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13060111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10321 GREENWOOD CT CONTRACTOR:ECONOMY ROOTER PERMIT NO: 13060111 OWNER'S NAME: CUPERTINO COMMUNITY SERVICES PO BOX 2252 DATE ISSUED:06/13/2013 OWNER'S PHONE: 4087173232 SANTA CLARA,CA 95055 PHONE NO:(408)249-4922 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL E] License Class 3 Lic.# l5 I SCJ UNIT 2-REMOVE AND REPLACE 40 GALLON WATER j HEATER Contractor Ft,,,� Z �� Date f�' IN SAME LOCATION 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:$750 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:36914025.10321 Occupancy Type: permit is issued. _ APPLICANT CERTIFICATION I certify that I have read this application and state that theabove information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and.coun y ordinances and state laws relating WIT 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 D S F OM LAST 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 Issued by Date°l�• ` /� granting of this permit. Additionally,the applicant understands and will comply with all non-point sour a regulations per the Cupertino Municipal Code,Section 9.18. 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-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. 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,Sectio 5505,25533,and 25534. �/ Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: i 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If;aftermaking 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 GENERAL PERMIT APPLICATION �� MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 6 CUPERTINO (408)777-3228•FAX(408)777-3333•building (ftupertino.org MISC v ❑PLUMBING ❑MECHANICAL []ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 10 ! ,tF rAj uD a d c+ W 2- APN# OWNERNAME '3 f lett 'Z V AII +I C PHONEE-MAIL yc9l' 7-17-373 2 STREET ADDRESS J I SO N fd CITY,STATE,ZIP S•-T• G vie/ lt/ FAX CONTACT NAME PHONE J E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENo��ER LICENSE TYPE BUS.LIC# C,6- Lt•n•4 �SR�o C, COMPANY rE E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE V9 E'f34- i4u 4" /7 M• 9-r/3 a cloy 2Y9- Y922 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK / 1-7 TOTAL VALUATION: 79) 19 V RECE By my signature below,I certify to each of the following: I am the property owner or authorized agent to adf on&6 property owner's behalf. I have read this application and the information I have providen, correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building ction. I authorize representatives of Cupertino to enter the above-i entified property for inspection purposes. Signature of Applicant/Agent: Date. SUPPLEMENTAL INFORMATION REQUIRED O�FICE USE ONLY .USE ONLY w OVER-THE-COUNTER ❑ EXPRESS ❑ STANDARD V Z ❑ LARGE a ❑ MAJOR MEPMiscApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10321 GREENWOOD CT DATE: 06/13/2013 REVIEWED BY: MENDEZ APN: BP#: *VALUATION: $750 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Du lex PENTAMATION PRWHEATR USE: p PERMIT TYPE: WORKREMOVE AND REPLACE 40 GALLON WATER HEATER IN SAME LOCATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater . 1PRWHEATR 1 # $27 TOTALS: $27.00 Llech.Plan Check Plumb.PlaEffln Check 0.0 hrs $0.00 Elec-Plan(.;heck Mech.Permit Fee: Plumb.Permit Fee: 1PPERMIT Flee. Permit Fee: FVe',,h. ;1Zech.Insp. Other Plumb Insp. 0.0 hrs $45.00 Oilier Elec.Insp. Li Insp.Fee: Plumb.Insp.Fee: Etec,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 prelimina information available and are only an estimate Contact the Dept-for addn'l info, FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check hee: Sulppl. PC Fee PME Plan Check: $0.00 Per snit Fee: Suppl, Insp P:ee PME Unit Fee: $27.00 PME Permit Fee: $45.00 Consmuction Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? ®Yes (E) No $0.00 A(1vancecl Planning Fees: Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $160.501 $0.00 - r .:. ' T� ., $160.50 Revised: 04/29/2013