The URL can be used to link to this page

13050034 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10137 SANTA CLARA AVE CONTRACTOR:MARTI'S PLUMBING PERMIT NO:13050034 OWNER'S NAME: DAVID NOVOTNY 171 BRANHAM LN STE 10-418 DATE ISSUED:05/06/2013 OWNER'S PHONE: 4087415881 SAN JOSE,CA 95136 PHONE NO:(408)375-3190 LICENSED CONTRACTOR'S DECLARATION G�,�pO� 2� BUILDING PERMIT INFO: BLDG ELECT F PLUMB Class � 3 Lie.# [ .� b r MECH f— RESIDENTIAL r COMMERCIAL F Contractor - T _� Date 151-511 77 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:WATER HEATER,TANKLESS RIGHT SIDE REAR OF (commencing with Section 7000)of Division 3 of the Business&Professions HOUSE Code and that my license is in full force and effect. **SEE NOTES** 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:$2900 permit is issued. APPLICANT CERTIFICATION APN Number:32624021.00 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 of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 D YS FROM L T CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. �6 ` Signatu*&—� Date Issued by: l Date: ❑ 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: I,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: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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. 1 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 Codes J Sections 25 5,?�5533,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 or' Tagent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: J APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all 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 ! L - GENERAL PERMIT APPLICATION I MEP CQMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•building0cupertino.ong misc PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS / S � ) APN OWNERNAME "I P NE EMAIL STREET ADDRESS,I, CITY,STATE,ZIP �� -(N r)_ P 0 FAX CONTACT NAME' PHONE E-MAIL. 1/.t-' K-: STREET ADDRESS CITY,STATE ZIP FF 77 ❑OWNERQWNERBUII.DER�� ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT 11ENGINEER ❑ DEVELOPER 0-TENANT CONTRACTORNAME LICENSE NUMBER LICENSE TYPE BUS.LIC# Ll vtn� N o Z 0 COMPANY NAMESw fir- : E MAII F STREET RES ,,�'"l CITY,STATE,ZIP; PHONE AR LICENSE NUMBER BUS. :C a FAX OMPANY NAMF 11 STREET CITY,STATE,ZIP PHONE USE;OF I j.�SFD o[DUPLEX !❑ MULTI•FAMII.Y PROJECT IN WII,DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑.YES - BUILDING, , ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME?- ❑NO DEScttPTlor�J 1 II :iill lli /�✓ :t'NI / � ' !ilI:l�� ll�l i I II _I � I I ,I (.0 / I. l I III {I : '11 I 11 II::i �� I I Ili eve: ,I I u I . III• _I I I! ,I , I TOTAL AIiVf9?0�1 .l By lmy slgnatuie Jbelow,I certify to�each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read flus application and trle Information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply'with all applicable local, ordinances and sate laws relating to building c ction. I authorize representative pertino to enter the above-identified property for inspection purposes., ' I ! I;r Signature ofAp ll�ant/Agent Date: I, SUP MENTAL INFORMATION REQUIRED I lily I I I jil I II,IIIi � I�� i Joii - I,' MEPMiscApp_2011.doc revised 06/21/11 I I I. 'I 11 1 �• ! i ul CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10137 santa Clara ave DATE: 05/06/2013 REVIEWED BY: larrys APN: BP#: *VALUATION: Iso *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Du lex PENTAMATION PRWHEATR USE: . p PERMIT TYPE: WORK water heater,tankless right side rear of house SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $27 Piping, Gas <=4 Outlets 1PGASRES 1 # $67 TOTALS: ON Elm N a Mech.flan Check Plumb.Plan Check 0.0 fns $0.00 Elec.Plan{:;heck &Ach.Permil Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit Tec:: F Alech.Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elec.Insp. Imp.Fee: Plumb. Insp.Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prefindna information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS(Fee Resolution-11-053 E 7� FEE QTY/FEE MISC ITEMS Plan Check Fee: suppl.PC Fee PME Plan Check: $0.00 Permit.Fee: Suppl. Insp fee PME Unit Fee: $94.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fees: Travel Documentation Fee: 1TRAVDOC $45.00 i Strong Motion.Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 ' $226.00 $0.00 $ 6.00 Revised: 04/29/2013