13040033CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10490 PINEVILLE AVE
CONTRACTOR: BENJAMIN FRANKLIN
PERMIT NO: 13040033
PLUMBING
OWNER'S NAME: ASTURIAS MIKE AND CORSICK THER
PO BOX 1072
DATE ISSUED: 04/04/2013
OWNER'S PHONE: 4085056394
CAMPBELL, CA 95009
PHONE NO: (408)298-1776
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE]
LICENSED CONTRACTOR'S DECLARATION
�bi
LicenseClass C 3 Lic. # 5 7 3 S
REPLACE (E) WATER HEATER, SAME LOCATION
J"J I 1,14 ' h
Contractor JCA1 I2fN✓k 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
Sq. Ft Floor Area:
Valuation: $2219
performance of the work for which this permit is issued.
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: 36913033.00
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
WITHIN 180 DAYS ERMIT 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 DAYS FR ' 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
iLl y '
Issued Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cu�Municiode; Section
RE -ROOFS:
9.18.
s )
4//
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.
❑ O E ILDER 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
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)
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
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sections 25505, 25533
Owner or authorized agen 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
CONST ON 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 /j�
� M E P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building a1cuoertino.org ��
MISC
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R04AT`1ICAL F�ELECTRICAL FMISCELLANEOUS
PROJECT ADDRESS
ASPNo#
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03
OWNERNAME
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E-MAIL�1
STREETADDRESS/O 0 I�
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7 501
FAX
CON'TACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ O-ANER-BUILDER ❑ ONTIERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
3 Ni�1,J Jit, AACI_lA) TT0a6I�
LICIN NUMBER
5 3 S
LIE SE E
3
BUS. LIC #
EMAIL
FAX
Lfl S' _<o •O 4o
STREET ADDRESS
16(7A -L -DZ- 57E Onix
C STATE, ZIP g c�
ov/F4,P C� / 49741 /
PHONE /
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPAN`Y NAME '
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF FD or DUPLEX ❑ MULTI-FAMILYPROJECT
BUILDING: ❑ COMMERCIAL
IN WILDLAND ElYES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ElYES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK]
TOTAL VALUATION: Z Z I
�IVED:
By my signature below, I certify to each of the following: I am the property owner or auth zed agent to ac e property own, ' ,half. I ve read this
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 Iota]
ordinances and state laws relating to building cons orize represen nter the above -identified propegy for inspection purposes.
Signature of Applicant/Agent: Date: 7 f 3
SUPPLE ORMATION REQUIRED
OFFICE USE ONLY
OVER-THE-COUNTER
a
Y
❑ E}TRESS
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W
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❑ STANDARD
❑ LARGE
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❑ MAJOR
1EPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
lamm 101VZ+ Uc'7'Tlk4ArPnID _ UTTFF.nTN('- nIVICInN
APPLIANCE / EQUIP TYPE
ADDRESS: 10490 PINEVILLE AVE
DATE: 04/04/2013
REVIEWED BY: MELISSA
101 APN: 36913 033 BP#: *VALUATION: $2,219
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
Water Heater
PENTAMATION PRWHEATR
PERMIT TYPE: i
USE:
1
#
$27
WORK
REPLACE E WATER HEATER SAME LOCATION
Suppl. In:sp Fee
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Water Heater
1PRWHEATR
1
#
$27
Perinit .Fee:
Suppl. In:sp Fee
PME Unit Fee:
$27.00
PME Permit Fee:
$45.00
Construction Tori:
r
TOTALS:
_T
Administrative Fee: IADMIN
$42.00
27.00
}°
Xlech. Plan Ckjeck Plumb. Plan Check 10.0 1 hrs $0.00 Elec..1'lan C;hec,'k
1'erwit Fee: Plumb. Permit Fee: 1PPERMIT Iilec. Permit Fee:
Other .klech. Insp.E3--I- Other Plumb Insp. 0.0 hrs $45.00 Oiher Elec. Insp.
El
Adech. Insp f'ee: Plumb. Insp. Fee: Elec. Insp, fee:
JVnTF• Thk oatimato door not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Th a based on the , relimina information available and are on1v an estimate. Contact the Dept for aaan't into.
District, etc.. ese ees ar
FEE ITEMS LEee Resolution 11-053 E . 7ff 11112)
FEE
QTY/FEE
MISC ITEMS
Plein Check 1- ee:
Suppl. PC'.Fce;
PME Plan Check:
$0.00
Perinit .Fee:
Suppl. In:sp Fee
PME Unit Fee:
$27.00
PME Permit Fee:
$45.00
Construction Tori:
r
_T
Administrative Fee: IADMIN
$42.00
Work Without Permit?. 0 Yes No
$0.00
Advanced Planning Fees.
i
Travel Documentation Fee: ITRAVDOC
$45.00
Strom Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
r
$0.00w. ,� e WL
Bldg Stds Commission Fee: 1BCBSC
$1.00
$160.50
Revised: 04/U1 /2013
JOB ADDRESS: ( O 4 p ?wculllr &
PERMIT #
OWNER'S NAME: 7(3 T<
PHONE #, "'" ., OS .6 3 9
GENERAL CONTRACTOR: �A-v4 1A) FP-Adk-L1, J
BUSINESS LZCEITSE,#
ADDRESS:22 -DI617gt_ Vk— 7E' 010iE
CITY/ZIP .03E = t 0t fi%1`70 J'�f
*Our municipal code requires all businesses working in the city to have a City oIQ upertina>business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) L` BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND "ALL SUBCONTRACTORS HAVE OBS " ° CITY OF CUPERTINO
BUSINESS LICENSE. a
I am not using any subcontractors:
Owner /Contractor Signature _ Date