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10090198F__ CITY OF CUPERTINO BUILDING PERMIT PERMIT NO: 10090198 BUILDING ADDRESS: 22333 BAHL ST CONTRACTOR: `1'nr-- I'"E� "VNER'S NAME: ANN HUNTSMAN c,WNER'S PHONE: 5108498673 ❑ LICENSED CONTRACTOR'S DECLARATION License Class 36 Lic. # 2 Contractor v�%,7%a-&2 6&f'CE Date %Z 7,� 0 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. 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. APPLICANT CERTIFICATION 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 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 all non -point sou regulations per the Cupertino Municipal Code, Section 9.18. l �gature _� Date OWNER -BUILDER DECLARATION Fq N DATE ISSUED: 09/21/2010 PHONE NO: JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL INSTALL TANKLESS WATER HEATER Sq. Ft Floor Area: I Valuation: $8300 hereby affirm that I am exempt from the Contractor's License Law for one (I :he following two reasons: as owner of the property, or my employees with wages as their sole compensatio �, vill do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) [, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I in ist forthwith comply with such provisions or this permit shall be deemed revoked. APN Number: 32613093.00 I Occupancy Type: APPLICANT CERTIFICATION 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 relat ng to building construction, and hereby authorize representatives of this city to enter -n the above mentioned property for inspection purposes. (We) agree to save =nify 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 all non -point sour c lations per the Cupertino Municipal Code, Section 9.18. /� Signature i Date 0 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: l� RE -ROOFS: 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 inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 2 ,25533, and 25534. Owner or authorized agent: Date:�c //b CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: ,7 15�.( PERMIT # OWNER'S NAME: C/ PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working ui the city to nave a S.Iiy ui %-Upul tillu uua.■. — _«��• 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 subcontractors: S gnature PIPace check annlicable subcontractors and complete the following information: Date Date 0 tier / ontractor Signature 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 Date 0 tier / ontractor Signature ,��,�� CITY OF CUPERTINO Reffi /ll ivivT Ti CTTM A Tn Q _ RT J11,DING DIVISION APPLIANCE / EQUIP TYPE 1, JUJ L' y%�J 1 iXT Plumb. Plan Check �.O�hrs$0.00 QTY UNITS ADDRESS: 22333 Bahl St. DATE: 09/21/2010 REVIEWED BY: jsg 1 PRWHEATR ,<s 2:�j BP#: -VALUATION: $8,300 APN: Fee *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair —[-PENTAMATION PRIMARY SFD or Duplex p-�%«1 f�>/,��1, Firi PRWHEATR PERMIT TYPE: USE: $42.00 C'u17N11-11C[i In TIT WORK Tankless Water Heater SCOPE Work Without Permit? 0 Yes No APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check �.O�hrs$0.00 QTY UNITS BP FEES Water Heater 1 PRWHEATR ,<s 2:�j 1 # $25 Permit Fee PME Unit Fee: $25.00 PME Permit Fee: $42.00 C'u17N11-11C[i In TIT Work Without Permit? 0 Yes No 10.00 TOTALS: i Travel Documentation Fee: ITRA VDOC $25.00 Strong, Motion Fee: -i., n" octis,nto t^antart the Dent for addn'l info. NOTE: These fees are based on ttte prettinmunarrTy ,n FEE ITEMS (Fee Resolution 09-05I E f 7%7i70) r-��. Plumb. Plan Check �.O�hrs$0.00 <�ti�< }'/oar Jlc< ,A I E Plumb. Permit Fee: IPPERMIT Sifpj,/. PC Fee Other Plumb Inst. 0.0 hrs $42.00 ,<s 2:�j d lc � f•_ 11i.S�; 1`s �.. _. ft ;. Fcv -i., n" octis,nto t^antart the Dent for addn'l info. NOTE: These fees are based on ttte prettinmunarrTy ,n FEE ITEMS (Fee Resolution 09-05I E f 7%7i70) rmsui,u„ svu„uusc FEE: �••� �• �••• QTY/FEE -- - -- MISC ITEMS }'/oar Jlc< ,A I E Sifpj,/. PC Fee PME Plan Check: $ x.00 Permit Fee PME Unit Fee: $25.00 PME Permit Fee: $42.00 C'u17N11-11C[i In TIT Work Without Permit? 0 Yes No 10.00 i Travel Documentation Fee: ITRA VDOC Se -2.00 Strong, Motion Fee: $0.83 Select an Administrative Item Bldp Stds Commission Fee: IBCBSC 51.00 SUBTOTALS: $1 ' 0.83 $0.00 TOTAL FEE: $110.83 ^A^ Revised: yn4i2-u I 6 ITEMS OF 6 CITY OF CUPERTINO PERMI- RECEIPT Sec: Twp: Rng: Sub: Bl:c: Lot: APN ........: 32S13093.00 DATE ISSUED.......: 09/21/2010 RECEIPT #......... BSDO0011517 REFERENCE ID # ...: 1090198 SITE ADDRESS 22333 BAHL ST SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ANN HUNTSMAN ADDRESS 22333 BAHL ST CITY/STATE/ZIP CUPERTINO CA, OPERATOR: SylviaM COPY # : 1 95014-1006 RECEIVED FROM SUNGATE ENERGY 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 ---------- 8,300.00 ---------- 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 8,300.00 0.90 0.00 0.90 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 ---------- 224.90 0.00 224.90 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 224.90 --------------- 224.90 REFERENCE NUMBER -------------------- 6262 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---- 518 WATER HEATER CITY OF CXPERTINO WATER HEATER CUPEkT1NO PERMIT APPLICATION FORM tCDC) o I q Er APN # ZcP 13 0 Date: Building Address: ;,6V X 3 3 3 Owner's Name: � C� Phone #: 5I U • gni �. ��3 Contractor: Phone #: /l/) ./lU /� /C'•(J,�' Fax #: Cupertino Business License #: Contractor State License #: �'cc)3 Y,3 Contact: Phone #: Fax #: Building Permit Info: Bldg ❑ Elect ElPlumb Mech ❑ Residential Commercial ❑ Job Description: Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement ❑ Valuation (cost of project): � C> , Project Size: Express ❑ Standard M 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