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13070196 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19500 PRUNERIDGE'AVE CONTRACTOR;449 =F9-BB- PERMIT NO:13070196 ] vIIlVED OWNER'S NAME: DATE ISSUED:07/30/2013 OWNER'S PHONE: 9497205685 ��/� L�-C+ PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIALII License Class Lic.# BLDG 9-1ST FLOOR REMOVE AND REPLACE 11 WATER HEATERS UNITS Contractd(: �n� T Cn Date 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:$8000 I have and will maintain Worker's Compensation Insurance,as provided for by Kc—tion 3700 of the Labor Code,for the performance of the work for which this APN Number:31606037.00 Occupancy Type: . permit is issued. j,>• APPLICANT CERTIFICATION IRES IMAY nadmant Ur"S'T'ARTED I certify that I have read this application and state that the above information is p correct.I agree to comply with all city and county ordinances and state laws relating W D ei� �T ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter ;j�jt,� upon the above mentioned property for inspection purposes. (We)agree to save 18 RO AS LED INSPECTION. indemnify and keep harmless the_City ofCupertino against liabilities,judgments, REVIEWED FOR CODE COMPLIANCE costs,and expenses which may accrue against said City in consequence of the Issued b 0 e ,.Date• granting of this permit. Additionally,the applicant understands and will comply y Reviewed B ¢��r� with all non-point source regulations per the Cupertino Municipal Code,Section y 9.18. .. ( RE-ROOFS: Signature ate� Z ` 9"P> 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 lt,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ager. —' 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 soas to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I becogte 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 regulationsper the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O'RLP 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building(akupertino.ora MISC PLUMBING OmEcHANicAL ❑ELECTRICAL MISCELLANEOUS PROJECT ADDRESSe APN# /� /,� 19500 Pruineridge Ave ` V OWNERNAME PHONE E-MAII, The Irvine Company Apartment Communities, Inc. 949-720-5685 STREET ADDRESS CITY, STATE,ZIP FAX 110 Innovation Dr. Irvine,CA,92617 949-720-5466 CONTACT NAME PHONE E-MAIL Ben Thomas 1 408-202-7391 ben@lhourdrain.com STREET ADDRESS CITY,STATE, ZIP FAX 1260-A Yard Ct. San Jose,CA,95133 408-521-0101 ❑OwNER ❑ OwNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT ❑INGINEER ❑ DEVELOPER ❑TENANT _7 CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# Gallaher Company Inc. 946359 C36 COMPANY NAME E-MAIL FAX ben@ 1 hourdrain.com 408-521-0101 STREET ADDRESS CITY,STATE,ZIP PHONE 1260-A Yard Ct. San Jose,CA,95133 408-202-7391 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 WII.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE [3 NO EICHLER HOME? ❑NO DESCRIPTION OF WORK �E z ers u � �t ld1T__1© TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on thepe wner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. ee to comply with all applicable local ordinances and state laws rel ction. I authorize representatives of Cupertino to enter the above-identi ed property for inspection purposes. Signature ofApplic Date: SUPPLE INFORMATION REQUIRED Ago s „& HE aq?" . MINE ME-uSluaW TANDA1iD MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 19500 Pruneridge ave DATE: 07/30/2013 REVIEWED BY: Mendez 01APN: BP#: *VALUATION: 1$8,000 %PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: PRWHEAT WORK BLDG 9-1ST FLOOR REMOVE AND REPLACE 11 WATER HEATERS UNITS SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 11 # $308 TOTALS: $308.00 11-00 _ Ltech.Plan Check Plumb.Plan Check 0.0 hrs $0.00 Flee,Plan(:heck lfi.>c,h.Permit Fee: Plumb.Permit Fee: IPPERMIT Elea.Permit Fee: Other A9ech.Insp. Other Plumb Insp. 0.0 hrs $47.00 Other Elec,Imp. Hech. Insp. Fee: Plumb. Insp.Fee: Dec.Insp. Fee: NOTE:This estimate does not include fees due to other Departments(L a Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn7 info, FEE ITEMS(Fee Resolution 11-053 Eft 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee.: Suppl. PC.Fee PME Plan Check: $0.00 Permit.Fee: Suppl. Insp Fee PME Unit Fee: $308.00 PME Permit Fee: $47.00 Constrtrction Tar: Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong;Motion Fee: 1BSEISMICR $0.80 Select an Administrative Item.' Bldg,Stds Commission Fee: IBCBSC $1.00 x.. � : 1 $447.801 $0.00 $447.80 Revised: 07/01/2013