSE N JN[BER I BUS.LIC i COMPANY NAMEE-MAIL FAX STREET ADDRESS CITY,STATE ZIP PHONE USE OF ❑SFD.DUPICY ❑ MULTI-FAMILY PROJECT IN WBDL ND ❑ YES PROMCTIN ❑YES ISTHEBLDGAN ❑ YES B=NQ: []COMMERCAL URBAN INTERFACE AREA 1 NO FLOOD ZONE ❑NO I Et]HFR HOMER Cl NO DESCRIPTION OF WORX Pt9r, TOTAL VALUATION: �Z-UD cJ I RECEIVED BY: V1(ti, By my signamre below,I ,certify to each of the following: I am the property owner or authorized agent to act on the property owncr's behalf. I have read this application and the information I have provided is cosec. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances Bud sate laws relating m building construction. I authorize representatives Cupertino to enter the above-identified pmper^�for inspection pu(poses. Signature ofApplicanUAgrnc Date: '7- 1-7. IZ SUPPLEbENTAL INFORMATION REQUIRED OFFICE USE ONLY OVER-THE-COUNTER r ❑ EMPRESS 1 V ❑ STANDARD U Z ❑ LARGE ❑ MAJOR i%EP,Lfac4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 1:21 ADDRESS: 22426 MC CLELLAN RD DATE: 09/17/2012 REVIEWED BY: MENDEZ APN: BP#: 'VALUATION: $1,200 *PERMIT TYPE: Building Permit PLAN CIIECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION pRWHEATR USE: PERMITTYPE: WORK REPLACE WATER HEATER LIKE FOR LIKE SCOPE Afech. Plan Check Plumb. Plan Check 0.0 hrs $0.00 El,,. Plan Check Alech. Permit Fee: Plumb. Permit Fee: IPPERAHT Flee.. Permit Fee: Other,llceh. /nsp. Other Plumb Insp. 0.0 hrs $45.00 Other Elce.Insp. Afech.Insp. Fec: Plumb. bap. Fee: E•lce.Imp.Fee: NOTE: This evintate does not include fees Clue to other Departments(i.e. Planning, Public II'orks, Fire,Sanitary Sewer District,School District,etc. . These ees are based on the preliminan information available and are only an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution ll-053 E0: U//1 U FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Plumbing Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $27.00 1PRII'FIEATR Water Heater PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee0 Reg. Q OTE-o-1 Ins $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Constntction Tax: Administrative Fee: 1ADMIN $42.00 O Work Without Permit? O Yes (j) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRA PDOC $45.00 Building or Structure 0 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $133.501 $27.001 TOTAL FEE: $160.50 Revised: 07/01/2012 Proposed Bathroom Remodel E F� COPY AUG-Q.`t 2012 Fay : IG BY:J- Mr. & Mrs. Tsuchida _—Lj 7618 Hollandery Place Cupertino, CA 95014 20501.-71-2� bath floor plan modified - \ to full bath and % bath no change in total floor area , NO CUPER'L wn9>3j� Building DepeRment . 012 Andy Horiuchi Construction = gEP 0 4 2 847 Los Altos Ave. DE COMPUMACE F'E Los Altos, CA 94022 lEWED FO (650) 88 4975 R;�;ewEa sv 11 4 REVISION 0 � 9 -7 f