13070195 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19500 PRUNERIDGE AVE CONTRACTOR: PERMIT NO:13070195
PsEWE4CIedWED
OWNER'S NAME: —r �J �.tiPr DATE ISSUED:07/30/2013
O. .
OWNER'S PHONE: 9497205685 Lk C— PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class Lic.# '�7�7 BLDG 84ST FLOOR REMOVE AND REPLACE 8 WATER
�`Z� �I� HEATERS UNITS
Contracto G• O 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
ave 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:31606037.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PE IBES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relatingWI AYS OF +M*9" CE 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 Y OM LAST MhW fTtTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: JULDate:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. KLVIEWED FOR �� POMPLIANCE
Signatu' Date All roofs shall be inRG*Lh ��tq y ro emg installed.If a roof is
installed without first obtaining an ins`pecti ,I agree�ove 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,Sections 25505,25533,and 25534. �j ^�
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorize 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 V
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 ((j�
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M_^Ot"l
CUPERTlND (408)777-3228•FAX(408)777-3333•buildinaCa-)cupertino.org R' 'SC
PLUMBING ElmEcHANicAL ELECTRICAL MISCELLANEOUS
PROJECT ADDRESSjt t� APN# � D� O��S►
19500 Pruineridge Ave i /
OWNERNAME PHONE E-MAH.
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 408-202-7391 ben(Olhourdrain.com
STREETADDRESS CITY,STATE, ZIP FAX
1260-A Yard Ct. San Jose,CA,95133 408-521-0101
❑OWNER ❑ OwNER-BUu.DER ❑ OwNERAGENT ❑ CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHrrECT 13 ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
Gallaher Company Inc. 1946359 C36
COMPANY NAME E-MAIL FAX
ben@lhourdrain.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-FAMII.Y PROJECT IN WILDLAND E3 YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: 13 COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOMET ❑NO
DESCRIPTION OF WORK
ers
17- 03—
TOTAL VALUATION: / t �� RECEIVEDB' `
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on th PY
owner'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 acc I agree 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 of Applic Dater
SUPPLE INFORMATION REQUIRED
OFFICE IISE ONLY
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
APN: 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 8-1ST FLOOR REMOVE AND REPLACE 8 WATER HEATERS UNITS
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 8 # $224
TOTALS:
$224.00
a.
Xfec/t. Plari Check Plumb.Plan Check 0.0 hrs $0.00 Elec..Plan Check
ttech. Permit Fr:e: Plumb.Permit Fee: IPPERMIT l;lec. Permit Pee:
Ocher ;l9ec ka.Insp. Other Plumb Insp. 0.0 J hrs $47.00 Otlrer Elec.Insp. E3
�tlech.Insp.Fee: Plumb. hasp.Fee: Elec.Insp.Fee:
—L]NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution 11-053 E,ff.' 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fee:
Supp/, Insp Fee
PME Unit Fee: $224.00
PME Permit Fee: $47.00
Consiruction Tax:
Administrative Fee: IADMIN $44.00
Work Without Permit? ®Yes (E) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee: IBSEISMICR $0.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC 1 $1.00
_ „ k
$363.801 $0.00 ' �1 $363.80
Revised: 07/01/2013