13050136 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7886 BELKNAP DR CONTRACTOR:KENNY CONSTRUCTION PERMIT NO: 13050136
OWNER'S NAME: SU-MEI CHEN . 10227 BEARDON DR APT 3 DATE ISSUED:05/20/2013
OWNER'S PHONE: 4089730581 CUPERTINO,CA 95014 PHONE NO:(408)318-2739
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL
License Class Lic.# O3 j REPLACE(E)WATER HEATER,SAME LOCATION(IN
GARAGE)
Contractor o6e in v,.Y ��( Date 2J
I hereby affirm that I am licensed under the provisions of C apter 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:$700
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 APN Number:36210039.00 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 LA LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the r 2 U
granting of this permit. Additionally,the applicant understands and will comply Issued by:
with all non-point source er the Cupertino Municipal Code,Section
9.18. ,c
( RE ROOFS:
Signature Date 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.
❑
OWNER-BUINDER 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(x)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 the Bay it Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the ertino nicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectiold 25505,OP31 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this 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 LE DING 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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses whichmay 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
^ \10
GENERAL PERMIT APPLICATION
MER . :
�,,� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION -�
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
{408):771-3228• FAX(408)777-3333•building0-cupertino.org misc
C'UPIEiI:TIN+E� .
❑PLUMBING': ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS APN#
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❑OWNER ❑ OWNER-BUILDER:. ❑ OWNER AGENT &CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT _
CONTRACTOR NAME Pr LICENSE NUMBER LICENSE TYPE BUS.LIC#
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USE;OF 1 ,❑SFD of DUPLEX ❑ MULTI-FAMQ.Y PROJECT INWBALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING'.: jy •❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
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TOTAi VALIUATIQ�' ..��
* riy signature below,I:certlfy to each 6f the following: I am the property owner or auth rized t to act on the property owr e' half. I have read this
apghcahot�and�11e InfomlatlomI have provided is co ve read the Description of Work and verify it is accurate. I agree comply'withal'applicable locat.`I
ordinances and sate laws Felatinglt6 building co cti . I uthorize representatives of Cupertino to enter the above-identified property for inspection purposes i
I I I I
Srgnature ofAphGant/Agent I'.' Date: GJ 1'
i;1 SUPPLEMEN RMATION REQUIRED
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MEPMiscApp_2011.doc revised 06/21/11
.III I I I II I
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CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7886 BELKNAP DR DATE: 05/20/2013 REVIEWED BY: MELISSA
APN: 36210 039 BP#: "'VALUATION: $700
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: PRWHEAT i
WORK REPLACE E WATER HEATER SAME LOCATION IN GARAGE
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1 PRWHEATR 1 # $27
TOTALS: $27-0010
__
,tech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.. Plan Check
iLtech.Permit Fee: Plumb.Permit Fee: 1PPERMIT Elec.Permit Fee:
--L(hhcr A1ech.Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Flee.Insp. Li
F17ech. Insp.lee: Plunib. Insp.Fee: Flee.Insp.Fce:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the relimina information available and are onlyan estimate. Contact the De t or addn'1 info.
FEE ITEMS jFee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS
Plan Check hee:
Suppl. PC Fee
PME Plan Check: $0.00
Perinit Fee:
Suppl. Insp Fee
PME Unit Fee: $27.00
PME Permit Fee: $45.00
Construction Tax:
Administrative Fee: IADMIN $42.00
Work Without Permit? ®Yes G) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $45.00 A
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: : IBCBSC $1.00
l a
� n $160.50 $0.00 $160.50
�' Revised: 04/29/2013