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11060091 CITY OF CUPERTINO BUILDING PERMIT"" � BUILDING ADDRESS: 20588 STEVENS CREEK BLVD CONTRACTOR:_15 PERMIT NO: 11060091 OWNER'S NAME: BYER PROPERTIES LP DATE ISSUED:06/13/2011 OWNER'S PHONE: 4082522200 PHONE NO: 4 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r License Class Lic.# L �/ MECH r- RESIDENTIAL r COMMERCIAL r Contractor *1te ae (' JOB DESCRIPTION:HONG FU-REPLACE WATER HEATER,COMMERCIAL I hereby affirm that I am licen e u ndesions 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$1500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35908021.20588 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 to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: Date: Signature_c"— Date �� r OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,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, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.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 HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air 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 I 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 Compensation laws of California. If,after making this certificate of exemption,I Owner o authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CON TR TION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ig of this permit.Additionally,the applicant understands and will comply All non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 35908021 .20588 DATE ISSUED. . . . . . . : 06/13/2011 RECEIPT #. . . . . . . . . BS000013736 REFERENCE ID # . . . : 11060091 SITE ADDRESS 20588 STEVENS CREEK BLVD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER BYER PROPERTIES LP ADDRESS 66 POTRERO AVE CITY/STATE/ZIP . . . : SAN FRANCISCO, CA 94103-4837 RECEIVED FROM . . . . : DAHYN HUANG CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 500 . 00 1 . 00 0 .00 1 . 00 0 . 00 1BSEISMICO VALUATION 1, 500 . 00 0 .50 0 . 00 0 .50 0 . 00 1BUSLIC FLAT RATE 1. 00 115 . 00 0 . 00 0 . 00 115 . 00 1PCWHEATR UNITS 1 . 00 25 . 00 0 .00 25. 00 0 . 00 1PPERMITFE FLAT RATE 1. 00 42 .00 0 . 00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 225 .50 0 . 00 110 . 50 115 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 110 . 50 MC 43250Z --------------- TOTAL RECEIPT 110 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION MAPN: DDRESS: DATE: REVIEWED BY: I BP#: "VALUATION: 1$1,500 -� r°PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Water Heater PRIMARY Commercial Building PENTAMATION PCWHEATR USE: PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY BP FEES Water HeaterNent Unit Fee: 1 PCWHEATR 1 $25 7-7 Plumb.Permit Fee: IPPERMIT $42.00 NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the Det or addn7 info. FEE ITEMS (P'ee Resolution 09-051 IL f T 1110) FEE QTY/FEE MISC ITEMS PME Unit Fee: $25.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes G No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Select an Administrative Item 1314,, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $110.00 $0.00 TOTAL FEE: 00 Revised: 04/29/201 �� GENERAL PERMIT APPLICATION _ MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE- CUPERTINO. CA 95014-3255 (408)777-3228 - FAX(408)777-3333 •huilding(aDcuperdno.org �, misc CUPERTINO � ❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS 7 # PROJECT ADDRESS c APN Ste, iv f3 � 7 .'C 4•Z S d NAME OWNER // PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP F.AX CONTACT N / PHONE '.G S r b 7 E MAIL. STREET ADDRESS CITY,STATE, ZIP FAX OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMES , LICENSE PRIMEER LICENSE TYPE BUS.LIC# . r. ,'yam^ Yw COMPANY NAME E-MAIL FAX PHONE] _ STREET ADDRESS CITY,STATE,ZIP L � i � s L i K �' (i� r t �� S ARCHIL'ECT/ENGINEERNAME ,l (` J LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ;E OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WMMLAND PROJECT IN SMUCTURE. ❑ Commercial URBAN IN'IIItFACE AREA ❑ Yes Cl No FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK TOTAL VALUATION: �CE " �r By my signature below,I certify to each of a following: I am the property owner or authorized agent to act an the property owner's behalf. I have read this application and the information I have prov d i orrem 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 bui din co ction I auth rizwreentirives of Cupertino to enter the above-identified propertyfor inspection purposes. Signature of Applicant/Agent Date: SUPPLEMENTAL INF TION RE UMED MWER 3v &LEPMisc.�pjO11.doc revised 03/16/11