11010108 ' CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 821 STENDHAL LN CONTRACTOR:JA PLUMBING PERMIT NO: 11010108
OWNER'S NAME: NIEH DAVID Y AND HUANG JAMIE C 28306 INDUSTRIAL BLVD STE B DATE ISSUED:01/19/2011
OWNER'S PHONE: 6508882711 HAYWARD,CA 94545 PHONE NO:(510)266-5125
LICENSED CONTRACTOR'S DECLARATIONF
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# �/ _71911
nl MECH RESIDENTIAL COMMERCIAL
Contractor � /�k�w'L�/��, Date_ J�—//
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL TAKAGI TANKLESS WATER HEATER&55 FEET
(commencing with Section 7000)of Division 3 of the Business&Professions OF
ONE INCH GAS PIPE FROM METER TO UNIT
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
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$5800
permit is issued. „
APPLICANT CERTIFICATION Y L APN Number:37542044.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued
Signature L Date
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,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
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. _ Date: D/—/�
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
-,ts,and expenses which may accrue against said City in consequence of the
sting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: TraciC
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37542044 .00
DATE ISSUED. . . . . . . : 01/19/2011
RECEIPT #. . . . . . . . . ES000012521
REFERENCE ID # . . . : 11010108
SITE ADDRESS 821 STENDHAL LN
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER NIEH DAVID Y AND HUANG JAMIE C
ADDRESS 821 STENDAHL LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM JA PLUMBING
CONTRACTOR NIGEL EDWARDS LIC # 30554
COMPANY JA PLUMBING
ADDRESS 28306 INDUSTRIAL BLVD STE B
CITY/STATE/ZIP . . . : HAYWARD, CA 94545
TELEPHONE (510) 266-5125
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- -----
1BCBSC VALUATION 5, 800 . 00 1 .00 0 .00 1. 00 0 .00
1BSEISMICR VALUATION 5, 800 . 00 0 .58 0. 00 0 .58 0 .00
1PGASRES OUTLETS 1. 00 63 . 00 0 . 00 63 .00 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 173 .58 0 . 00 173 .58 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 173 .58 3377
---------------
TOTAL RECEIPT 173 .58
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- --------
518 WATER HEATER
CITY OF CUPERTINO
IclFEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 821 stendhal In. DATE: 01/19/2011 REVIEWED BY: bob s.
APN: aj��'Ia �'`-� BP#: ' `C) U� *VALUATION: $5,800
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION PRWHEATR
USE: p PERMIT TYPE:
WORK install new tankless water heater, and add new gas pipe.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $25
Piping, Gas <=4 Outlets 1 PGASRES 1 # $63
TOTALS: $88.00
7'lEr,t Chc(A Ch( Plumb.Plan Check0.0 hrs $0.00
W 'h
. _ I ,rm r L.> Plumb.Permit Fee: IPPERMIT F1,17 Po,,,%r t �:
C)ther;t'lc °i.Irf s Other Plumb Insp. LLO hrs $42.00 oib,11'1"10 ii�V).
1117,1W), /nspz F�,"" klo(,Imp, F""
NOTE: These fees are based on the preliminary in ormation available and are onl an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 09-05I a- .71,'1/10) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Szz��E71. PC:`Fercf
PME Plan Check: $0.00
f}enni.t Fee:
Supp1. hisp I°'ec>
PME Unit Fee: $88.00
PME Permit Fee: $42.00
C()nSlt if('tiOn Ta
,1(."Oustic al lic vie:v FCV:
Work Without Permit? 0 Yes E) No $0.00
I'lunPtIntr Fees:
Travel Documentation Fee: ITRA VDOC $42.00
Strong Motion Fee: IBSEISMICR $0.58 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $173.58 $0.00 TOTAL FEE: $173.58
Revised: 01/03/2011
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: g .5+-e J L-�-o I PERMIT# �/
OWNER'S NAME: Dc .\./D kr.-- PHONE# - 91 25r
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS:?-$3d CITY/ZIPCODE: S�iS
*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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractor
Signature Date
Please check applicable subcontractors and complete the following information:
S/ 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
} CITY OF CUPERTINO
WATER HEATER 01plD19
CUPEkTINO PERMIT APPLICATION FORM
APN # 42Date:
3T5_5' ... D�
Building Address: gat ,Sv e of Lam— I 1--ru
Owner's Name: \1(V t- Phone #: GSo - 0 o8-2-t 1I
Contractor: Phone #:
Fax #:
Cupertino Business License #: Contractor State License #:
Contact: Phone #:
Fax #:
Building Permit Info:
Bldg g--' Elect Plumb Mech ❑
Residential D---" Commercial ❑
Job Description: T/l r� G< Q �.i /c »' k'a
Strapped On Platform ❑ Bonded �ew Location ❑ Replacement
Valuation (cost of proje t):
5 v o
Project Size: Express ❑ Standard ❑ Large ❑ Major
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to
the application or if applicable, include in plan set & the sheet index.
Green Building Points achieved:
Revised 03/10/10