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11020113 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10817 W ESTATES DR CONTRACTOR:ALLSTAR PLUMBING PERMIT NO: 11020113 OWNER'S NAME: ELIZABETH MULLEN 326 PHELAN AVE DATE ISSUED:02/28/2011 OWNER'S PHONE: 4082545757 SAN JOSE,CA 95122 PHONE NO:(408)230-5569 Fz. LICENSED CONTRACTOR'S DECLARATION F BUILDING PERMIT INFO: BLDG r ELECT PLUMB License Class L;c.# -7302 6 L i 7_� �� MECH F RESIDENTIAL F COMMERCIAL F Contractor ate I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:WATER HEATER INSTALLATION AT GARAGE LOCATION (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. Sq.Ft Floor Area: Valuation:$1900 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 t is permit is issued. APN Number:36923035.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above informat' n i correct.I agree to comply with all city and county ordinances and state I ws r ating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply �'7 with all non-point urce regulations the Cupertino Municipal Code,Section Issued bye -- Date:G 9.18. / Signature Date RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this 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;s 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 Owner r autho ' ) Compensation laws of California. If,after making this certificate of exemption,I Date: 02. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, c(,-' and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION g g of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. wuI.all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36923035 . 00 DATE ISSUED. . . . . . . : 02/28/2011 RECEIPT # . . . . . . . . . : BS000012786 REFERENCE ID # . . . : 11020113 SITE ADDRESS . . . . . : 10817 W ESTATES DR SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ELIZABETH MULLEN ADDRESS : 10817 W ESTATES DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4537 RECEIVED FROM . . . . : FAROUQ DAOUD CONTRACTOR . . . . . . . : DUARTE TADEV LIC # 22189 COMPANY . . . . . . . . . . : ALLSTAR PLUMBING ADDRESS . 326 PHELAN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95122 TELEPHONE . . . . . . . . : (408) 230-5569 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 900 . 00 1 . 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 1, 900 . 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 ----------------- --------------- -------------------- CREDIT CARD 110 . 50 VISA --------------- TOTAL RECEIPT 110 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10817 w. estates dr. DATE: 02/28/2011 REVIEWED BY: APN: BP#: *VALUATION: 1$1,900 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY PENTAMATION USE: --[SFD or Duplex PERMIT TYPE: PRWHEAT; WORK re lace water heater at garage location. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $25 TOTALS: $25.00 vlca T'I.x. 0,70 A Plumb.Plan Check 0.0 hrs $0.00 11/cc, Chc,A i=c" Plumb.Permit Fee: IPPERMIT Oftrc3 lic+.Ia. ,'t�,»_ Other Plumb Insp. 0.0 hrs $42.00 � r'a- 1!, u. 1�cc- 1'irrr��h. !ii.h. Ft=;� r;i�x�_Inv, I L,e" NOTE. Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 09-051 Eff'.7%1110,) FEE QTY/FEE MISC ITEMS Man Chccl4 nSttx�jrl. 1'C.'FE'c PME Plan Check: $0.00 Permit Fcc: s1fly1, 117,1p 1-"A, PME Unit Fee: $25.00 PME Permit Fee: $42.00 C_'OI;s7rw('IiO) 7 1',L\- Work Without Permit? 0 Yes E) No $0.00 I'Ic,rtrrftr Travel Documentation Fee: ITRAVDOC $42.00 Strong,Motion Fee: IBSEISMICR $0.50 Select an Administrative Item BldpStds Commission Fee: IBCBSC $1.00 SUBTOTALS: $110.50 $0.00 TOTAL FEE:; $110.50 Revised: 01/15/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 10 (7 ( /, PERMIT# �l OWNER'S NAME: e I zen�e:�k PHONE#QQ GENERAL CONTRACTOR: Vt( 3T -/jrZ )0 .LtA j N( BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY I PECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL BCONT TORS 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: 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 1 ( 0Z, v l 15 WATER HEATER CU PE T]NO PERMIT APPLICATION FORM APN # �� 2 U Date: 2 _Z 1 Building Address: Owner's Name: Phone #: Contractor: Phone #: Fax #: Cupertino Business License #: Contractor State License #: � 97�%Z 6 1 f Contact: Phone #• ®g) 76-g_ C9++ Fax #: Building Permit Info: Bldg [' Elect Plumb Rr Mech Residential 12/'*' Commercial ❑ Job Description: WG`1�✓ �nC��ET �S+-C' Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement Valuation (cost of project): I pct . foo Project Size: Express ❑ Standard 1Z 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