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11020091 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21050 CANYON OAK WAY CONTRACTOR: PERMIT NO: 11020091 OWNER'S NAME: STUART MENAKER A ALaJo DATE ISSUED:02/24/2011 OWNER'S PHONE: 6506250810 PHONE NO: LICENSED CONTRACTOR'S DECLARATIONF BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class G Lic.# F F I� MECH RESIDENTIAL COMMERCIAL Contractor J r� �W M L�iN(o Date 24Zi �� I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTLL TANKLESS HYBRID WATER HEATER APPRX 15FT (commencing with Section 7000)of Division 3 of the Business&Professions FROM EXISTING WATER HEATER,RUN A Code and that my license is in full force and effect. GAS FROM METER TO UNIT,INSTALL WATTERER SOFTENER 35FT OF 1" 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:$5755 permit is issued. APPLICANT CERTIFICATION APN Number:34261004.00 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 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DA OM LAST CALLED INSPECTION. with all non-point source regulations p the Cupertino Municipal Code,Section .17 9.18. y. Issued b L�!� / Date: Signature C _ ate 2 Z l 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: 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 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 an iz a forthwith comply with such provisions or this permit shall be deemed revoked. Date: L 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 co— and expenses which may accrue against said City in consequence of the g of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION w....dil non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional 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:7-1 M-0 ()t-J W PERMIT# ` OWNER'S NAME -LJlp-<� PHONE # - 5=CO I GENERAL CONTRACTOR:) Pt,-L)"4 N& BUSINESS LICENSE# ADDRESS:; iN pvV-F-J 1fZ- g r/;,;� 57- f-1- CITY/ZIPCODE:4. W,'�V'0 *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 SUBCONTRACTOR HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Z/2-Y/) Sign t re Date Please check applicable subcontractors and complete the following information: 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 6 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 34261004 . 00 DATE ISSUED. . . . . . . : 02/24/2011 RECEIPT # . . . . . . . . . BS000012762 REFERENCE ID # . . . : 11020091 SITE ADDRESS . . . . . : 21050 CANYON OAK WAY SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER STUART MENAKER ADDRESS 21050 CANYON OAK WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JA PLUMBING 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 5, 755 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 5, 755 . 00 0 . 58 0 . 00 0 . 58 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1PREPPIPE 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 152 . 58 0 . 00 152 . 58 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 21050 Canyon Oak Way DATE: 02/24/2011 REVIEWED BY: gs APN: BP#: *VALUATION: 1$5,755 xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Du lex PENTAMATION PRWHEATR USE: p PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $25 Piping, Water Treatment 1 PREPPIPE 1 # $42 TOTALS: $67.00 Plumb.Plan Check 0.0 hrs $0.00 ? Plumb.Permit Fee: IPPERMIT 01h", t i,!1. hl;,T, Other Plumb Insp. El hrs $42.00 NOTE: Theseees are based on the preliminaiqy in ormation available and are only an estimate. Contact the De t or addn I info, FEE ITEMS (Fee Resolution 09-05I Eff.7,1.,"10) FEE QTY/FEE MISC ITEMS rZl J Pf. PC."F,le PME Plan Check: $0.00 PME Unit Fee: $67.00 PME Permit Fee: $42.00 Colislvi;(-fioll I'J", F 1t fJtISIGt'Lt! Rt'rrE w VC, Work Without Permit? C) Yes E) No $0.00 Travel Documentation Fee: ITRAVDOC $42.00 Strom Motion Fee: IBSEISMICR $0.58 Select an Administrative Item Bldp-Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $152.58 $0.00 TOTAL FEE.-T $152.58 Revised: 01/15/2011 CITY OF CITY OF CUPERTINO srRl C u P E RTI N o PERMIT APPLICATION FORM APN# ;2ate: ,l )— � I o c,L� D2� ` Building Address: 2-1 Q'E)0 CSN Owner's Name: Phone#: (©-o Contractor: Phone#:go 3 7Lx.��,A NCS Fax#: Contact: Phone#: S) Fax/e-mail: Contractor License #: `� kzz��1L4 Cupertino Business License #: Job Description: j - -fldv)e SS `J F ?Aw ItIk __T t- two �`S 1�1N� 'vw�(--t � �t�1 AUX �� F'T" ate- � ` �S �-�+'^ r•.t►-t�2 'Ti3 Residential [ Commercial ❑ Valuation: Project Size: Counter 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: Quantity , Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1 BPREPIPE Commercial re-pipe per fixture P 1 CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 12/06/10