13070194 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS-' 3 A'q— CONTRACTOR.=11-In^UF PERMIT NO:13070.194
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DETERMQTJI
OWNER'S NAME: IRVINE COMPANY LLC 4 C DATE ISSUED:07/30/2013
OWNER'S PHONE: 9497205685PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL[]
License Class Lic.# 0 '4&S!;A BLDG 74ST FLOOR REMOVE AND REPLACE 10 WATER
1 I C-6
� `` Date HEATERS UNITS
Contractor �.. � W —1 ^Z�
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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$8000
tave 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 CUPS
I certify that I have read this application and state that the above information is T Ei XPj � OT STARTED
correct.I agree to comply with all city and county ordinances and state laws relatingVa.
.ISN 180 DAYS P SSUANCE OR
to building construction,and hereby authorize representatives of this city to enter . AY RS)Yi 1T CALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
dF n nt= r-n�a o n w i nate•
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. VIEW y: `
RE-ROOFS:
Signature Date /- 2071 ^( � 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,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ager0 -�—�—� Date:�''2� '
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
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ON
CUPERTiNO (408)777-3228•FAX(408)777-3333•building(ftupertinp.9 �A MISC
PLUMBING MECHANICAL ELECTRICAL MISCELLANEOUS
[PROJECT ADDRESS APN# �^
19500 Pruineridge Ave CO &V c
OWNERNAME PHONE E-MAIL
The Irvine Company Apartment Communities, Inc. 1949-720-5685
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@lhourdrain.com
STREET ADDRESS CITY,STATE,ZIP FAX
1260-A Yard Ct. San Jose,CA,95133 1408-521-0101
❑OwNER ❑ OwNER-BUILDER ❑ OwNER AGENT ❑ CONTRACTOR is CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
Gallaher Company Inc. 1946359 1 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-FAMILY PROJECT IN Wn.DLAND E] YES PROJECT IN [3 YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME9 ❑NO
DESCRIPTION OF WORK
ers
777, Oi
TOTAL VALUATION: e RECEIVED B Ykw
r s
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the 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 accurat I agree to comply with all applicable local
ordinances and state laws rel ction. I authorize representatives of Cupertino to enter the above • entif?ed property for inspection purposes.
Signature of Applic Date:
1SUPPLEINFORMATION REQUIRED � k. '-
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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 R
WORK [q!,Dq7-1ST FLOOR REMOVE AND REPLACE 10 WATER HEATERS UNITS
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 10 # $280
TOTALS: e $280.00
P
,1-tech. Plan Check Plumb.Plan Check 0.0 hts $0.00 Elec.Plan[;heck
-1ch.Perwit Fee: Plumb.Permit Fee: IPPERMIT /glee. Permit Fee:
Ofher.Akxh.Insp. Other Plumb Insp. 0.0 hrs $47.00 01her Elec.Imp.
:1lech, b2sr. 1'ee: Plun7b. Insp.Fee: Elec.Insp.Fee.,
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prefinddha information available and are only an estimate. Contact the De t or addn7 info,
FEE ITEMS(Fee Resolution 11-053 Ef. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Feta:
Supp 1. PC fee
PME Plan Check: $0.00
Permit.Fee:
Suppl. lnsp Fee
PME Unit Fee: $280.00
PME Permit Fee: $47.00
Consir-taction Tax:
Administrative Fee: 1ADMIN $44.00
Work Without Permit? ® Yes iq No $0.00
Advanced Planning Fees:
Travel Documentation Fee: 1TRAVDOC $47.00 A
Strong Motion Fee: IBSEISMICR $0.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$419.80 $0.00 d �� 419.80
xf~
E 4 J p . s $
Revised: 071G1/2013