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10110168 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10161 CAMINO VISTA DR CONTRACTOR:FALCONE PLUMBING& PERMIT NO: 10110168 HEATING INC OWNER'S NAME: LIANG KAI TRUSTEE 650 LINCOLN AVE#B DATE ISSUED: 11/24/2010 VNER'S PHONE: 4089962687 SAN JOSE,CA 95126 PHONE NO:(408)293-5676 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL License Class " 2 C-j� Lic.# ;�6 ill©X 7 REPLACE 75 GALLON WATER HEATER IN EXISTING LOCATION,STRAPPED,BONDED,AND ON PLATFORM Contractor f-���Gyl c' /�l`=�-�i�t� Date �� � �D 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: 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:$1500 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� APN Number:34214085.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnifyand keep less the City of Cupertino against liabilities,judgments, costs,and expens s ich may at crue against said City in consequence of the _. ��_Z��� granting of this pe it. A iti nally,the applicant understands and will comply Issued Date: with all non-p6int.oprce gpilations per the Cupertino Municipal Code,Section 9.18. o/�v RE-ROOFS: Signature,, Date All roofs shall be inspected prior to any roofing material being installed.If a roof is L installed without first obtaining an inspection,I agree to remove all new materials for inspection. ' ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by th,"ay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with t e upe n unicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 5 5, 5533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this �e Owner or authorized agent' � Date: "",/,? permit is issued. / I certify that in the performance of the work for which this permit is issued,I shall 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 Anon the above mentioned property for inspection purposes.(We)agree to save mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION .,is,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date 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: Z016 / C4 01111-q 0 !/is 7�� Iii; PERMIT# 1 ie OWNER'S NAME: /`1q- u PHONE# o� GENERAL CONTRACTOR: y _ �1BUSINESS LICENSE# ADDRESS: 1656, &IA7e 0/-r - 5'7 �;�1 ITY/ZIPCODE: �. - c✓ �� *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCU CY I PECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL So TORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. /� Z 2 /�� 1 am not using any subcontractors: / Signature Date Please check applicable subcontractors and complete the following information: V 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 FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10161 camino vista ave. DATE: 11/24/2010 REVIEWED BY: bobs. APN: �, ( �<<,'�� BP#: n 'VALUATION: 1$1,500 FPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Du lex 7 1„ PENTAMATION PRWHEATR USE: p �''�-� `��� 3 F i PERMIT TYPE: � WORK re lace existing water heater at same location. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $25 TOTALS: $25.00 Plumb.Plan Check 0.0 hrs $0.00 I l Plumb.Permit Fee: IPPERMIT P ; Other Plumb Insp. 0.0 hrs $42.00 r� 1 twp, NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 09-051 a. 7%7%701 FEE QTY/FEE MISC ITEMS 1 1,1"m C171:'t` Ti_'t nslipp/. lay 'r:' ' F-1 tPME Plan Check: $0.00 PME Unit Fee: $25.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes No $0.00 1'IdJ�r7rt,;�r f't:e'�: Travel Documentation Fee: 1TRAKDOC $42.00 Strong?Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $110.50 $0.00 TOTAL FEE: 1 $110.50 Revised: 11/08/2010 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 34214085 . 00 DATE ISSUED. . . . . . . : 11/24/2010 RECEIPT #. . . . . . . . - : BS000012090 REFERENCE ID # . . . : 10110168 SITE ADDRESS . . . . . : 10161 CAMINO VISTA DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER LIANG KAI TRUSTEE ADDRESS 10161 CAMINO VISTA DRIVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MIKE FALCONE CONTRACTOR . . . . . . . : MIKE FALCONE LIC # 25006 COMPANY . . . . . . . . . . : FALCONE PLUMBING & HEATING INC ADDRESS . . . . . . . . . . : 650 LINCOLN AVE #B CITY/STATE/ZIP . . . : SAN JOSE, CA 95126 TELEPHONE . . . . . . . . : (408) 293-5676 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 1BSEISMICR VALUATION 1, 500 .00 0.50 0 .00 0 .50 0. 00 1BUSLIC FLAT RATE 1.00 114 . 00 0 .00 114 . 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 224 .50 0 . 00 224 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 224 .50 5912 --------------- TOTAL RECEIPT 224 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER CITY OF CUPERTINO U OF WATER HEATER CUPEkTINO PERMIT APPLICATION FORM APN# ,-� �� ,� � � , � Date: 4� Building Address: Owner's Name: 1���• .� Phone Contractor: _ � i . /� � ; Phone #: q�y - Z 9 Fax #: 5�c�' Cupertino Business License #: Contractor State License #: Contact: `li/`re /C - Phone #: Zc? 2- 7U Fax #: Building Permit Info: Bld ❑ Elect ❑--� Plumb O Mech D---- Residential --- -Residential In- Commercial ❑ Job Description: ll� � � Pc` '' Strapped On Platform ( Bonded New Location ❑ Replacement 21 Valuation (cost of project): � 2�a 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