13060056 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 957 MILLER AVE CONTRACTOR:REPIPE 1 PERMIT NO:13060056
OWNER'S NAME: WOLF ERIKA M AND ERWIN 14724 VENTURA BLVD STE 507 DATE ISSUED:06/07/2013
OWNER'S PHONE: 4084464339 SHERMAN OAKS,CA 91403 PHONE NO:(818)981-5015
❑ LIICENSED C�JONTRACTOWS DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALO
License Class LU !Cxic.# (DUPLEX)COPPER RE-PIPE&REPLACE(E)WATER
HEATER,SAME LOCATION
Contractor Date
I hereby affirm that I. n 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: "AN ITARY
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:$8650
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:36919051.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and stats 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 F CALLED 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 b Date:
granting of this permit. Additionally,the applicant understands and will comply -4ab 3
with all non-point source reg lations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date U— — / 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-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)
1,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 the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S tions 2 d 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater
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 CONSTRUCTION LENDING AGENCY
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 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 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
M O
CONSTRUCTION PERMIT APPLICATION bo
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION O
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 M
CUPERTINO (408)777-3228-FAX j408)777-3333-building(acupertino.ora
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I-V ANNINCi APPI.II Q NO PLANNING AITROVAL 1,13717131k CICHI.P:R IIoRI1t? ❑N(
It. nl)'siguaulrC below,l et rtify to arch of the Collowing: I am flu prop ow�lcr or author• aM' to on I properly o\\•w s lielYulf 1 have road this
application and the information 1 haves •provided i c e ave d the Dose.6ption of Worlc and 'crit it is« urate. I agree to comply with all applicable total
ordBlances rend state laws relaxin it " l autht '.e eprrscntatives of Cupertino to cr the above-idollifie pro rty for inspection purposes.
Signature of Applicant/Agent: Date: 211-3
SUPPLEMFNITALINFORMATION REQUIRI,:U PLAN CHECK TYPE ROUTINCSLIP
Ne\\ SI:I)or Multifamily dwellings: Apply for demolition pcmlit I'or VER-111E..CorNTRk ❑ 1tull.not:Pt��ua:vtr_w
e�isling buildino(S). Demolition permit iS Nquired prior to iSSWIIICC ON-wilding
permiL for new building. ❑ RNPRES$ ❑ Pt,ANN1NG"',AN RPVIFw
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure O srANDARD ❑ PuaLICwnkKS
w li)rm il•tm) 1132ardous Materials are being used as part ufthis pr(ject.
M- ❑ LARGE ❑ FIRF Dvr r
Iw• _C'upy of Planning Approval Letter or Mcotino with Planning prior to
❑ MAJOR 13 SANITARYsm.vpRwsmc-r
tiubmittal ul'Building PermiL application.
❑ F.N1'IRONMF.NTAL 11EALTII
BIdgApp_:201/.dov revised 06.%2/71
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 957&959 MILLER AVE DATE: 06/07/2013 REVIEWED BY: MELISSA
APN: 369 19 051 BP#: *VALUATION: $8,650
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION 1 RPRP
USE: SFD or Duplex PERMIT TYPE: i
WORK DUPLEX COPPER RE-PIPE& REPLACE E WATER HEATER SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Re-Pipe Interior 1PRREPIPE 2 # $26
Water Heater 1PRWHEATR 1 # $27
TOTALS: _ $53.00
Tech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Cheek
wch.Perin it Fee: Plumb.Permit Fee: IPPERMIT Iles. Permittee:
Other Afech.Insp. rtherPlumblnsp. 0.0 hrs $45.00 Other Elec.Imp.
�fiech. In h..l'ee: . hish.ree: Elec.Insp, Fee:
NOTE:This estimate does not include fees due to other Departments(i.a Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prefimina information available and are only an estimate. Contact the Dept for addn7 info,
FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
.Suphl. PC Fee
PME Plan Check: $0.00
Permit Fee:
.Suppl. Insp Pee
PME Unit Fee: $53.00
PME Permit Fee: $45.00
(Amstr action Tax:
Administrative Fee: IADMIN $42.00
Work Without Permit? ®Yes (E) No $0.00
Adv(.,tzced Plcanrzing i,ees:
Travel Documentation Fee: 1TRAVDOC $45.00 i
Strong Motion Fee: 1BSEISMICR $0.87 Select an Administrative Item
Bldiz Std s Commission Fee: 1BCBSC $1.00
$186.87 $0.0NNER0 a TOTALZ+EE $186.87
' Revised: 04/29/2013