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11050033 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22800 STONEBRIDGE ST CONTRACTOR:LOEWEN&FRECH INC PERMIT NO: 11050033 OWNER'S NAME: BILL&JOAN BONIN 245M MT HERMON RD DATE ISSUED:05/05/2011 OWNER'S PHONE: 4083430842 SCOTTS VALLEY,CA 95066 PHONE NO:8313354632 / LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE&REPLACE EXISTING 82 GALLON SOLAR ELECTRIC License Class A Lic.# STORAGE WATER HEATER TANK. GO'e �?jINC. Contractor 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. Sq.Ft Floor Area: Valuation:$2500 1. 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 APN Number:34213046.00 Occupancy Type: performance of the work for which this permit is issued. 2. 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. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR I certify that I have read this application and state that the above information is 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: Date: indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may ace a against said City in consequence of the granting of this permit. Addition ly the applicant understands and will comply with all non-point sourc ti s er a Cupertino Municipal Code,Section 9.18. RE-ROOFS: L All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature Date � installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I 5y affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER ti lowing two reasons: 1. 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 HAZARDOUS MATERIALS DISCLOSURE sale(Sec.7044,Business&Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the 2. I,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain construct the project(Sec.7044,Business&Professions Code). compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. I hereby affirm under penalty of perjury one of the following three declarations: Additionally,should I use equipment or devices which emit hazardous air 1. I have and will maintain a Certificate of Consent to self-insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation,as provided for by Section 3700 of the Labor Code,for the maintain compliance wit the Cupertino Municipal Code,Chapter 9.12 and the performance of the work for which this permit is issued. Health&Safety Code, a tions 25505,25533,and 25534. 2. I have and will maintain Worker's Compensation Insurance,as provided for by Owner o i d ent: / Section 3700 of the Labor Code,for the performance of the work for which this Date: permit is issued. 3. I certify that in the performance of the work for which this permit is issued,I shall CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code,I for which this permit is issued(Sec.3097,Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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 Licensed Professional indemnify and keep harmless the City of Cupertino against liabilities,judgments, 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 a'' -point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34213046 . 00 DATE ISSUED. . . . . . . : 05/05/2011 RECEIPT #. . . . . . . . . : BS000013384 REFERENCE ID # . . . : 11050033 SITE ADDRESS . . . . . : 22800 STONEBRIDGE ST SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BILL & JOAN BONIN ADDRESS 22800 STONEBRIDGE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5651 RECEIVED FROM . . . . : LOEWEN & FRECH INC CONTRACTOR . . . . . . . : LOEWEN, DEBRA LIC # 21212 COMPANY LOEWEN & FRECH INC ADDRESS : 245M MT HERMON RD CITY/STATE/ZIP . . . : SCOTTS VALLEY, CA 95066 TELEPHONE . . . . . . . . : 8313354632 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 500 .00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 2, 500 . 00 0 .50 0 . 00 0 . 50 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1PRWHEATR UNITS 1 . 00 25 . 00 0 . 00 25 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 110 .50 0 . 00 110 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 110 . 50 1253 --------------- TOTAL RECEIPT 110 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER ALTERNATIVE ENERGY PERMIT APPLICATION Is COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTIN4 (408)777-3228•FAX(408)777-3333 •Widing(cDcupertino.org PROJECT ADDRESS � (�J (,J /�� /,��J.,I�. APN# OWNER NAME �� H 4 n E-MAIL STREET C11 Y, STATE, V �'U/JV� FAX CONTACT NAIL PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME --�--/ LICEN ENUI�BER LICENSE BUS.LIC COMPANY�fAME , E-MAIL� FAX S T (D/(RF?S� CITY. / PH[J� ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL. FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF STD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AMA El Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO ❑SOLAR PANELS �_c ELECTRIC VEHICLE CHARGING STATION I t, OLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UMTS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALVA 0 6W DESCRIPTION OF WORK 7-4 RECEIViD BYw` By my signature below,I certify to each of the followin 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 corr ct. 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 buil i c o I authorize r resentatives of Cupertino to enter the above-ide tified pr perty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIREDN. " �EI�LF3IJIYIEIL W,� gx..- t STANDARD C7 LARGE" a `U"MAJOIt'e P VApp_201 1.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 22800 stonebridge DATE: 05/05/2011 REVIEWED BY: APN: BP#: y L>La "VALUATION: $2,500 '°PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Du lex PENTAMATION PRWHEATR USE: p PERMIT TYPE: WORK replace solar water heater tank at garage location SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1 PRWHEATR 1 # $25 TOTALS: $25.00 Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $42.00 NOTE. These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS OW Resolution 09-051 Fff. 7;1'10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $25.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg Stds Commission Fee: IBCBSC $1.00 1ADMIN SUBTOTALS: $110.50 0 TOTAL FEE Revised: 04/29/2011 Building Department City Of Cupertino ELI] 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 4Z2 '�c) l ne►�/upGc- PERMIT# OWNER'S NAME: ✓1 4*' Nlh PHONE# �/ — 32. GENERAL CONTRACTOR: 1-� Ih/G BUSINESS LICENSE # 'Zl ZI 'Z— ADDRESS: ?W5,44 4-. rt-wort 2 CITY/ZIPCODE: C^V/ifjSO G *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 ALL SUBCONTRACT?,JRS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: I/ 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date