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09110030CITY OF CUPERTINO BUILDING PERMIT BUILDING ADIJRESS: 10335 STERN AVE CONTRACTOR: ALL VALLEY PLUMBING PERMIT NO: 09110030 OWNER'S NAME: TODD WEBB 3345 SELDON CT DATE ISSUED: 11/05/2009 r F_R'S PHONE: 4084733295 FREMONT, CA 94539 PHONE NO: (510)376-4816 r ❑ LICENSED CONTRACTOR'SDECLQARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 3 Liz. # / MECH I— RESIDENTIAL � COMMERCIAL Date Contractor,:��--'h JOB DESCRIPTION:WATER HEATER REPLACEMENT 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. 1 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 Sq. Ft Floor Area: Valuation: $700 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 37510051.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED I certify that I have read this application and 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 to save 180 DAYS FROM LAST CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree harmless the City of Cupertino against liabilities, judgments, indemnify and keep costs, and expenses which may accrue against said City in consequence of the and will comply Dat Issued b ' granting of this permit. Additionally, the applicant understands with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. _ Signature 5�–L Date _ p 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 [� OWNER -BUILDER DECLARATION inspection. 1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: 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, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to the (Sec.7044, Business & Professions Code). HAZARDOUS MATERIALS DISCLOSURE construct project I hereby affirm under penalty of perjury one of the following three 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 declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health Safety Code, Section 25532(a) should 1 store or handle hazardous material. Compensation, as provided for by Section 3700 of the Labor Code, for the Additionally, should I use equipment or devices which emit hazardous air performance of the work for which this permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will 1 have and will maintain Worker's Compensation Insurance, as provided for by maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Section 3700 of the Labor Code, for the performance of the work for which this Health & Safety Code, Sections 25505, 25533, and 25534. permit is issued. 1 certify that in the performance of the work for which this permit is issued, I shall Owne ize4,agVUW Date' 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 Compensation of the Labor Code, I must CONSTRUCTION LENDING AGENCY become subject to the Worker's provisions forthwith comply with such provisions or this permit shall be deemed revoked. 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.) APPLICANT CERTIFICATION Lender's Name I certify that I have read this application and state that the above information is Lender's Address 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 the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION upon nify and keep harmless the City of Cupertino against liabilities, judgments, accrue against said City in consequence of the I understand my plans shall be used as public records. L and expenses which may granting of this permit. Additionally, the applicant understands and will comply Licensed Professional with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37510051.00 DATE ISSUED.......: 11/05/2009 RECEIPT #.........: BS000009133 REFERENCE ID # ...: 09110030 SITE ADDRESS .....: 10335 STERN AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER TODD WEBB ADDRESS ..........: 10335 STERN AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: ALL VALLEY PLUMBING CONTRACTOR .......: MARY SANDBRINK LIC # 23015 COMPANY ALL VALLEY PLUMBING ADDRESS ..........: 3345 SELDON CT CITY/STATE/ZIP ...: FREMONT, CA 94539 TELEPHONE ........: (510)376-4816 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 700.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BSEISMICR VALUATION 700.00 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 ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 224.50 --------------- 224.50 REFERENCE NUMBER -------------------- #2453 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER eta CITY OF CUPEkTINO CITY OF CUPERTINO WATER HEATER PERMIT APPLICATION FORM APN #— 3-7-- Date: Building Address: S� I ten► � � , � i.�. �'% -U�% t � ,^J t� � . Z� (S -U 1 L Co33� Owner's Name: Phone #: eC Phone #: �r C --Wk) P Contractor: Fax #: 51C, v. (o(o l - Cq. 7'1 Cupertino Business License #: Contractor State License #: Contact: Phone #: _57 C r- t. yeti 1 C l r'i /l1 IC Fax #: � f C' C-' 7� Building Permit Info: BldgElect ❑ Plumb [�' Mech [� Residential [ Commercial ❑ Job Description: lv�,a -f e A El Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement Valuation (cost of project): Project Size: Express andard ❑ 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 6/16/08 a10F L,jPEkTINO CITY OF CUPERTINO WATER HEATER PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group Permit Type 1PCWHEATR Commercial Water HeaterNent B PCWHEATR 1BSEISMICOM Seismic Commercial B f 1 PRWHEATR Residential Water HeaterNent B PRWHEATR f 1BSEISMICRE Seismic Residential B 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel & Documentation B 1 BUSLIC Business License B CITY OF �UPEkTINO JOB ADDRESS: OWNER'S NAME: v GENERAL CONTRACTOR: CL I am not using any subcontractors: Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Buildin De artment PERMIT # C) v > PHONE # � C55-L-� FAX # Signature Date Owner/ Contractor Signature Date