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13060031 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22715 STEVENS CREEK BLVD CONTRACTOR:DRAIN MASTERS PERMIT NO: 13060031 OWNER'S NAME: SN HANSON TRUSTEE&ET AL 1132 ERIN WAY DATE ISSUED:06/04/2013 ,OWNER'S PHONE: 4083153589 CAMPBELL,CA 95008 PHONE NO:(408)963-7272 J IIQ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALE] 'License ClassL—liro Lic.# % 3 REPLACE(E)WATER HEATER,SAME LOCATION Contractor�� Date /20 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. Sq.Ft Floor Area: Valuation:$900 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:34212118.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state thatthe 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 FR T LLED 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 6 (� granting of this permit. Additionally,the applicant understands and will comply Issued Date: with all non-point sour regul ' ns per the Cupertino Municipal Code Section 9.18. RE-ROOFS: Signat a Dat / 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. ❑ OWN R-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) 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. 1 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 Cu . o Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety CodSe ' s 2 e, 550 5 , 5534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorize gent: 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 LENDING 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 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 GENERAL PERMIT APPLICATION MER .':. ._ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (40 4).777-3228 FAX(408)777-3333•building(�cupertino.org misc �UP�RTINC} PLUMBING' . []MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN# OWNER N ! P `�'V 3157 3Y D 9 EMAIL STREET ADDRESS,I CITY, STATE,ZIP FAX CONTACT NAME"' t PHONE E-MAIL C STATE,ZIP FAX STREETADDRESS ,; , 21 ❑OWNER ❑ QWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 11ENGINEER 13DEVELOPER El TENANT CONTRACTOR N LIC ENS NMB UER LICENSE TYPE BUS.LIC# - COMPANY NAME E-MAIL FAX STREET ADDRESSi CITY,ST ZIP PHONE �' ARCHITECT/ENGINEER;NAME LICENSE NUMBER BUS.LIC# : COMPANY NAME I E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE:OF ❑SFD of DUPLEX ❑tMUf.Ti-FAMB.Y PROJECT IN WE.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑.YES BUILDING : ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTIONpF,V�ORiC 1 I � MR- TOTAL'VAI,U,ATIQNI - By my signature Ibelow I certify tpieach of the following: I am er or authorized ag nt to act on the pro ehalf. I have read this apphcatio>x and the info'rmahori!Lhave " ve read the Desc ' tion ork and verify it is accuratEagrto comply with all applicable localordinances andstate laws g to bW din nstruction. I orize ntatives of Cu ino to enter the above property for inspection purposes.', Signature ofApplI ant/Agent, Date: I, !,!I PLEMEN AL ORMATION REQUIRED o I .,� III MEPMiscApp_2011.doc revised 06/21/11 ii i Iill .Ili I rni'i; i 'TI i CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 22715 STEVENS CREEK BLVD DATE: 06/04/2013 REVIEWED BY: MELISSA its APN: 342 12 118 BP#: *VALUATION: $900 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION USE: SFD or DuplexL I PERMIT TYPE: PRWHEAT WORK REPLACE E WATER HEATER SAME LOCATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $27 TOTALS: $27.00 z ./tech. Plan(:'heck Plumb.Plan Check 0.0 firs $0.00 Elec.Plan t heck 11ec;h.Permit Fec:: Plumb.Permit Fee: IPPERMIT Fkc.Permit tee: Other:Wech.Insp. Other Plumb Insp. hrs $45.00 Other Elec.Insp. 0.0 dfech.In•sh.Fee: Plumb. hrsp.Fee: Elec.Insp.Fee: NOTE:This estimate doesnot include fees due to other Departments(Le.Planning,Public Works,Fire,SanitarySewer District,School District,etc). These ees are based on the prefimina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS(Fee Resolution 11-053 E . 7/1/121 FEE QTY/FEE MISC ITEMS Plan Check I-ee: Suppl. PC Fee PME Plan Check: $0.00 Permit free: Suppl. Insp I'ee PME Unit Fee: $27.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: 1ADMIN $42.00 Work Without Permit? ®Yes (E) No $0.00 A dvanced Planning Fees: Travel Documentation Fee: ITRAVDOC $45.00 Stroniz Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission.Fee: 1BCBSC $1.001 1 : .- .. $160.50 $0.00 a .:. �a F $1 60 50 Revised: 04/29/2013