13060112 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10311 GREENWOOD CT CONTRACTOR:ECONOMY ROOTER PERMIT NO:13060112
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❑ COMMERCIAL0
�� UNIT 1-REMOVE AND REPLACE 40 GALLON WATER
License Class Lie. HEATER
Contractor d�009_ Date 6'�'t 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:36914025.00 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 R LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 22
costs,and expenses which may accrue against said City in consequence of the Issued by: Date:
granting of this permit..Additionally,the applicant understands and will comply
with all non-point o rce regulations per the Cupertino Municipal Code,Section
9.18.
r 3 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
1,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 Aupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectionk 15505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent:
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
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION t``�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �1�v`
CUPERTINO (408)777-3228•FAX(408)777-3333•buildindCa)cupertino.org MISC
❑PLUMBING ❑MECHANICAL ❑ELECTRICAL [—]MISCELLANEOUS
PROJECT ADDRESS 10 2 1 ) / ,et�.N�OBd CT * APN#
OWNER NAME CC/JR C�7v�t,�� PHONE �O� 7/7
. Z 3 L E-MAIL
STREET ADDRESS r� Gam^ n a A o fv / CITY,STATE,ZIP FAX
�L�,(J H4 G/ S•y Po( . q s/I/
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT )CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LIC E6
LICENSE TYPE BUS.LIC#
oaz� L�'rr•� 9avYs c a�
COMPANY NAME E-MAIL FAX
-9. 9
STREET ADDRESS CITY,STATE,ZIP PHONE
iL+eN xar l� 5 I. �}S/J� Vo? z2 z
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMH.Y PROJECT IN WH,DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
cELIQ a&41b-S (1N• 0= I1
TOTAL VALUATION: 199 QRECEIVED BY-
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act o the,10perty owner's behalf. I have read this
application and the information I have o ided is correct. I have read the Description of Work and verify it is acci6die. I agree to comply with all applicable local
ordinances and state laws relating to bu construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: O t7— 7
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
w OVER-THE-COUNTER
❑ EXPRESS
V
❑ STANDARD
V
❑ LARGE
a
❑ MAJOR
MEPMiscApp2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10#1 GREENWOOD CT DATE: 06/13/2013 REVIEWED BY: MENDEZ
APN: BP#: "VALUATION: $750
%PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION PRWHEATR
USE: SFD or Duplex PERMIT TYPE:
WORK REMOVE AND REPLACE 40 GALLON WATER HEATER IN SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $27
NO
TOTALS: $27.00.a�,_. ,
n
mx
kfech.Plan Check Plumb.Plan Check0.0 hrs $0.00 Elec.Plan Check
M11eclr.Perrrrit Fee: Plumb.Permit Fee: 1PPERMIT Ek:c. Permit lee:
Other rilci:h.Insp. Other Plumb Insp. 0.0 TrsL$45.00 Other Glee.Insp.
0
Alech.Insp.fee: Plumb. Issh.Fee: 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 prelimina information available and are only an estimate Contact the Dept for addn'1 info
FEE ITEMS(Fee Resolutiom11-053 E 7ff /1/12) FEE QTY/FEE MISC ITEMS
Plan Check I Ee:
SatPlal. PC:iee
PME Plan Check: $0.00
Permit.Fee:
Suhpl. Insp Fee
PME Unit Fee: $27.00
PME Permit Fee: $45.00
Construction Tax:
Administrative Fee: IADMIN $42.00
Work Without Permit? ®Yes No $0.00
Advanced Planning Fees:
Travel Documentation.Fee: ITRAVDOC $45.00 i
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$160.50 $0.00 $160.50
Revised: 04/29/2013